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Medicaid is a public health care program funded by the state and federal government. It provides healthcare coverage to individuals and families with limited income, children, pregnant women and people who are aged, blind or who have disabilities. Services may differ in each state because they have some options on which groups and what income levels they will cover for Medicaid.
If your income is too high for traditional Medicaid, you may qualify for a Waiver which can waive, or set aside, some of the strict eligibility requirements of traditional Medicaid. Eligibility for a waiver is tied to the income and resources of the individual, not the family.
The Complex Care Center at Cincinnati Children’s provides information to help families and healthcare providers identify sources of financial assistance.
The Medicaid Program provides medical benefits to groups of low-income people, including some who may have no medical insurance or inadequate medical insurance. Although the Federal government establishes general guidelines and required services for Medicaid, additional program requirements and optional services are actually established by each state. Some of the required services include inpatient hospital, outpatient services at federally qualified health centers, physician and nurse practitioner services, home health services, nursing facility care, laboratory and x-ray, and non-emergency transportation. States can then provide optional services such as community mental health, dental, home and community based waivers, hospice care, intermediate care facility services, prescription drugs, and durable medical equipment and supplies. But remember that these optional services can vary greatly between states.
You may be eligible for home care services through:
The Ohio Department of Job and Family Services (ODJFS) administers in-home care and daily living services that are covered by Medicaid. Establishing medical need, through a physician, is one of the requirements prior to receiving services. When an individual is approved, services are coordinated through a single case management agency, CareStar. CareStar provides information about services, resources and supports.
Nursing, aide and/or skilled therapy services may be provided through the Ohio Medicaid State Plan. You must have a Medicaid card (available through your county department of job and family services), doctor's orders for the needed services, and a Medicare certified home health agency. Your doctor will work with the home health agency to adjust your services as needed. For help locating a provider, you will need to contact the case management agency for your part of the state. Services must be provided by a Medicare-certified home health agency, accredited home health agency, or non-agency RN / LRN.
Resources are available to help you:
Ohio Medicaid provides additional options for homecare through their Home and Community Based Service Waivers. A Medicaid waiver can waive, or set aside, some of the strict eligibility requirements, including income guidelines, benefits and health care delivery options, allowed under federal Medicaid program regulations. The waiver program only considers the income of the person on the waiver and not the income of the family, however there is a waiting list for services. These programs of home and community care can help individuals remain at home instead of being in a nursing home, hospital or institutional care facility for people with mental retardation and / or developmental disabilities (ICFMR). Services can support people with severe disabilities and medically unstable conditions. In addition to the basic Medicaid benefits, an Ohio waiver program can provide another option for nursing, daily living and skilled therapies.
Institutional Medicaid may be available when a child resides in an institution (hospital or residential facility) for more than 30 days. The income and resources ot the child's parents are no longer counted in determining the Medicaid eligibility of the child. Therefore, children who are institutionalized for more than one month will generally qualify for Medicaid while they are in the hospital or residential facility. This coverage is only for care after the 30 days and is not retroactive to the first month. Once children are discharged, they no longer qualify for Institutional Medicaid and must then qualify based on the family's income or through a Home and Community Based Waiver.
Medicaid for the Aged, Blind or Disabled (ABD) in Ohio may require that adults who receive health care benefits join a Managed Care Plan (MCP), depending on their local county office. This means that certain private health insurance companies have an agreement with the Ohio Department of Job and Family Services to provide health care to individuals that receive Medicaid. Eligible consumers in the Southwest Ohio Region must select and enroll in an MCP. Additional information is available through the Ohio Department of Job and Family Services:
An individual may want to have Medicare in addition to Medicaid because the combination can provide better access to care. People with Medicare who have limited income and resources may get help paying for their out-of-pocket medical expenses from Medicaid. There are various benefits available to "dual eligibles" who are entitled to both Medicare and Medicaid benefits. Medicaid can play a critical role filling in Medicare’s gaps in coverage. For people who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that are available under their state Medicaid program. Services that are covered by both programs will be paid first by Medicare and the difference by Medicaid, up to the state's payment limit. Medicaid also covers additional services, including nursing facility care beyond the 100 day limit covered by Medicare, prescription drugs, eyeglasses, and hearing aids.
Because Medicare is a federally funded health insurance program, eligibility is the same in each state and covers:
Applications for Ohio Job and Family Services financial assistance programs are available on their web site along with a directory of county offices.
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