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 Covered Services

Ohio's Medicaid program provides a comprehensive package of services that includes preventive care for consumers. Some services are limited by dollar amount, number of visits per year, or setting in which they can be provided. Read more about how to get the services listed below.

 

 By federal law, Ohio Medicaid must provide the following services to consumers:   

Ohio also offers these services to Medicaid consumers: 

  1. Ambulance/Ambulette
  2. Chiropractic services
  3. Community alcohol & drug addiction treatment
  4. Community mental health services
  5. Dental services
  6. Durable medical equipment & supplies
  7. Home and Community-Based Services Waivers
  8. Hospice Care
  9. Independent psychological services
  10. Intermediate Care Facility services for people with Mental Retardation (ICF-MR)
  11. Occupational therapy
  12. Physical therapy
  13. Podiatry
  14. Pregnancy Related Services
  15. Prescription drugs
  16. Private Duty Nursing
  17. Speech therapy
  18. Vision care, including eyeglasses 

Description of Covered Services

Community alcohol and drug addiction treatment
Medicaid covers some alcohol and substance abuse treatment services.

 

Call your caseworker at your local County Department of Job and Family Services and ask for agencies in your community that can help.


Dental

Service Who should have this service? How often?
Regular dental check-up and cleaning All recipients Every 180 days (6 months) for children (younger than age 21).
Every 365 days (12 months) for adults (age 21 and older).
Fillings, Extractions, Crowns All recipients As needed. May require prior authorization.
Dentures All recipients.
Dentures and partial plates must be prior authorized by the state.		 Dentures may be replaced every 8 years.
Braces Must be prior authorized by the State. The State approves braces only in extreme cases and only for children younger than age 21.
Root Canals All recipients As needed.

 


Emergency

Service Who should have this service? How often?
Emergency Room visits All recipients Automatically covered.

If you are in a managed care plan, refer to your plan's guide for more information.
Ambulance/Ambulate All recipients Covered when medically necessary and patient cannot be transported by any other type of transportation.

 


Inpatient  (Services you get in the hospital)

Service Who should have this service? How often?
Hospital stay All recipients Your doctor will schedule the surgery and may need to get approval to admit you to the hospital for certain elective surgeries. Emergency admissions are automatically covered.
Surgery All recipients If medically necessary. May require prior authorization.
Anesthesia All recipients If medically necessary. May require prior authorization. 

 


Long-Term Care

Service Who should have this service? How often?
Home care All recipients except In-home care and daily living services that are covered by Medicaid are provided based on need.
Facility-based care All recipients except Available to individuals who need long-term care in a nursing home or intermediate care.
Home and community-based care All recipients except Available through one of the home and community-based waiver programs.
 Hospice care Medicaid patients with a life expectancy of six months or less. Hospice is designed to meet the needs of the patient during the final stages of illness, dying, and grieving.

 


Medical Equipment
Your health care provider must fill out a prior authorization form before you can get the equipment.
 
Medical equipment is also called Durable Medical Equipment. Examples of medical equipment are:

  • Wheelchairs
  • Hospital beds
  • Orthotics and Prosthetics
  • Diabetic supplies
  • Canes, walkers and crutches
  • Lifts
  • Ostomy supplies
  • Oxygen supplies

Mental Health
You can get mental health services through your community mental health system. If you need mental health services, contact your local board of mental health. If you do not know the number, call your caseworker at your local county department of job and family services.

Service Who should have this service? How often?
Counseling All recipients 25 visits per 12 month period, eight hours of psychological testing per year.
Psychology services All recipients 25 visits per 12 month period, eight hours of psychological testing per year.

 

 Patient  (Services you get at your health care provider's office)

Service Who should have this service? How often?
   Doctor visits All recipients No more than 24 visits per 12 month period
   Lab testing and X-rays All recipients Covered when medically necessary and ordered by your doctor
   Family planning visits and services All recipients As needed
   Well-Child visits         
    (Healthchek)		 Recipients younger than age 21 Recommended 12 visits by age three and once every 12 month period year after age three.
   Chiropractor All recipients 15 visits 12 month period and associated x-rays for adults.
30 visits 12 month period and associated x-rays for children younger than age 21.
   Occupational therapy All recipients

30 visits per 12 month period for any combination of physical therapy and occupational therapy.
   Speech-language 
   pathology therapy		 All recipients

30 dates of service per 12 month period for any combination of speech-language pathology and audiology services
   Physical therapy All recipients

30 visits per 12 month period for any combination of physical theraphy and occupational therapy.
   Hearing services All recipients Exam covered and aids may be covered with prior authorization

 


 Pregnancy Related Services

Service Who should have this service? How often?
Prenatal & postpartum doctor visits All female recipients All pregnancy related services are covered by Medicaid. Newborn can get health care and immunizations through Healthchek.
Ultrasounds Pregnant women If medically necessary
Childbirth classes Pregnant women No limit
Labor & Delivery/Hospital stay Pregnant women (except Expedited Medicaid) If you have full medical coverage labor and delivery is covered. Hospital stay for the child is also covered.

 


Prescriptions
If a consumer is eligible for both Medicare and Medicaid (dual eligible), their prescription drug coverage will be provided by Medicare Part D (Extra Help) prescription drug plan.  Medicaid will no longer provide prescription drug coverage for this population.  In addition, the Medicare prescription drug plan may charge copayments between $1 and $5 per prescription or refill.

There is a $3 copayment for prescriptions or refills that require prior authorization for Medicaid and Disability Medical Assistance consumers, and there may be a $2 copayment for most brand name (non-generic) medications per prescription or refill. (more information)

Service Who should have this service? How often?
Prescription drugs All recipients Medicaid covers generic prescriptions. Name-brand prescriptions are covered only when a generic is not available. Prior authorization is needed when a name-brand prescription is prescribed when a generic is available. 

 


 
Preventive Health Screening

Service Who should have this service? How often?
Work physicals Individuals who are required to have a physical for a job when an employer does not provide a physical free of charge. As needed
Prostate exams (test for prostate cancer) For men beginning at age 50 Once every 12 month period.
Mammography (test for breast cancer) For women between the ages of 35-40 One screening for women between the ages of 35-40 and then once every 12 month period thereafter
Pap smears and pelvic exams For adult women and young women who are sexually active Once every 12 month period.
Tetanus-Diphtheria (TD) booster shot For all adults Every 10 years
Flu shot For adults, teens and children Once every 12 month period. Usually given October through December.
Pneumonia shot For consumers age 65 and older or those with weak immune systems or chronic health problems Once every 12 month period.
Chest X-ray For long-term care facility residents Once every 12 month period.
Physical exam For residents in residential facilities licensed by the Ohio Department of Mental Retardation & Developmental Disabilities Once every 12 month period.
Dermatology (skin) services All recipients Must be medically necessary and related to a disease or condition.

 


Transportation
If you cannot get to an appointment for health care services paid by Medicaid, contact your local county department of job and family services for help.

Plan Ahead!  You must ask for transportation at least 10 working days before your appointment.
 
If you are enrolled in a managed care plan, call your plan's Member Services phone number to ask about transportation.


Vision
There may be a copayment of $2 for routine examinations and $1 for eyeglasses fitting for adults (age 21 and over). 

Service Who should have this service? How often?
Eye exams All recipients Once every two years for consumers age 21-59. Once every 12 month period for recipients age 20 or younger and recipients age 60 or older.
Eye glasses All recipients Once every two years for recipients age 21-59. Once every 12 month period for recipeints age 20 or younger and recipients age 60 or older.
Contact lenses, tinted lenses, Prosthetic eye, low-vision aids All recipients Must be prior-authorized and medically necessary.