Who Is Covered by Medicaid?
Ohio Medicaid provides health care coverage to children, pregnant women, families, adults age 65 and older and people with disabilities. Some consumers may need to pay monthly premiums or co-pays for certain services. Covered groups include:
- Families and Children: In general, families, children (up to age 19) and pregnant women with limited incomes (see chart) are covered through Medicaid under Healthy Start or Healthy Families Programs. Certain youths aging out of the foster care system at age 18 may continue receiving health care coverage until age 21 at no cost to them.
Families who participate in the Ohio Works First (OWF) Cash Assistance Program are automatically covered by Medicaid. Families who leave OWF for employment are eligible for 6-12 months of coverage during that transitional period.
- Aged, Blind and Disabled (ABD): Ohioans age 65 and older and people with disabilities of any age may also qualify for Medicaid health coverage. To be eligible for Medicaid as an ABD consumer in 2008, an individual’s gross countable monthly income must be less than $556. They must also have resources (e.g., cash, savings, stocks etc.) of $1500 or less. Couples applying for Medicaid must have gross monthly income of $956 or less and resources of $2250 or less.
- Medicaid Spend-Down Program: In some cases, consumers applying for ABD Medicaid meet eligibility requirements except their income is too high. These individuals can participate in the Medicaid Spend-Down Program. A spend down is like a monthly deductible determined by the county caseworker. To qualify for coverage in a given month, consumers must submit proof of medical expenses that equal the spend-down amount. They can also choose to pay their spend down directly to the county office. Once the spend down is reached, the consumer is then eligible for Medicaid for the rest of the month.
- Medicaid Buy-In for Workers with Disabilities (MBIWD): MBIWD provides health care coverage to working Ohioans ages 16 to 64 who are disabled. MBIWD was created to encourage Ohioans with disabilities to work and still keep their health care coverage. To qualify for MBIWD, an individual’s gross countable income must be no more than 250% of the federal poverty level (FPL), and they must also have resources that do not exceed $10,000. Monthly premiums are required for those eligible for MBIWD with an annual gross income greater than 150% FPL.
- Medicare Premium Assistance Program: Low income Medicare beneficiaries can receive help from Medicaid with all or part of their Medicare cost sharing expense.This includes Medicare Part A and B premiums, co-insurance and deductibles. Different levels of assistance are available depending on income.
- Breast and Cervical Cancer Project (BCCP): Medicaid also provides health care coverage to eligible women screened through Ohio Department of Health’s Breast and Cervical Cancer Project. To qualify for ODH’s BCCP, women must have income below 200% FPL, be between the ages of 40-65 and uninsured. Once screened and diagnosed as having breast and/or cervical cancer, BCCP Medicaid may be available to women who are in need of treatment services. Women who are covered by BCCP Medicaid have access to the full Medicaid benefit package in addition to their cancer treatment.