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You are here: Home > Benefit Services > Medicaid & Managed Care Plans

Medicaid & Managed Care Plans

What is Medicaid?

Medicaid is a government funded health care coverage. Medicaid provides assistance to low income and medically vulnerable people. Cuyahoga County residents who are eligible for Medicaid are entitled to medical services at no or low cost.

What does Cuyahoga JFS work to do with Medicaid?

Cuyahoga County Job and Family Services work to determine eligibility of applicants and recertify recipients.

Changes to Medicaid Program

The Affordable Care Act (ACA) significantly changed Ohio’s Medicaid program. The ACA requires each state to provide web based applications, verifications and determinations for public benefits. The ACA uses a new methodology termed (MAGI) which stands for Modified Adjusted Gross Income to determine an applicant’s eligibility. This new method relies on gross monthly income, household composition and family size to determine the applicant’s eligibility. The ACA also allows states to extend Medicaid coverage to additional adults without children who meet the poverty guidelines.  Ohio has chosen to extend coverage to those individuals.

Medicaid Expansion

Under the expanded Guidelines implemented under the Affordable Care Act. Ohio is now accepting applications for Medicaid. Medicaid Expansion expands eligibility to single individuals ages 19-65 , without children and whose gross monthly income falls within 138 percent of the federal poverty guidelines.  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. 

Household

Size

Annual Household Income at 138% FPL

1

$0-$15,856

2

$0-$21,404

3

$0-$26,951

4

$0-$32,499

5

$0-$38,047

What you may need when applying?

Before applying for Medicaid an applicant may want to have Social Security numbers (or document numbers for any legal immigrants who need and are applying for medical coverage), Birth dates, Employer & income information for everyone in your family (it would be helpful to have paystubs or Forms W-2, Wage and Tax Statements), Policy numbers for any current medical coverage Information about any job-related medical coverage available to your family. Applicants may also want to have documents regarding proof of income available.

Some examples of documents used to verify income include:

  • Identification
  • Immigration Status
  • Sponsored Noncitizen information
  • Residency
  • SSN/Application for all Household Members
  • Income(Earned, Unearned, or from self employment)
  • Property/Assets
  • Disability
  • Utility or Shelter Expenses
  • Medical Expenses

*Medicaid Including Expansion Frequently Asked Questions

Managed Care Plans

In Cuyahoga County, most individuals who have Medicaid must join a one of the five (5) managed care plans 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. Managed Care Plans act just like regular health insurance. 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 then have the opportunity to change the managed care plans during open enrolment each November.

  • Buckeye Community Health Plan: (866) 246-4358
  • CareSource: (800) 488-0134
  • Molina Healthcare of Ohio: (800) 642-4168
  • Paramount Advantage: (800) 462-3589
  • United Healthcare: (800) 895-2017

Mandatory Services

Ohio’s Medicaid program through its Managed Care Plans includes services mandated by the federal government, as well as optional services Ohio has opted to provide for customers. Some services are limited by dollar mount, the number of visits per year, or the setting in which they can be provided. With some exceptions, all services are available as medically necessary to all Medicaid consumers.

Mandatory Services are as follows:

  • Transportation to medical appointments
  • Medical and surgical dental services
  • Medical and surgeons  vision services
  • Durable medical equipment and supplies
  • Family planning services and supplies
  • Home health services
  • Inpatient hospital
  • Lab and  X-ray
  • Medicare premium assistance
  • Nursing facility care
  • Nurse midwife services
  • Certified family nurse practitioner service
  • Certified pediatric nurse practitioner services
  • Outpatient services including those provided by rural health clinics and federally qualified health centers
  •  Physician services
  • Healthcheck program services (screening and treatment services to children 21 and younger

Optional Services

Each Managed Care Plan receives the option of providing these various services through the state of Ohio. Some examples of optional services are as follows:

  • Ambulance
  • Chiropractic services for children
  • Community alcohol and drug addiction treatment
  • Dental services
  • Home and community based services waivers
  • Hospice care
  • Intermediate care facility services for people with mental retardation (ICF-MR)
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Podiatry
  • Prescription drugs
  • Independent psychological services for children
  • Vision care (including eyeglasses)

For more detailed explanations of the services provided by plans, please visit each individual Plans website.