MEDICAID

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Medicaid is a program that provides health coverage to some low-income Ohio residents. Medicaid covers families with children and pregnant women, the elderly, and people with disabilities, if state and federal guidelines are met. Those who qualify for Medicaid programs must be Ohio residents and U.S. citizens. Additionally, certain legal residents who are not U.S. citizens may be eligible for coverage. Non-citizens who do not have immigration documents cannot enroll in Medicaid programs.

For all categories of Medicaid, eligibility is based on the amount of your household income. For children with family incomes over 150% of the federal poverty level, eligibility is restricted to uninsured children who have not had health insurance for at least 6 months. For those who are applying for coverage because they are elderly or have a disability, eligibility is also based on the amount of assets an individual may have. Assets are things like cash, savings, stocks and bonds, etc.

Low income persons eligible for Medicaid in Ohio*

Category — Income eligibility (as percent of federal poverty level)
Uninsured Children — 200%
Children (up to 19) — 200%       
Pregnant women — 150%
Parents – 90%

*Eligibility information was compiled from State Health Facts Online, the Henry J. Kaiser Family Foundation, and may have changed since this guide was published.  Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2006:

Size of Family Unit           Poverty Guideline (annual income)
      1                                              $  9,800
      2                                              $13,200
      3                                              $16,600
For larger families add $3,400 for each additional person.

So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $33,200, or a monthly income of $2,767.

Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

What is Healthy Start?

  • The name of the Medicaid program for low income children and pregnant women in Ohio is Healthy Start. Eligibility requirements are as follows:
  • A child whose family has a household income between 151 - 200% of the federal poverty level (FPL) must be uninsured in order to be eligible for Healthy Start. For a family of 3, this is an annual income of up to $33,200- or $2,767 per month.
  • A child whose family has an income below 150% FPL can be eligible for Healthy Start regardless of insurance status. For a family of 3, this is an annual income of about $24,900 - or $2,075 per month.
  • A pregnant woman whose family income is below 150% FPL is also eligible for Healthy Start. When determining eligibility, a pregnant woman, at minimum, is considered a family of two. In addition, babies born to mothers on Healthy Start are automatically eligible for coverage for one full year.
  • Healthy Start does not impose a pre-existing condition exclusion period. If a family meets the eligibility guidelines, a child’s pre-existing medical condition does not exclude him or her from coverage.
  • Healthy Start provides comprehensive coverage to enrollees including, but not limited to, doctor visits, hospital care, prescriptions, mental health services and substance abuse, preventive well-child exams, immunizations, dental, and vision services.
  • To apply, families must complete a short, mail in application. No face-to-face interview is required. Applications can be obtained by contacting
    1-800-324-8680/TDD 1-800-292-3572, or by visiting the local county Department of Job and Family Services, or on the internet at www.state.oh.us/odjfs/ohp.

What is Healthy Families?

  • The name of the Medicaid program for low income families - both parents and children - is Healthy Families. A family with income less than 100% FPL is eligible. (See page 27 for poverty level for 2006).
  • Healthy Families provides comprehensive coverage to enrollees including doctor visits, hospital care, prescriptions, mental health services and substance abuse, preventative well-child exams, immunizations, dental, and vision services.

To apply, families must complete a short, mail in application. No face to face interview is required. Applications can be obtained by contacting 1-800-324-8680/TDD 1-800-292-3572, or by visiting the local county Department of Job and Family Services, or on the internet at www.state.oh.us/odjfs/ohp.

Who else is Eligible for Medicaid Coverage?

  • Families and children participating in Ohio Works First (OWF) cash assistance program are automatically covered. Families who leave OWF for employment are eligible for 6 to 12 months during a transitional period, in addition, your children may qualify for Healthy Start if your family’s income meets those income standards, even if your income rises above 100%FPL.
  • Poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage if you are elderly or you are still considered disabled and you continue to have medical need.

  • Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid through the Ohio Medicare Premium Assistance Program. Even though your income may be too high to qualify for Medicaid coverage, there may be other ways Medicaid can help you.

If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance.

If your household income is above 100% but below 135% of the poverty level, Medicaid will pay for your monthly Medicare premiums only.

Contact your County Job and Family Services office for more information about other eligibility requirements. Call 1-800-324-8680/ TDD 1-800-292-3572 to obtain the location and telephone number of this office.


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