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 Wayne 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?
Wayne County Job and Family Services administers several different types of Medicaid, but there are many factors that can come into play when determining eligibility.
Wayne 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, ages 60 and older
• 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
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
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:
If you do not have a HMO Plan, call Fee for Service (FFS): 1-800-324-8680
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. You will only receive one (1) card. If you need a duplicate, or if your card is lost, please contact your HMO/Medicaid using the above available numbers.
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.
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 Wayne County Job and Family Services. The best way to return documents is to fax them to 330-287-5899.
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 330-287-5899. You can also return applications via mail to 356 W North St, P.O. Box 76, Wooster, OH 44691, or deliver them in person to the same location.
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
Non-Emergency Transportation (NET) is a statewide program administered by Wayne County Job and Family Services for Medicaid eligible customers. NET provides transportation to and from Medicaid providers. Transportation authorization may be in the form of bus passes, cab or van services, or mileage reimbursement. Must complete a Medical Transportation Application in order to be eligible.
LINKS FOR NET SERVICES:
Client Rights and Responsibilities
Medical Provider Verification Form
NET Application
NET Customer Request Form
CONTACT US
Please contact 330-287-5800 for additional information.
The Ohio Department of Medicaid has comprehensive Medicaid information for consumers. Although Wayne County residents will likely need to apply through Wayne 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.
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:
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.
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: 330-287-5800 FAX: 330-287-5899 Email: wayne-ltc@jfs.ohio.gov
Early and continual prenatal care plays an important role in positive pregnancy results and the birth of a healthy baby. Ohio Medicaid’s PRS (Pregnancy Related Services) program was developed to improve and maintain the health of the pregnant woman, increase her chances for a healthier baby and promote positive birth outcomes. This is a free service to all Medicaid eligible pregnant women and is also known as the Healthy Start Program for pregnant women. An application for eligibility can be completed at your local County Department of Job and Family Services (CDJFS), online at http://odjfsbenefits.ohio.gov or by calling the Medicaid Consumer Hotline at 1-800-324-8680 (TDD 1-800-292-3572).
Eligibility A woman may be eligible for PRS from the date she suspects that she is pregnant and reports it to her County Department of Job and Family Services through 60 days after the end of her pregnancy. She may also have eligibility for three months prior to her date of application (retroactive eligibility). If there are problems determining a woman’s initial eligibility for the program, Expedited Medicaid may also be available for 60 days for any pregnant woman who verifies her pregnancy to Wayne County Job and Family Services, but is required to submit other verification prior to ongoing approval. Expedited Medicaid services will cover her pregnancy related doctor’s visits and prescriptions.
Covered Services The enhanced services of the PRS program include referrals, individual pregnancy counseling and education, group education, case management, nutrition intervention, transportation to Medicaid reimbursable appointments and fetal delivery.
At Wayne County Department of Job and Family Services, we have designated PRS coordinators to provide case management, referrals and transportation services.
Healthchek Services for Children Younger than Age 21
Healthchek is Ohio’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. It is a service package for babies, kids, and young adults younger than age 21 who are enrolled on Ohio Medicaid. The purpose of Healthchek is to discover and treat health problems early. If a potential health problem is found, further diagnosis and treatment are covered by Medicaid.
Healthchek covers ten check-ups in the first two years of life and annual check-ups thereafter and offers a comprehensive physical examination that includes:
medical history
complete unclothed exam (with parent approval)
developmental screening (to assess if child’s physical and mental abilities are age appropriate)
vision screening
dental screening
hearing assessment
immunization assessment (making sure child receives them on time)
lead screening; and
other services or screenings as needed
If your child(ren) are enrolled on Ohio Medicaid, Healthchek services are available to them. If you are younger than age 21 and are also enrolled, you can receive Healthchek services, too.
For more information:
Read the Healthchek and Pregnancy Related Services Information Sheet: English or en Español
Go to the Frequently Asked Questions
If you still have questions about Healthchek, send the State a note through the Healthchek Questions form or call 330-287-5800.
Wayne County Healthchek and Pregnancy Related Services Useful Links
Find below a listing of possible resources for assistance with clothing, housing, food, and other services in Wayne County.
Women Infants and Children 940 N Cable Road, Suite 4 Lima, OH 45805 419-224-8200
Allen County Health Department 219 E Market St Lima, OH 45801 419-228-4457
Allen Metropolitan Housing Section 8 Program 600 S. Main St. Lima, OH 45804 419-228-6065
West Ohio Community Action Partnership 540 S. Central Ave Lima, OH 45804 419-227-2586
United Way of Lima 616 South Collett Street Lima, OH 45805 419-227-6341
Help Me Grow 967 Bellefontaine Ave Lima, OH 45804 419-665-3322
If you disagree with any action on your case or if you believe WCDJFS 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, emailing your request to BSH@jfs.ohio.gov or contact Wayne County directly at 330-287-5800.
To find out more about state hearings, please review the state hearing section of the ODJFS Program Enrollment and Benefit Information document.
Did you know that Wayne county Job and Family services is a Designated agency for the National Voter Registration Act (NVRA)? That means we have all the information you need if you decide you want to register to vote or need to update any information with the voter’s bureau. Click here to find out more information.