• Medicaid

    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:

    • Traditional Medicaid, where eligibility is based on the family's income or
    • Home and Community Based Waivers, where some of the strict financial guidelines are set aside and eligibility is based only on the income of the individual receiving services.   
    • FamiliesUSA has links to specific Medicaid state information as well as information on public and private sources of health insurance.

    Some states have expanded Medicaid, under the Affordable Care Act, to cover more people. If you have Medicaid coverage, you’re considered covered under the health care law and don’t have to buy a Marketplace plan. In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program covers all low-income adults below a certain income level.

    • Find out if your state is expanding Medicaid and learn what that means for you. Ohio and Kentucky will expand their Medicaid program in 2014.
    • If you live in a state that's expanding Medicaid, you'll probably qualify if you make up to $16,104 a year for 1 person ($32,913 for a family of 4).

    Some states aren’t expanding their Medicaid programs in 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls. You will be able to buy a private health insurance plan in the Marketplace and may get lower costs based on your household size and income.

    Medicaid programs must follow federal guidelines, but they vary somewhat from state to state. Coverage and costs to you may be different from state to state.

    The Ohio Department of Medicaid is Ohio’s first Executive-level Medicaid agency. With a network of more than 70,000 active providers, it delivers health care coverage to nearly 2.4 million residents of Ohio on a daily basis. The Ohio Department of Job and Family Services (ODJFS) administers in-home care and daily living services that are covered by Medicaid. Contact your local ODJFS county office or the Ohio Department of Medicaid Ohio Department of Medicaid consumer hotline. You can find a comprehensive listing of Medicaid covered services.  

    Establishing medical need, through a physician, is one of the requirements prior to receiving services. Most individuals who have Medicaid must join a managed care plan to receive their benefits. Managed care plans are companies that work with Ohio to provide all the health care services you can get with an Ohio Medicaid card. These plans work with doctors, hospitals, and medical specialists who will give you the care you need. The managed care plans in Ohio include Buckeye Community Plan, CareSource, Molina Healthcare of Ohio, Paramount Advantage and United HealthCare. You can find out specific information about each of these plans through the Medicaid Consumer Hotline website.

    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:

    Medicaid Spenddown Program allows individuals with disabilities the option to deduct medical expenses from their income in order to meet Ohio Medicaid income guidelines. Bills for medically necessary services can be counted toward reaching the spenddown amount. Expenses can include medical bills, prescriptions, therapy, equipment, lab work, insurance premiums, transportation costs to medical appointments and disposable medical supplies.

    Medicaid Buy-In for Workers with Disabilities (MBIWD) is an Ohio Medicaid program that provides health care coverage to working individuals with disabilities. Historically, people with disabilities were often discouraged from working because their earnings made them ineligible for Medicaid coverage. MBIWD was created to enable Ohioans with disabilities to work and still keep their health care coverage. The program has eligibility and financial requirements. Applications are available from your local county office of 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:

    • Adult children of parents who currently receive Medicare may also be eligible if the adult child developed a permanent and severe disability before age 22. 
    • Individuals younger than age 65 with permanent disabilities can be enrolled in Medicare after they have received Social Security Disability Insurance (SSDI) payments for 24 months. To qualify for SSDI, an adult child who is age 18 or older and has been disabled before age 22, may be eligible to receive monthly benefits if a parent is deceased or is currently receiving retirement or disability benefits. This is called a "Disabled Adult Child" benefit and is paid based on the parent's earning record. An advantage of this program is that it does not consider the individual's non-employment income, such as an inheritance, a law suit settlement or a spouse's income. The five month waiting period before SSDI begins is not required for Disabled Adult Child benefits. 
    • Individuals younger than age 65 with end-stage renal disease (ESRD) or Lou Gehrig’s disease are eligible for Medicare benefits as soon as they begin receiving SSDI payments, without having to wait 24 months.
    • Individuals age 65 and older, if they or their spouse made payroll tax contributions for 10 or more years.

    Applications for Ohio Job and Family Services financial assistance programs are available on their web site along with a directory of county offices.