Paul Sanchez
Medicaid is a health care program for low-income individuals of all ages, jointly funded by the state and federal government. In Ohio, Medicaid is administered by the Ohio Department of Medicaid (ODM), and individuals must join a managed care plan (MCP) to receive healthcare. As such, it is possible to have Medicaid and another form of insurance in Ohio, and this is referred to as having dual benefits. For example, MyCare Ohio is a dual-benefits plan that integrates care coordination through a care team, providing benefits from both traditional Medicare and Medicaid programs.
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What You'll Learn
Medicaid eligibility criteria
Medicaid is a federal and state-funded program that provides healthcare coverage for low-income individuals, including adults, children, pregnant women, seniors, and disabled individuals. In Ohio, Medicaid is administered by the Ohio Department of Medicaid (ODM), and eligibility is determined by the agency based on specific criteria.
Firstly, applicants must be Ohio residents and U.S. citizens or meet non-citizen requirements. Secondly, eligibility is primarily based on household income as a percentage of the Federal Poverty Level (FPL). The income limits vary depending on factors such as family size, marital status, and the presence of dependent children. For example, in 2025, a single nursing home applicant must have an income under $2,901 per month and assets under $2,000. Additionally, individuals with Supplemental Security Income (SSI) eligibility may have different income thresholds.
When applying for Medicaid in Ohio, applicants must provide the correct documentation to avoid delays. They can apply online through the Ohio Benefits Portal, by phone via the Medicaid Consumer Hotline, or in person at their local Department of Job and Family Services (JFS) office. The application process is designed to be straightforward, and support is available through the Medicaid helpline and county service representatives.
It is important to note that Medicaid eligibility criteria can change annually, and Ohio offers alternative pathways to eligibility. For instance, individuals who are eligible for Supplemental Security Income (SSI) are automatically approved for Medicaid. Furthermore, Ohio's Medicaid program includes long-term care services, and applicants for these programs must demonstrate a medical need, such as requiring a Nursing Facility Level of Care (NFLOC) or having functional needs with Activities of Daily Living (ADLs).
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Medicaid and private insurance
In Ohio, most individuals who have Medicaid must join a managed care plan (MCP) to receive their healthcare. An MCP is a private healthcare insurance company that provides medically necessary healthcare. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package.
Medicaid is jointly funded by the state and federal government, with the state administering the program within federally set parameters. The Ohio Department of Medicaid (ODM) is the administering agency. Medicaid is a health care program for low-income individuals of all ages. While there are varying Medicaid coverage groups, the focus is on long-term care for Ohio residents aged 65 and older.
Medicaid health care coverage is available for eligible Ohioans with low incomes, pregnant women, infants and children, older adults, and individuals with disabilities. In addition to nursing home care and care services in assisted living facilities, Ohio Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.
OhioRISE enrollees will receive behavioral health benefits through Aetna (the OhioRISE plan) and their medical, dental, vision, and other health services through one of the seven managed care programs or fee-for-service Medicaid.
MyCare Ohio is another plan that integrates care coordination through a care team, led by the enrollee, to ensure that all parties are knowledgeable of and involved in their care. The MyCare Ohio plan benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services in the community and in a nursing facility, as well as behavioral health services.
If you have full Medicaid eligibility and are having difficulty accessing a medically necessary service, you may request transportation assistance. Medicaid managed care and MyCare Ohio plans can offer free transportation to their members as an additional benefit.
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Medicaid and Medicare
In Ohio, Medicaid and Medicare are available to eligible residents. While Medicare is a federal program, each state runs its own Medicaid program, following general rules set by the federal government. This means that eligibility and benefits can vary from state to state.
Medicaid is a health insurance program for eligible individuals and families with low incomes, older adults, pregnant women, infants, children, and people with disabilities. In Ohio, Medicaid is available through managed care plans that provide personalized healthcare to meet specific needs. These plans are available across the state, and members can choose from a range of options. OhioRISE enrollees, for example, receive behavioral health benefits through Aetna and other health services through one of seven managed care programs or fee-for-service Medicaid.
Ohio's Medicaid Consumer Hotline provides support and information about the various plans and benefits available. The hotline operates Monday through Friday from 7 a.m. to 8 p.m. and on Saturdays from 8 a.m. to 5 p.m. Eastern Time. Open enrollment occurs annually during the month of November, allowing members to change their plan if desired.
Medicare, on the other hand, is a federal health insurance program for people aged 65 and over, as well as younger people with disabilities. It consists of several parts, including Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). Medicare Advantage, also known as Part C, is offered by private insurance companies as an alternative to traditional Medicare, providing all the benefits of Parts A and B, and often including additional benefits like dental, vision, and prescription drug coverage.
The Ohio Department of Insurance, through its Ohio Senior Health Insurance Information Program (OSHIIP), provides free and objective information about Medicare, Medicaid, and related topics. This includes counseling and educational resources to help beneficiaries understand their options and make informed decisions about their healthcare coverage.
In Ohio, individuals can have both Medicaid and Medicare, and the MyCare Ohio plan offers dual-benefits, integrating care coordination for both programs. This includes long-term care services in the community or a nursing facility, as well as behavioral health services. With MyCare Ohio, members have the convenience of a single point of contact and seamless care across services and settings.
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Medicaid and MyCare Ohio
Medicaid is a health insurance program for eligible Ohioans with low income, pregnant women, infants and children, older adults, and individuals with disabilities. It provides a personalized approach to support healthcare needs.
MyCare Ohio is a Medicare-Medicaid plan that delivers extra benefits and coordinated care needed by both patients and caregivers, giving patients more coverage and caregivers more options. It is currently the managed care program for Ohioans who receive both Medicaid and Medicare benefits. MyCare Ohio is available in 29 counties, including Columbiana, Cuyahoga, and Geauga.
MyCare Ohio dual-benefits enrollment integrates care coordination through a care team, led by the enrollee, to ensure that all parties are knowledgeable of and involved in the enrollee's care. The benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services in the community, nursing facilities, and behavioral health services. MyCare Ohio plans may also elect to include supplemental 'value-added' benefits, such as additional transportation, over-the-counter allowances, and member rewards.
Ohio Medicaid's managed care plans send one permanent card when enrollees sign up, instead of the monthly paper card sent by Medicaid fee-for-service. This card must be kept while enrollees are on the plan. The plan will also send information about doctors, health services, and the scope of coverage. Enrollees will also receive newsletters, healthcare reminders, and opportunities to earn wellness incentives.
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Medicaid and transportation
In Ohio, most individuals with Medicaid must join a managed care plan (MCP) to receive their healthcare. MCPs are private healthcare insurance companies that provide medically necessary healthcare. The Ohio Department of Medicaid contracts with plans that provide services as determined by the Ohio benefit package.
Medicaid-eligible individuals in Ohio may request transportation assistance if they are having difficulty accessing medically necessary services. The type of assistance available may depend on whether the individual is a member of a Medicaid managed care or MyCare Ohio plan, the county they live in, and whether they use a non-folding wheelchair or power scooter.
Medicaid managed care and MyCare Ohio plans can offer free transportation as an additional benefit beyond what the state requires. This "value-added" benefit may be limited to a specific number of trips per year and can be used for healthcare appointments and other services. For example, MyCare Ohio plans may include supplemental benefits such as additional transportation, over-the-counter allowances, and member rewards. Similarly, Humana Healthy Horizons in Ohio provides its members with 30 one-way (15 round) trips each calendar year with no approval needed.
Individuals enrolled in a managed care plan can contact their plan's member services department or consult their member handbook to learn more about their transportation benefits. They can also contact the Medicaid Consumer Hotline for assistance.
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Frequently asked questions
Ohio Medicaid is a health care program for low-income individuals of all ages. It is jointly funded by the state and federal government, with the state administering the program within federally set parameters.
Eligibility for Ohio Medicaid is determined by income and asset limits, which vary depending on age, marital status, and medical needs. You can take a free Medicaid Eligibility Test to see if you qualify.
Having both can provide additional coverage for medical services not included in Medicaid. Private insurance can also help with co-payments for services that require them under Medicaid.
