An Overview of Medicaid Insurance

Good health is important to everyone and these days health insurance is a necessity that you can’t afford to be without. If you can’t afford to pay for health insurance right now, you might be eligible for Medicaid. Medicaid can make it possible for you to get the care you need to get healthy and stay healthy. Certain low income individuals and families may qualify for Medicaid if they fall into an eligible group that is recognized by the federal and state government.

Medicaid sends payments to your health care provider and depending on the rules in your state, you may be required to pay for a portion of the cost of some medical services. Medicaid is administered by each state and it is up to the state to set the eligibility guidelines. This article mainly focuses on some of the guidelines that have been established for the state of Ohio. The basic elements of Medicaid are the same throughout the country, but the eligibility guidelines and the services provided through Medicaid can differ from state to state.

Who Qualifies for Medicaid In Ohio

Ohio Medicaid provides coverage to the following groups of people:

  • Children
  • Pregnant women
  • Families with children younger than age 19
  • People with disabilities
  • Older adults (age 65 and older)
  • Certain women screened for breast and/or cervical cancer
  • Other Types of Assistance: Medicare Premium, Disability Medical, Refugee Medical, Alien Emergency Medical

To qualify for Medicaid, a person must meet these basic requirements:

  • be a U.S. citizen or meet Medicaid citizenship requirements
  • be an Ohio resident
  • have or get a social security number
  • meet certain financial requirements

Programs for Children, Families and Pregnant Women

Ohio Medicaid offers two programs: Healthy Start and Healthy Families. Healthy Start is for children and Healthy Families is for families and pregnant women with limited income. Once eligible for Medicaid, each child (birth through age 20) will have access to an important group of services known as HealthChek.

HealthChek is Ohio’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. It provides a group of services to children and teens (birth through age 20) which include: prevention, diagnosis and treatment. The purpose of HealthChek is to discover and treat health problems early. These services are marketed as HealthChek to parents as a set of preventive health screenings with follow-up diagnosis and treatment. If a potential health problem is found, further diagnosis and treatment is covered.

Healthy Start

Healthy Start (also called SCHIP) is a Medicaid program available to:

  • Children (younger than age 19) in families with income up to 200% of the federal poverty level.
  • Pregnant women in families with income up to 200% of the federal poverty level.

Healthy Families

Healthy Families is a Medicaid program available to families with income up to 90% of the federal poverty level (families must include a child younger than age 19).

What Is The Federal Poverty Line?

There are two slightly different versions of the federal poverty measure: the poverty thresholds and the poverty guidelines.

The poverty thresholds are updated each year by the Census Bureau and are the original version of the federal poverty measure. They are used for the statistical purposes like knowing how many Americans are in poverty each year. To find out how the Census Bureau applies thresholds to a family’s income to determine its poverty status, see “How the Census Bureau Measures Poverty” on their website.

The poverty guidelines are the other measurement of federal poverty. The are released each year in the Federal Register by the Department of Health and Human Services (HHS). They are used to determine eligibility for certain federal programs. You can view the current guidelines at the Federal Register notice of the 2009 poverty guidelines.

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia are as follows:

1 person in family – $10, 830
2 persons in family – $14,570
3 persons in family – $18,310
4 persons in family – $22,050
5 persons in family – $25,790
6 persons in family – $29,530
7 persons in family – $33,270
8 persons in family – $37,010

*For families with more than 8 persons, add $3,730 for each person.

This information was obtained from the United States Department of Health and Human Services website.

Medical Services That Are Covered by Medicaid

Ohio’s Medicaid program limits some services by dollar amount, number of visits per year, or setting in which they can be provided. The program also includes preventative care. By Federal Law, the Ohio Medicaid program must offer the following services: Ambulatory Surgery Centers, Certified family nurse practitioner services, Certified pediatric nurse practitioner services, Family planning services & supplies, Healthchek (EPSDT) program services (screening & treatment services to children 21 and younger), Home health services, Inpatient hospital, Lab & X-ray, Medical & surgical dental services, Medical & surgical vision services, Medicare Premium Assistance, Non-Emergency Transportation (NET) to Medicaid services, Nursing facility care, Outpatient services, including those provided by Rural Health Clinics & Federally Qualified Health Centers, and Physician services.

Ohio also offers other Medicaid services which can be found on the Ohio Job and Family Services website.

How To Apply

To apply for Medicaid, you must fill out an application and either fax, mail it, or take it to your local county Job and Family Services location. The eligibility guidelines are attached to the application which will help you determine if you meet the criteria. The Ohio Job and Family Services Department suggests that you should apply even if you are unsure if you are eligible. In the event you don’t meet the guidelines, they might be able to find another program you are eligible for. Once your application is received, along with any required documentation, you will be scheduled for a face to face interview.

Once eligible, coverage may be retroactive up to 3 months prior to the application. Most States have additional “State-only” programs to provide medical assistance for specified poor persons who do not qualify for the Medicaid program. No Federal funds are provided for State-only programs.

Published or Updated: June 5, 2011

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