Medical Assistance Questions/Answers

What kind of medical or healthcare providers will see me if I have Medicaid?

Various doctors, dentists, pharmacists, eye doctors, physical therapists, hospitals, clinics, ambulance services, x-ray and laboratory services, home health agencies and psychologists, among others, accept Medicaid. However, before making an appointment, you should always contact the doctor's office or provider to see if they accept Ohio Medicaid or the Medicaid Managed Care Plan you have.

What is a managed care plan?

 

A Managed Care Plan (MCP) arranges healthcare for its members through a network of providers. You must get your medical treatment from a doctor who works with your MCP, or is in the MCP's network. With most MCPs, you will need to choose one doctor or a group of doctors as your primary care physican (PCP). This allows you to develop a close relationship with your PCP. If you or your children need th services of a specialist, your PCP will make the referral at no cost to you. For more information on Managed Care Plans, please call 1-800-234-8680 (Ohio Medicaid Consumer hotline).
What expenses does Medicaid cover? Please review the covered services section of our Medical Assistance page

What is the difference between Medicare and Medicaid?

Medicare is an insurance program mainly serving people with disabilities or who are 65 years of age or older who have worked and earned qualifying quarters and are now eligible for medical coverage regardless of their income. Medicare is federally funded and administered by the Social Security Administration.

Ohio's Medicaid program is a health coverage program serving certain eligible low-income people of all ages who do not have enough money or health insurance coverage for medical care. Medicaid is funded by both the federal governnment and the state of Ohio and is administered by the Ohio Dept. of Job and Family Services.

What is a spend-down?

If you are aged, blind or disabled and your income is more than the specified level for regular Medicaid, you may be eligible for a spend-down provision. Briefly, here is how spend-down works: your caseworker will tell you the amount of your monthly income that is over the specified level for regular Medicaid eligibility. That amount becomes your "deductible" for each month and is the amount you are responsible for incurring in medical expenses each month before you can become eligible for Medicaid. Medicaid will pay for covered services after eligibility is established by meeting or paying your spend-down (deductible) amount.

After you have incurred medical expenses each month which equal the same or more than that of your spend-down amount, you will receive a Medicaid card that is good from the date you reached your spend-down amount through the rest of the month. Those medical expenses incurred before you get your medical card cannot be billed to Medicaid; they are your responsibility. The medical card entitles you to covered health services under Medicaid for the rest of that month at no cost to you.

EXAMPLE: Your caseworker tells you that your spend-down amount is $50. On March 3rd, you go to the doctor and the bill is $30. On March 4th, you go to the pharmacy for a prescription and the bill is $24. The next day, you take these two medical receipts totaling $54 to your county's dept. of Jobs and Family Services agency. You have met your March spend-down on March 4th. Medicaid will cover the extra $4 from March 4th and you will qualify for a medical card from that date through the end of that month, March 31st.