Medicaid
Medicaid is a public health care program funded by the state and federal government. It provides health care 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 Medicaid, you may qualify for a Medicaid Home and Community Based 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 Center for Infants and Children with Special Needs at Cincinnati Children’s Hospital Medical Center provides information to help families and health care providers identify sources of financial assistance.
Medicaid Overview | Home Care Services | Institutional Medicaid | Aged, Blind or Disabled | Medicaid Spenddown | Medicaid Buy-In | Dual Medicaid / Medicare Coverage
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.
Ohio Medicaid Program Information
Applications for Ohio Job and Family Services financial assistance programs are available on their web site along with a directory of county offices. Families who want to apply for Medicaid only do not have to go to the Job and Family Services office:
- Simply print and fill out the Healthy Start / Healthy Families application located on the web site.
- Fax it to 513-946-7474 and keep the fax receipt.
- Within 20 days you will be given a checklist of items that must be submitted.
- You should receive a decision within 45 days of submitting the application.
FamiliesUSA has links to specific Medicaid state information as well as information on public and private sources of health insurance.
You can find Medicaid program information for Kentucky and Indiana.
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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.
- Home Health Services is designed for people who need a limited amount of home care services. Individuals can receive part time, intermittent services up to a total of 14 hours per week. Eligibility is based on medical need and requires a doctor's order.
- Increased Home Health Services can provide services up to 28 hours per week for up to 60 consecutive days from the date of hospital discharge. Eligibility requires medical need and requires a 3 day hospital stay. A physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.
- Private Duty Nursing Post-Hospital Stay is designed for individuals requiring continuous skilled nursing up to 56 hours per week for up to 60 consecutive days from the date of hospital discharge. Eligibility requires medical need and requires a 3 day hospital stay. A physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.
- Private Duty Nursing provides continuous skilled nursing. The physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.
Resources are available to help you:
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Ohio Medicaid provides additional options for home care 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.
Learn more about Waiver Programs in Ohio, Kentucky and Indiana.
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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:
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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 disposible 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.
Dual Medicare / Medicaid Coverage is available for qualified individuals. You will be automatically enrolled in Medicare after you get Social Security Disability Insurance benefits for two years. Additionally, certain dependent adult children of parents who receive Medicare are also eligible for Medicare if they developed a permanent and severe disability before age 22.
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If your questions are not fully answered by our Special Needs Resource Directory and its links, please contact us via email.
Rev. 8/09
