Jane Dotson
Ohio's Medicaid program offers a personalized approach to healthcare, catering to the unique needs of eligible Ohioans. The program provides medical services to those with low incomes, pregnant women, infants, children, older adults, and individuals with disabilities. Ohio Medicaid's managed care plans offer coordinated access to medical services, focusing on preventative care, care coordination, and complex health condition management. This raises the question: can Medicaid act as secondary insurance in Ohio?
| Characteristics | Values |
|---|---|
| Can Medicaid be secondary insurance in Ohio? | Yes, it is possible for Medicaid beneficiaries in Ohio to have one or more additional sources of coverage for health care services. |
| Who is eligible for Medicaid in Ohio? | Eligible Ohioans with low income, pregnant women, infants and children, older adults, and individuals with disabilities. |
| How to apply for Medicaid in Ohio? | Apply online using the self-service Ohio Benefits Portal, by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or by visiting your local Department of Job and Family Services (JFS) office. |
| What is the role of MyCare Ohio? | MyCare Ohio is a managed care program for Ohioans who receive both Medicaid and Medicare benefits. |
| What are the benefits of MyCare Ohio? | The primary benefit is the coordination of all services, including medical, behavioral, and long-term care. MyCare Ohio members only have to carry one medical coverage card and have access to one point of contact for seamless care across services and settings. |
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What You'll Learn
MyCare Ohio
The primary benefit of MyCare Ohio is the coordination of all services, including medical, behavioural, and long-term care. Members only need to carry one medical coverage card, and have one point of contact. This means that members can cut down on paperwork and phone calls, and easily navigate their healthcare.
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Medicaid eligibility
Medicaid is a health care program for low-income individuals and families. It provides healthcare benefits and long-term services to eligible applicants. In Ohio, Medicaid eligibility is based on income and asset limits, which vary depending on the applicant's age, marital status, and medical condition.
For adults under the age of 65, the income limit is up to 138% of the federal poverty level. Adults aged 65 and older must have an income under $2,901 per month and assets under $2,000 to be eligible for Nursing Home Medicaid. For children, the income limit is up to 211% of poverty, or up to 206% according to another source. Pregnant women can qualify with a household income of up to 205% of poverty, or up to 200% according to another source, and coverage continues for 12 months after giving birth.
Certain low-income individuals who are blind, disabled, or aged 65 and above can also enroll in Ohio Medicaid, but they must meet low asset/resource level requirements. Additionally, persons who are eligible for SSI are automatically approved for Medicaid in Ohio.
To determine eligibility, applicants can use the Ohio Medicaid (Ohio Benefits) website to check their eligibility and apply for benefits. Enrollment in Medicaid is year-round, and applicants can also call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or visit their local Department of Job and Family Services (JFS) office.
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Third-party liability
States are required to take all reasonable measures to ascertain the legal liability of third parties to pay for care and services available under the Medicaid state plan. This includes gathering information on potentially liable third parties and other sources of health coverage when individuals apply for medical assistance. States periodically update this information whenever a Medicaid enrollee's eligibility is renewed and conduct data matches to identify third-party resources. For example, states match with public entities such as the Department of Defense to identify enrollees covered by the Military Health Services system and the TRICARE program. States also match with workers' compensation and state motor vehicle accident files to identify injuries that may be covered by workers' compensation or automobile insurance policies.
The contract language between the State Medicaid agency and the Managed Care Organization (MCO) dictates the terms and conditions under which the MCO assumes TPL responsibility. The Deficit Reduction Act of 2005 included several provisions related to TPL and coordination of benefits for Medicaid beneficiaries. Additionally, there have been changes to third-party liability in Medicaid due to the Bipartisan Budget Act of 2018 and the Medicaid Services Investment and Accountability Act of 2019.
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Medicare benefits
In Ohio, Medicaid-covered services are provided through traditional Medicare or a private insurance company, commonly referred to as a "Part C" plan. MyCare Ohio is a managed care program for Ohioans who receive both Medicaid and Medicare benefits. It is currently available in 29 counties and offers a coordinated approach to medical services, providing members with a single point of contact and seamless care across services and settings.
Medicaid health care coverage in Ohio is available for eligible individuals with low income, pregnant women, infants and children, older adults, and individuals with disabilities. Members can receive prescription drugs through their Part D plans, with any associated co-payments.
Ohio Medicaid's managed care plans aim to provide a personalized approach to meet individual healthcare needs. These plans offer coordinated access to medical services, focusing on preventative care services, care coordination, and management for complex health conditions.
One popular plan in Ohio is CareSource, which provides access to a large provider network, including eye and dental services. They also offer reward programs like Kids First and Babies First®, free rides to health care appointments, and pharmacies. CareSource does not charge a copay for any medical or behavioral health service.
Ohio residents can apply for Medicaid benefits through the Ohio Benefits website, which allows them to check eligibility and apply for various benefits. They can also call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or visit their local Department of Job and Family Services (JFS) office.
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Managed care plans
Ohio's Medicaid program offers a range of managed care plans, which are designed to provide a personalized approach to healthcare. These plans are tailored to meet the specific needs of individuals and their families. Managed care plans provide coordinated access to medical services, with a focus on improving health outcomes through preventative care, care coordination, and management of complex health conditions.
Ohio Medicaid's managed care plans are available through various providers, including CareSource, the state's most popular Medicaid plan, with over 1.4 million members. CareSource offers a large provider network, reward programs, and free rides to healthcare appointments, pharmacies, and more. They also provide access to a personal life coach, who can help address needs beyond physical health, such as those related to the home, workplace, and community.
Another option is MyCare Ohio, which is currently available in 29 counties across the state. MyCare Ohio is specifically for individuals who receive both Medicaid and Medicare benefits. This plan offers the benefit of coordinating all medical and behavioral health services, as well as long-term care. MyCare Ohio members only need to carry one medical coverage card and have access to a single point of contact for all their healthcare needs.
OhioRISE is another specialized managed care program for youth with complex behavioral health and multisystem needs. Enrollees in this program receive behavioral health benefits through Aetna and their medical, dental, vision, and other health services through one of seven managed care programs or fee-for-service Medicaid.
Ohio Medicaid allows individuals to choose the managed care plan that best fits their needs and preferences. They can explore the various plans available and enroll through the Ohio Medicaid Consumer Hotline or the Ohio Benefits website. If a plan is not chosen, one will be selected for the individual. Ohio Medicaid members can also change or disenroll from their plan at any time for Just Cause by contacting the Ohio Department of Medicaid through the Ohio Medicaid Consumer Hotline.
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Frequently asked questions
Yes, it is possible for Medicaid beneficiaries to have one or more additional sources of coverage for healthcare services. This is known as Third Party Liability (TPL).
TPL refers to the legal obligation of third parties (e.g. certain individuals, insurers, or programs) to pay part or all of the expenditures for medical assistance under a Medicaid state plan. States are required to identify and take all reasonable measures to ascertain the legal liability of third parties to pay for care and services available under the Medicaid state plan.
COB refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through a third party that is liable to pay for healthcare services. States gather information on other sources of health coverage when individuals apply for medical assistance and conduct data matches to identify third-party resources.
Yes, you can have Medicaid as a secondary insurance in Ohio as long as you meet the eligibility requirements. Medicaid health care coverage is available for eligible Ohioans with low income, pregnant women, infants and children, older adults, and individuals with disabilities.
