Learn About Coverage For Medicaid in Ohio

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Ohio Medicaid coverage caters to eligible low-income individuals and households that meet specific criteria. The OH Medicaid program allows Ohioans to receive quality and essential health care for free or at a very low cost. Before looking at what services are covered by Medicaid, it’s important to know that the program has not been expanded to include more people as proposed by the federal government.

The question “How much does Medicaid cost in Ohio?” is answered with program details and stipulations below. Information regarding the types of Medicaid insurance available is also provided. In particular, the following Medicaid coverage information is provided:

What Services are Covered by Medicaid in Ohio?

Ohio Medicaid services include a number of health care programs. The programs include preventive care, and are meant to help low-income families afford health care coverage. Some of the services offered are limited by number of visits per year, the dollar amount or the setting in which they can be provided.

This section highlights what is covered by Medicaid OH and through Managed Careplan. Ohio Medicaid covers alcohol and drug addiction services like drug or alcohol screening/lab urinalysis, ambulatory detoxification, and individual or group counseling by MHA certified providers. OH Medicaid coverage also includes an introduction to buprenorphine and the administration of methadone and medic somatic.

Medicaid services also include dental work such as the provision and installation of braces, teeth checkups and cleanings, installing dentures, fillings, extractions and crowns, root canals and surgical dental services. Download our informative guide to learn more about Medicaid coverage and costs.

If you are still wondering what services are covered by Medicaid in Ohio, there are mental health, preventive health and professional medical services. Under mental health, services provided include psychological testing for mental illness, mental health assessment, injections of long-acting antipsychotic medications and crisis intervention.

Medicaid coverage for preventive health includes preventive screenings and exams, physical health examinations, mammography, vaccines and immunization, X-rays and laboratory tests. Professional medical services include on-demand ambulatory surgery centers, audiology services such as hearing aids, occupational and speech therapy, doctor services, podiatrist services and private duty nursing services.

Medicaid coverage also enables beneficiaries to visit the emergency room, family planning, health check, inpatient and outpatient hospital services, medical equipment, pregnancy, prescription drugs, ambulance transportations, non-emergency transportation, surgical and medical vision services, ophthalmologist and optometrist services.

How Much Does Medicaid Cost in Ohio?

If you or someone you know has asked “How much is Medicaid?” it should be noted that Medicaid cost estimates in Ohio depend on the service a patient is seeking. Some OH Medicaid services are offered completely free, while others services require patients to pay a co-payment.

Ohio Medicaid coverage fully promotes all alcohol and drug addiction programs. When discussing how much does Medicaid cost in OH, remember that the majority of dental services have a co-payment of $3. Get more details on covered services and costs by downloading our detailed guide.

What Does Medicaid Not Cover in Ohio?

Curious about what is not covered by Medicaid? Full Medicaid coverage does not apply to all services. Generally, Medicaid coverage excludes the following:

  • Services offered to treat obesity, unless determined to be medically necessary
  • Drugs not covered by Medicaid, e.g. drugs for treatment of obesity
  • Inpatient treatment offered to help a member stop alcohol or drug dependence. However, in-patient detoxification services offered in a general hospital are covered
  • Miscarriage or sex counseling
  • Cosmetic or plastic surgery that is not medically necessary
  • Voluntary sterilization if legally incapable of providing consent for the procedure or if under 21 years old
  • Infertility services for both males and females, including reversal of voluntary sterilization
  • Abortions except when it is medically necessary to save the life of the mother or in reported cases of incest or rape
  • Experimental procedures and services, including equipment and drugs not covered by OH Medicaid
  • All supplies or service that are not medically necessary

OH Medicaid coverage also excludes some common services like paternity testing, services that have been determined by another party as not medically necessary, services related to forensic studies of those to find cause of death (autopsies), biofeedback and acupuncture services and comfort items in the hospital (e.g. phone or TV) or inpatient hospital custodial care.

The answers to the question “What does Medicaid not cover in Ohio?” are many. In addition, there are some specialist services for which patients need to acquire prior authorization before receiving treatment. Your doctor will call or arrange for these services for you, tell you what to do or provide a written approval for you to have eligibility for special Medicaid services.

Some of these services that Medicaid coverage excludes include: lab and x-ray diagnostic services, specialist services such as visiting a dermatologist, outpatient hospital services, physical and occupational therapy and renal dialysis (kidney disease).

Apart from requiring prior authorization, some services require a referral. These services include:

  • Nursing facility services
  • Physical, occupational and speech therapy sessions that last more than 2 hours a day require prior authorization.
  • Respite services for members that are below 21 year and receive Supplemental Security Income(SSI)
  • Some durable medical equipment, including contact lenses, customized wheelchairs and hearing aids
  • Developmental therapy services of children under 6 years
  • Prosthetics or orthotics
  • Services offered by a provider that is from out of the plan’s network
  • Some pain management therapy services
  • Some dental services, including orthodontia
  • Ambulance transportation. However, emergencies do not require prior authorization or a referral.

Apart from the above, Medicaid coverage excludes all inpatient hospital services except emergency room services and hospice care for terminally ill patients, e.g. those suffering from cancer.

Understanding Types of Medicaid Insurance in Ohio

There are several types of Medicaid insurance in Ohio. The insurance is offered by different plan providers present in all of the counties in Ohio. The plans available for Medicaid include Buckeye Health Plan, CareSource, Molina HealthCare of Ohio, Inc., Paramount Advantage and United Healthcare Community Plan of Ohio.