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Medical Assistance

Overview

Medicaid (medical assistance) provides health care coverage to families who may not otherwise have access to health care. The program is designed to safeguard the health and well-being of Allen County residents, particularly children, pregnant women, elderly, individuals with disabilities, and those looking for Long-Term Care and/or In-Home Waiver Care.

Medicaid programs include Healthy Start; Healthy Families; Healthchek; Pregnancy-related services; and Aged, Blind and Disabled among others. Individuals who receive Medicare, but whose income is too high to qualify for Medicaid, may be eligible for the Medicare Premium Assistance Program.

Do I Qualify?

Allen County Job and Family Services administers several different types of Medicaid, but eligibility is usually based on income and circumstances.

Allen County Job and Family Services oversees Medicaid programs that provide health care coverage to:

• Income-eligible parents and their children up to age 21
• Preventive and treatment services up to age 21
• Pregnant women
• Older adults
• Income-eligible people with disabilities
• Children in foster care
• Children who have aged out of foster care up to age 21
• Adults ranging in ages 19-64, depending upon eligibility factors

Resources

Apply For Medicaid Only

In some cases, you may want to apply to receive Medicaid without applying for cash or food
assistance. By visiting www.benefits.ohio.gov or calling 1-844-640-OHIO (6446), you can apply for
Medicaid only, without applying for cash or food assistance at the same time.
To apply through the site, click “Check your eligibility” and follow the prompts.

Visit benefits.ohio.gov

Managed Care Plans

In Ohio, most individuals who have Medicaid must join a managed care plan to receive their health care. Managed care plans are health insurance companies that are licensed by the Ohio Department of Insurance and have a provider agreement with the Ohio Department of Medicaid to provide coordinated health care to Medicaid beneficiaries. These managed care plans work with hospitals, doctors and other health care providers to coordinate care and to provide the health care services that are available with an Ohio Medicaid card.

Once you are approved for Medicaid, you will receive information in the mail to help you select a managed care plan. You will have the opportunity to change managed care plans during open enrollment each November.

For more detailed explanations of these programs, visit:

Managed Care plans act just like regular health insurance. Once you are enrolled in a managed care plan, you should receive a new card in the mail.

Medicare Premium Assistance

Medicare is different from Medicaid. Medicare is the federal health insurance program for persons age 65 and older, and to some persons of all ages who have a disability. The Medicare Premium Assistance Program (MPAP) is a program for Medicare consumers whose income is too high to qualify for Medicaid. This program helps people eligible for Medicare who have limited income and assets get help in paying the cost of one or more of the following:

  • Medicare premium(s)
  • Medicare deductibles
  • Medicare coinsurance

No face-to-face interview is needed to apply for the Medicare Premium Assistance Program. Consumers may call 1-800-324-8680 for an application or apply through Allen County Job and Family Services.

TO QUALIFY FOR THE MEDICARE PREMIUM ASSISTANCE PROGRAM, APPLICANTS MUST:

  • Be eligible for Medicare;
  • Be a U.S. citizen or meet Medicaid citizenship requirements;
  • Be an Ohio resident;
  • Have or get a social security number; and
  • Meet certain financial requirements

When applying for MPAP, proof of income, resources, age or disability, citizenship (if not a U.S. citizen) and other health insurance is required. No face-to-face interview with the local county department of job and family services is necessary. Applicants can ask an authorized representative to apply on their behalf.

FEDERAL MEDICARE INFORMATION

Medicaid Expansion

Ohio is now accepting applications for Medicaid under the expanded guidelines implemented under the Affordable Care Act.

Medicaid Expansion expands Medicaid eligibility to 138% of the Federal Poverty Level and includes adults without children (under age 65). Gross monthly income is used to determine eligibility. See the chart below to determine if you might qualify for Medicaid under expansion based on your household size and income.

 

SUBMIT YOUR APPLICATION ONLINE

The quickest and easiest way to apply for health care benefits is online at www.benefits.ohio.gov.  There you will answer a series of questions and your answers will direct you to the correct application for health care.

  • If your income is within the new legal limit implemented by Medicaid Expansion (for eligibility effective Jan. 1, 2014), you will be directed to the citizen’s self-service portal.
  • If your income is above 205% of the Federal Poverty Level, you will be directed to the Federally Facilitated Health Insurance Marketplace to shop for health care.

After you submit your application online, you may be asked to send verification documents to Allen County Job and Family Services. The best way to return documents is to fax them to (419) 227-2448.

Visit www.healthcare.gov or www.benefits.ohio.gov to learn more or call the Medicaid Consumer Hotline at 1-800-324-8680. Representatives are available to answer questions related to eligibility for Medicaid due to the Affordable Care Act and Medicaid Expansion and answer questions about where to apply.

 

 

Household Size 138% of Federal Poverty Level (gross monthly income)
1 $1,321
2 $1,783
3 $2,245
4 $2,708
5 $3,170

 

SUBMIT A PRINT APPLICATION

If you are unable to complete an application online, print a Medicaid-only application, or you can complete an application in person at our office.

The best way to return a print application is to fax it to (419) 227-2448.  You can also return applications via mail to 1501 South Dixie Hwy, P.O. Box 4506, Lima, OH 45802-4506, or deliver them in person to the same location.

Program Enrollment and Benefit Information

For complete information about cash, food and medical assistance, you may want to review the Ohio Department of Job and Family Services (ODJFS) Program Enrollment and Benefit Information booklet.

The booklet may help you determine:

  • What types of services ODJFS offers
  • Frequently asked questions about applying
  • The difference between various Medicaid programs and services
  • Your rights and responsibilities
  • Information about state hearings
  • Penalties for providing false information or committing fraud
  • How we use social security numbers
  • Information about citizenship and immigration status
  • Your civil rights
  • And other helpful resources

LEARN MORE

State Hearings

If you disagree with any action on your case or if you believe ACJFS has not taken an action it should have, you may request a hearing by phoning the ODJFS Consumer Access Line at 1-866-635-3748 or by emailing your request to [email protected] or contact Allen County directly at (419) 228-2621 or [email protected].

To find out more about state hearings, please review the state hearing section of the ODJFS Program Enrollment and Benefit Information document.

Learn About Medicaid in Ohio

The Ohio Department of Medicaid has comprehensive Medicaid information for consumers. Although Allen County residents will likely need to apply through Allen County Job and Family Services, the state information can help individuals be better informed. Individuals can learn the various types of Medicaid, how to obtain Medicaid coverage, about Managed Care Plans, what your benefits include, which services are covered and answers to frequently asked questions.

LEARN MORE

Long-Term Care and/or In-Home Waiver Care

Long-Term Care (LTC) is a variety of services and supports that help an individual meet their personal care needs. LTC services do not need to be medical care, but includes assistance with everyday life tasks and  can be considered into two categories:

  1. Institutional or facility services, which include impatient, comprehensive services in a nursing facility, ICF-IID, or other medical institution for more than 90 days. The comprehensive care includes room and board.
  2. Home & Community-Based Services (HCBS or Community), which includes waiver and PACE services. HCBS allows individuals to receive services in their own home or community and does not include payment for room and board.

Those wanting to apply for Long-Term Care and/or In-Home Waiver who are currently receiving Medicaid, simply have to request LTC via the 2399 (waiver application).  Those who are not receiving Medicaid, must submit an 7200 application and note they are applying for Long-Term Care services.

Additionally, ensure that you complete and send us the Resource Questionnaire so that we can get an understanding of your resources.

Long-Term Care/In-Home Waiver Care Contact Information:
Phone:  (419) 228-2621
FAX:  (419) 999-0301
Email:  [email protected]

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