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Ohio Medicaid Health Insurance Information – Applications And Qualifications

Ohio Medicaid Health Insurance is available to many Buckeye State residents. Medical plans are currently provided to more than three million individuals and families, with pre-existing conditions covered, and premiums either free or extremely inexpensive. Comprehensive benefits  are provided after a short application is submitted and approved. Food and cash assistance, help with housing and utilities, and mental health and addiction services are also offered through other Agencies.

Qualifications

Applicants that can qualify for benefits include individuals with low income, persons with disabilities, older adults, infants, small children, and pregnant women.  Additional requirements are US citizenship, legally reside in Ohio, and be able to meet specific income guidelines. Applications can be submitted online or through the mail. A personal visit is not required. Non US citizens that are ineligible for coverage can apply for alien emergency medical assistance or refugee medical assistance.

CHIP and Medicaid eligibility is largely determined by the MAGI (Modified Adjusted Gross Income). Of course, the more money the household earns, the less federal or state funds are provided. You can view specific information regarding the calculation here.  Expansion has taken place in many states (including Ohio), so more applicants are now eligible.  “Healthy Start” and “Healthy Families” are available to state residents that have a social security number and meet certain financial requirements.

Healthy Start

“Healthy Start” (also known as “SCHIP”) is available to uninsured children (19 and under) with household income up to 206% of the Federal Poverty Level (FPL). Applicants must  be a US citizen, permanent resident, or legal alien. Any person that has illegally entered the United States will not be eligible for benefits.

Pregnant women in families with income up to 200% of the FPL and covered children (19 and under) with household income up to 156% of the FPL also qualify.  There is no pre-existing condition clause, or waiting period for treatment, once enrolled in the program.  After becoming eligible for Medicaid, each child will have access to Healthchek, Ohio’s early and periodic screening, diagnosis and treatment program.

Comprehensive coverage is provided (including preventative benefits) along with other coverage, including  dental, ER, alcohol and drug addiction, family planning, hospitalization, Healthchek (see below), vision, transportation, mental health, pregnancy, transportation, prescriptions, and medical equipment.

Healthy Families

“Healthy Families” is offered to families, with a child under age 19,  that have income no higher than 90% of the Federal Poverty Level. Coverage is available to the adults, but not children. Applicants must be a US citizen and a legal resident of Ohio. There is no cost to enroll or secure coverage. Once approved for Medicaid, fee-for-service benefits begin, although you are required to re-apply every six months. Proof of US citizenship and income will be required.

Household income will be re-calculated every six months to ensure continued eligibility. Case workers should always be informed of changes that impact income or eligibility. Once approved, there is no waiting period before using services. A case worker will be assigned to provide assistance, and record changes that may impact eligibility.

Applying for coverage can be completed online by completing a CPA (Combined Programs Application). Phone assistance is also available. Covered benefits include Preventative healthcare, dental, vision,  ER, outpatient and inpatient hospital expenses, prescription drugs, pregnancy and prenatal care, drug and alcohol addiction, and HealthChek. Typically, a “managed care” plan must be chosen.  The four available options in Ohio are:

UnitedHealthcare Community Plan

Molina Healthcare

CareSource

Buckeye Health Plan

Paramount Advantage

Healthchek

Healthchek” provides newborns, children, and young adults (through age 20) preventative, diagnosis and treatment services. Ten  checkups in the first two years along with follow-up annual checkups provide comprehensive healthcare. If additional treatment is required, Medicaid will pay for the expenses. NOTE: The program is also known as EPSDT (Early Periodic Screening, Diagnosis, and Treatment).

Each physical examination includes a medical history review, complete unclothed exam, vision and dental screening and other screenings and services, if recommended by the attending physician. Physical therapy benefits are actually more comprehensive than similar coverage offered to adults. Dental coverage is also more comprehensive than many plans offered to adults.

Other  services include hearing and immunization assessments and additional diagnosis and treatment if a potential health problem is discovered. Any necessary lab tests  and nutritional advice will also be provided. Additional  information can be found here. Note: Newborns should utilize all 10 exams before their third birthday. By age three, only one exam is generally required each year. Physicians that accept Medicaid for insurance reimbursement, can also be used for Healthchek exams. If you move to a different county, a Healthchek Coordinator should be notified.

Long-Term Care

Disabled and older adults often need assistance with routine daily activities, such as eating, getting mail, taking baths or showers,  and preparing meals. LTC services help individuals and families enjoy a more routine and comfortable life, with Medicaid’s help. Specific services offered include private duty nursing (PDN), if the need is between 4 and 12 hours of continuous assistance. The personal-care physician (pcp) can help coordinate nurse’s care. Hospice services are also available for the terminally ill, and they can discontinue the benefits at any time.

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One Response

  1. TS says:

    mental health is of course very important but most people just ignore it and focus more on their body ””;,