Skip to main content
Doctor holding a stethoscope and clipboard with a paper that says "Medicaid"
Company

Guide to Medicaid in Ohio

Learn about eligibility, application steps, and coverage under Ohio Medicaid
SingleCare logo
By | Aug. 20, 2024 Medically reviewed by Scott Dershowitz, LMSW, CMC

Key takeaways

  • More than 3 million Ohio residents are covered under Medicaid.

  • Medicaid unwinding may have incorrectly terminated coverage for 80,000 people in Ohio.

  • You can apply for Ohio Medicaid online, by mail, or in person. If you need assistance with your application, visit your local Department of Jobs & Family Services.

  • Ohio Medicaid enrollees have the option of enrolling in one of five managed care plans: the Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage, or UnitedHealthcare Community Plan.

  • Ohio Medicaid is generally free, but there are some instances in which enrollees are responsible for out-of-pocket expenses like copays for certain procedures, medications, and medical devices.

In this article:

Each U.S. state operates its own Medicaid program in accordance with federal regulations. In Ohio, this program provides coverage to more than 3 million people. The ending of the COVID-19 pandemic program, during which the eligibility guidelines had been relaxed, state Medicaid programs began unenrolling, or unwinding, people who are no longer eligible. In Ohio, this process was expected to conclude in early 2024, but a federal audit by the Office of the Inspector General found that up to 78,486 people were incorrectly classified, some of whom may have had their coverage incorrectly terminated. 

Even a short disruption in coverage may result in a massive financial burden. This guide will equip you with the knowledge you need to determine if you are eligible for Ohio Medicaid and how to apply or re-enroll.

Eligibility for Ohio Medicaid

Just like other state Medicaid programs, Ohio Medicaid has a list of requirements that applicants must meet before they can receive coverage. If you’re unsure whether you qualify, take an online self-assessment to determine your eligibility. The Ohio Medicaid program encourages you to apply, even if you’re unsure that you qualify.

Income requirements

The income requirement of Ohio Medicaid is in part based on the number of people living in a household. For single-person households in 2024, it is $20,030 pre-tax income, and for eight-person households, it is $70,118. If you have more than eight people living in your household, add $7,155 for each additional person. 

Age requirements

Ohio Medicaid provides coverage to individuals of any age who meet the income and asset eligibility guidelines, as well as other eligibility criteria. Ohio Medicaid also offers specific age-related coverage programs for certain circumstances:

  • Youth who are in foster care can continue receiving benefits. Their case worker will complete the Medicaid application process for them. Youth who have aged out of foster care can also receive benefits, provided they were in foster care on or after their 18th birthday and are still younger than 26.

Disability requirements

If you are legally blind or have another condition that meets the Social Security Administration’s definition of a disability, you may be eligible for Ohio Medicaid, assuming you meet various other criteria. You may also be eligible if another member of your household has a disability. 

Citizenship and residency requirements

Ohio Medicaid is open to residents who are U.S. citizens or nationals, U.S. permanent residents, or legal noncitizens. You must also have a Social Security number. If you don’t meet these requirements, you may still be eligible for assistance through other programs, such as the Alien Emergency Medical Assistance (AEMA), Refugee Medical Assistance, or State-Funded Medical Assistance for Non-Citizen Victims of Trafficking (NCVOT).

Ohio Medicaid benefits

After being approved, you’ll have the option of enrolling in one of five managed care plans: the Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage, or UnitedHealthcare Community Plan.

Choosing the plan that’s best for you is critical for ensuring the services, medications, and medical devices are available to you to meet your healthcare needs. For a broad overview of the five plans, check the Ohio Medicaid report card (PDF). For more detailed information about what each plan covers, visit their individual websites or call their hotlines:

Covered medical services

Each state must provide medical services mandated by the federal government and may provide additional services. In Ohio, additional Medicaid services may include dental services, physical therapy, speech therapy, vision therapy, and many others. Some of these services have limits on how often they are covered or on the dollar amounts covered. 

Prescription drug coverage

If you have Medicare Part D in addition to Medicaid, you will probably use it to pay for your prescriptions. If Medicare Part D doesn’t cover some of these prescriptions, Medicaid may be able to help pay in some instances. Medicaid covers about 46,000 drugs. If you have Medicare in addition to Medicaid, contact your Part D plan if you have questions about whether your plan covers a particular medication. There may be other ways to get your medication covered if the Part D plan doesn’t cover your prescription (appeals, etc).

Dental coverage

All Ohio Medicaid recipients are eligible for a variety of dental services, including checkups/cleanings, dentures, fillings, extractions, crowns, root canals, and dental surgeries. In addition, recipients who are younger than 21 may also be eligible to receive braces, although this requires prior authorization. 

Vision coverage

All Medicaid enrollees are eligible to receive medically necessary vision services, including glaucoma screenings and contact lenses. Some providers may require prior authorization for certain services, while others may not.

Medicare covers certain eye care services, including surgery, eyeglasses or contacts, and eye exams if you have a chronic condition like cataracts or glaucoma. It only covers routine eye care if you have diabetes or are at high risk for glaucoma.

Long-term care services

Ohio Medicaid offers long-term care options, including at-home and community-based programs such as private nursing services, hospice care, in-home therapies, and mental health and addiction treatment services. In addition, Medicaid provides a residential state supplement (RSS) program, which assists people who may not be ready for long-term care but who have increased care needs.

Ohio Medicaid programs

In addition to the broader Medicaid program, Ohio Medicaid offers smaller programs that provide coverage to individuals in unique situations.

The programs listed below provide coverage for children, people who are pregnant, and people with disabilities who are still working. 

Healthy Start & Healthy Families: Coverage for pregnant women and infants

Ohio Medicaid offers three different programs to assist pregnant women, children, and families whose income is limited but too high to otherwise qualify for Medicaid.

  • Healthy Start provides Medicaid coverage for pregnant women in families whose income is up to 200% of the federal poverty level. This program also covers children (18 years old and younger) who are members of families whose income is up to 156% of the federal poverty level. 
  • The CHIP program covers children of families whose income is up to 206% of the federal poverty level. 
  • Healthy Families provides Medicaid coverage to families whose income is up to 90% of the federal poverty level and to children aged 18 and younger. 

Medicaid expansion program

The Affordable Care Act expanded Medicaid, enabling participating states to allow applicants to qualify for coverage based on income alone—i.e., without additional age, family status, or health requirements. Ohio participates in this program. Residents may qualify for Medicaid coverage if their household income is below 138% of the federal poverty level.

Aged, Blind, or Disabled Medicaid

Aged, Blind, or Disabled (ABD) Medicaid provides coverage to individuals who are 65 years or older, legally blind, or defined as disabled by the Social Security Administration (SSA). 

In the past, people with disabilities often did not work because working would have made them ineligible for Medicaid due to income limits. Medicaid Buy-in for Workers with Disabilities is a program for people with disabilities who are working either part-time or full-time and are 16 to 64 years old.

How to apply for Ohio Medicaid

Once you’ve determined which Ohio Medicaid program is right for you, apply online, by mail, or in person. If you need assistance with any part of your application, visit your local Department of Jobs & Family Services or call the consumer hotline at 1-800-324-8680.

Required documents for the application

Applicants will need the following documents:

  • Proof of income (pay stubs, tax records, child support, unemployment, worker’s comp) and resources (bank account statements, investment account statements, certificates of deposit, trusts, annuities, retirement accounts)
  • Proof of citizenship or legal noncitizen status (original birth certificate, state ID, passport)
  • Proof of pregnancy, if applicable (statement from the individual, a healthcare provider, or a managed care organization)
  • Policy numbers for any other insurance you may have, including from other household members, such as job-related health insurance
  • Proof of age or disability 

If you do not submit all the required documents, you may receive a letter asking for more information and details about how to submit these documents.

Online application process

Visiting https://benefits.ohio.gov/ tends to be the most convenient option to apply for Ohio Medicaid. The website will ask you questions to determine which application you should use. After applying, you might need to supply verification documents to your county’s Department of Job & Family Services via fax or mail.

Paper application process

You can print the Medicaid application form or request one be mailed to you if you are unable to print it. After completing the form, submit it to your local Department of Job & Family Services office via email, fax, or mail. 

In-person application process

If you require assistance, complete an in-person application at your county’s Department of Job & Family Services. They will have all the forms you need. Make sure you take all the required documents with you.

You can also have an authorized representative drop off your application. The authorized representative must be at least 18 years old and bring a written statement that names them as your representative and details the specific duties you have authorized your representative to perform on your behalf.

Cost of Ohio Medicaid

Although Ohio Medicaid is generally free, there are some instances in which enrollees are responsible for out-of-pocket expenses. For example, the Medicaid Buy-in for Workers with Disabilities program has a monthly premium if your or your family’s income exceeds 150% of the federal poverty level. 

There are also copays for some procedures, medications, and medical devices, as listed below. Some people will not be charged a copay, such as individuals younger than 21 and pregnant individuals.

  • Prescription copays are generally $2 for non-generic refills and $3 for refills that require prior authorization.
  • The copay for eyeglasses is $1 per fitting and $2 for eye exams.
  • Copays for dental services are $3 per visit. 

Additional Ohio Medicaid resources

Ohio Medicaid FAQ

How do I find a doctor who accepts Medicaid?

Before making an appointment, remember to ask your doctor, pharmacist, or medical device provider if he or she accepts Ohio Medicaid. If you already have a provider, the easiest way to find out is to call. If you’d like to find a provider, visit this site. If you’ve been prescribed medication, find a pharmacy that accepts Ohio Medicaid.

How do I renew Medicaid coverage?

Now COVID-19 continuous enrollment protections have ended, everyone must renew their coverage annually. After receiving a renewal packet in the mail, renew your coverage using the same methods as the application process.

How do I appeal a denied claim?

When a state agency denies, reduces, or ends your services, it is required to send you a notice by mail that explains the decision. If you disagree with the decision, file a Medicaid appeal. The first step in this process is to request a state hearing, either by:

  • Filling out and mailing the hearing form that came with your notice to: ODJFS Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825
  • Faxing the form to 1-614-728-9574
  • Requesting a hearing online
  • Requesting a hearing by phone by calling 1-866-635-3748
  • Emailing bsh@jfs.ohio.gov with the subject line “State Hearing Request”

If you disagree with the outcome of the state hearing, file for an administrative appeal. Lastly, if you disagree with the administrative appeal, pursue a judicial review. 

How do I report Medicaid fraud?

If you did not enroll in Medicaid but received documents implying you did, the Ohio Department of Job and Family Services requests that you inform them as quickly as possible. Provide them with as much documentation about the issue as possible. Each type of fraud (identity theft, childcare fraud, and food assistance fraud) has its own form.

Sources