Athens County Job and Family Services
13183 State Route 13, Millfield, Ohio 45761-9901
More people are eligible for Medicaid than ever before
Medicaid is a state and federally funded health program for certain low-income and medically vulnerable people. As an entitlement program, those who meet eligibility requirements are guaranteed coverage through the Medicaid program. In Ohio, Medicaid is administered by the Ohio Department of Job and Family Services (ODJFS) via 88 local county department of job and family services. Click here for information from the Ohio Department of Job and Family Services about the Medicaid program.
To qualify for Medicaid, a person must:
Ohio Medicaid provides coverage to the following:
*Some individuals with Medicaid may be required to join an HMO for their Medicaid coverage.
Who is Covered by Medicaid?
Medicaid provides health care coverage to people who meet certain requirements including:
Adults who meet income guidelines
As a part of Ohio's Medicaid expansion, adults between the ages of 19 and 65 are now eligible for Medicaid coverage if their annual household income falls below 133 percent of the federal poverty level (assuming they are not eligible under another Medicaid category).
The quickest and easiest way to determine eligibility is to apply for Medicaid online at www.benefits.ohio.gov. Those who need access to the Internet can use a computer for free at The Work Station in The Plains. The paper application can also be downloaded. For more information, call 797-2523 or visit the agency's County Home office on Route 13.
Families and Children (Healthy Start / Healthy Families)
Families, children up to age 19, and pregnant women with limited incomes are covered through Medicaid under Healthy Start or Healthy Families. Additionally, families with children under age 18 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)
Adults 65 and older can be eligible for Medicaid. Individuals of any age with disabilities, including individuals who are legally blind, can also qualify for Medicaid. In some cases, individuals can “spenddown” their income to become Medicaid eligible.
What is Medicaid Spenddown?
Medicaid spenddown is forABD individuals who meet the Medicaid eligibility guidelines except their income is too high. These individuals can use paid or incurred medical expenses to “spend down” their income to qualifying Medicaid income levels. Once the consumer reaches his or her designated “spenddown” limit each month he or she becomes qualified for Medicaid. The date of eligibility each month depends on the date the consumer reaches the spenddown amount.
Breast & Cervical Cancer Medicaid
Medicaid is available to women who have been screened for breast or cervical cancer through the Ohio Department of Health’s Breast & Cervical Cancer Prevention Project, and are found to be in need of treatment for breast and/or cervical cancer, including precancerous conditions. In order to qualify, women also need to be uninsured and meet the basic Medicaid requirements (e.g., income, Ohio residency, etc.) Women who qualify will receive full Medicaid coverage benefits not just cancer treatment benefits. Medicaid coverage ends when cancer treatment is completed.
Medicaid Buy-In for Workers with Disabilities (MBIWD)
MBIWD is an Ohio Medicaid program that provides health care coverage to working Ohioans with disabilities. Historically, people with disabilities were often discouraged from working because their earnings made them ineligible for Medicaid coverage. MBIWD was created to enable Ohioans with disabilities to work and still keep their health care coverage.
To qualify for MBIWD, a person must:
Monthly premiums are required for those eligible for MBIWD with an annual gross income greater than 150% of the federal poverty level (FPL). To obtain and maintain health coverage, the full amount of the premium must be received by the due date or it will be considered non-payment. (more information)
To Apply, please complete:
Click here for additional information on the Medicaid Buy-In for Workers With Disabilities program
Ohio's Medicaid program provides a package of medical services that includes preventive care, community mental health/alcohol and drug addiction treatment and home care for people with serious disabilities, as well as doctor visits, hospitalization, nursing home care, and many other services.
Some services are limited by dollar amount, number of visits per year, or setting in which they can be provided. With some exceptions, all services are available as medically necessary to everyone enrolled in Medicaid statewide.
Ohio's Medicaid Consumer Guide
This guide will help consumers know what to expect once they receive their medical card; available benefits, programs and services; and how to maintain their Medicaid services.
For printed copies of the Medicaid Consumer Guide, please fax an order toODJFS: 614/728-7724.
You may request up to 250 copies.
Ask for publication JFS 8102 and remember to include your shipping address.
MEDICARE premium assistance program
Individuals with low incomes who are eligible for Medicare can receive help with all or part of their Medicare Part B
Medicare Prescription Drug Benefit and how it works with Medicaid
Dual eligibles (people with Medicare and Medicaid benefits) will no longer receive their drug coverage through Medicaid, but will receive drug coverage from Medicare, which may be different from what is included on the Ohio Medicaid drug formulary. However, Medicaid will still pay for other medically necessary services (e.g., doctor visits, hospital care, dental, vision etc..) for those who are dually eligible
Dual eligibles will be automatically enrolled in the Medicare Prescription Drug Benefit and will need to select a PDP to get their prescription coverage, or one will be selected for them. In addition, they will only be responsible for paying co-payments which can range from $1-$5 per prescription. Copayments will be waived for dually eligible beneficiaries who reside in long-term care institutions or who are enrolled in Medicaid’s Program of All-Inclusive Care (PACE).
Extra Help with Drug Costs
Extra help is available to provide people with limited income and resources assistance with premiums, deductibles and co-pays under the Medicare Prescription Drug Benefit through the Social Security Administration (SSA). An application must be completed and filed with SSA. Beginning July 1, 2005, beneficiaries can apply on-line www.socialsecurity.gov for this extra help. In addition, applications can be obtained at local social security offices and at the county departments of job and family services.
Additional Information on Medicaid
Medicaid was passed as part of the Social Security Act of 1965 and began in Ohio in 1968. Each state operates its own distinct program within guidelines established per the Social Security Act. The federal government plays a very active oversight role through the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services
November is the Open Enrollment Month for all Medicaid clients in southeast Ohio, including Athens County. November is the only month of the year that Athens County residents can switch between the different managed care plans providing Medicaid coverage. Click here to read more.
How Do Consumers Receive Medicaid Services?
Medicaid provides primary and acute care services through a fee-for-service system or, for consumers in some areas, managed care plans. *NOTE: Managed care plans (HMOs) are required for those with Healthy Start/Healthy Families Medicaid.
Both delivery systems provide all medically necessary primary care, specialty and emergency care and preventive services.
To learn more about the Medicare Prescription Drug Benefit call: 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov .
To learn more about getting the extra help for prescription drugs visit www.socialsecurity.gov.
Additional training and information can be obtained from the Ohio Senior Health Insurance Information Program (OSHIIP). For more information, click here or call 1-800-686-1578.