SI CHI01730.011 (OH) Ohio Medicaid (RTN 404 -- 03/2007)

A. General

The Department of Job and Family Services in Ohio is the agency with the authority to establish and supervise the state's medical assistance program. The program is in operation statewide through the County Departments of Job and Family Services (CDJFS). Applications for Medicaid are taken at, and processed by, the county departments. Applications for the Breast and Cervical Cancer Project (BCCP) Medicaid program are taken and processed by the Ohio Department of Job and Family Services (ODJFS).

Since the Social Security Administration does not determine Medicaid eligibility in the State of Ohio, the following material is for informational purposes only. It provides a general background on Medicaid eligibility in Ohio. Claimants requesting more specific information or wishing to apply for Medicaid should be referred to the Ohio Medicaid Consumer Hotline (1-800-324-8680) or the CDJFS or, for BCCP Medicaid, to ODJFS.

B. Eligibility and the January 1, 1980 Changes

In determining Medicaid eligibility, the state has elected to use eligibility criteria that are more restrictive than those for SSI entitlement, though not more restrictive than the Ohio requirements in 1972.

Medicaid eligibility is determined on an individual basis. To be eligible for Medicaid, an applicant must be an Ohio resident; a U.S. Citizen, or a qualified alien; a member of a covered group; and meet all other eligibility criteria including income and resource requirements. Eligibility may be retroactive up to three months prior to the month of application.

C. Covered Groups for Medicaid

1. Covered Families and Children (CFC) Group

  • Ohio Works First (OWF) Recipients -- All persons who are eligible for and receiving OWF are automatically entitled to Medicaid and do not need to file a separate application.

  • Low-Income Families (LIF)

    • Includes families who would be eligible for OWF cash assistance but decline the cash.

    • Includes individuals who are not eligible for OWF cash due to an OWF requirement that is not applicable to Medicaid or is prohibited by Medicaid.

    • The family’s gross countable income cannot exceed 100% of the Federal Poverty Level for the assistance group size.

  • Healthy Start

    • Includes pregnant women whose countable income does not exceed 150% of the Federal Poverty Level.

    • Includes children up to age 19 whose countable income does not exceed 200% of the Federal Poverty Level for the assistance group size.

  • Children up to age 21 whose countable income does not exceed the OWF payment standard.

2. Aged, Blind and Disabled Groups

  • The standard (or regular) groups are those aged, blind, or disabled persons who meet all Medicaid eligibility requirements and have income less than or equal to the financial need standard. The other groups listed below must meet all the same requirements, plus the variations noted for each group.

  • The “spend down” group has countable income (as determined under the Medicaid program) in excess of the financial need standard (see E below). This group becomes eligible for Medicaid when the financial need standard is met after deducting the cost of allowable medical expenses from their excess income.

  • The nursing home group includes those individuals who require nursing home care.

  • The philanthropic long term care facility group includes individuals who have life-care contracts with such homes that have proven they are financially unable to continue operating.

D. Resource Requirements for Aged, Blind and Disabled Groups

One automobile that is specifically equipped for a disabled person, necessary for employment, necessary for treatment of specific or regular medical problems, or necessary because of climate, terrain, distance or similar factors, for the performance of essential daily activities may be excluded. If not excluded for one of these reasons, the first $4,500 is exempt with the remaining value counted as a resource, without regard to liens or encumbrances.

  • One burial plot per immediate family member is exempt.

  • Irrevocable pre-need burial contracts are exempt.

  • The home that is owned and is being lived in by the individual is considered the principal place of residence and is exempt.

Where an eligible individual resides with an ineligible spouse, resources are determined as they would be for an eligible couple. Where a child under age 18 resides with his parents, the above exclusions apply to the ineligible parents, and then again to the eligible