Who Is Covered?

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 clip_image002_002annual household income falls below 133 percent of the federal poverty level (assuming they are not eligible under another Medicaid category).

Adults who apply under the expanded eligibility standards cannot be in receipt of, or eligible for, Medicare. However, an individual can be eligible for expansion benefits if they have been determined to be disabled by SSA but are currently in the two-year waiting period for Medicare.

Parents residing with minor children cannot qualify for expansion benefits unless the child has creditable coverage (privately or through Medicaid).

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 coverage for 6-12 months during that transitional period. Through the Healthchek Program, children and young adults through age 21 can also receive services.

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 for ABD 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.

Spend down clients also have the option of paying cash for their spend down, or they can use a combination of cash and incurred medical expenses.

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.