Medicaid for Beginners: 5 Facts about Ohio Medicaid

Everyone has heard of Medicaid. It is one of the largest health insurance providers in Ohio and covers individuals and families who don’t have insurance and can’t afford to buy it. More than 2.9 million people in Ohio get health insurance through Medicaid every year. But did you know that Medicaid is much more than health insurance for the poor? Here are five facts about Medicaid that might surprise you.

Medicaid is a State-Federal Partnership

People sometimes confuse Medicaid and Medicare. The names sound similar, but they are very different programs. Medicare is a Federal benefit for seniors and some individuals with disabilities and is the same no matter where you live. Medicaid is a Federal-State partnership where each state runs its own Medicaid program. The Federal Government gives the state money if it meets certain Federal guidelines. Every state offers different Medicaid coverage, and some states cover groups that other states don’t.

Everyone in Ohio who Financially Needs Medicaid Can Get It

Ohio’s Medicaid plan has a lot of different programs or coverage groups. Until 2014, only people in groups like pregnant women or those over age 65 could get help from Medicaid. Then in 2014 Ohio expanded Medicaid to include adults who make less than 138% of the Federal Poverty Level (FPL). In 2021 an individual who makes less than $1,467.00 per month is eligible for expansion Medicaid (also known as MAGI). For MAGI, there is no limit on how much in assets you have, as long as your income is below the limit. MAGI is only available to adults who are under age 65 and not on Medicare.

Medicaid is Essential for Ohioans with Disabilities

For Ohioans with disabilities, Medicaid provides essential healthcare to meet their needs. If a person with a disability does not have Medicare, they can qualify for MAGI if they are under the income limit. A person with a disability with Medicare can receive additional Medicaid coverage. They can have up to $2,000.00 in assets, and income up to $794 per month. The Medicaid Premium Assistance Program (MPAP) pays Medicare premiums, co-pays, and deductibles. Medicare recipients with under $7,970.00 in assets and income under $1,064.00 per month qualify for MPAP. A person with a disability who works full-time or part-time can buy-in (pay premiums) for Medicaid. A worker with a disability who has up to $12,555.00 in assets and earns up to $2,659.00 per month in income can buy-in to Medicaid.

Individuals with More Serious Conditions have a Medicaid Program Just for Them

Specialized Recovery Services (SRS) helps people with severe mental illness, chronic conditions, or who are waiting for an organ transplant. SRS has no asset limit and a higher income limit (up to $2,349.00 per month). SRS recipients get full Medicaid coverage and also get individual help from a care manager. The care manager develops a specific care plan for the individual. They can also help the individual find and keep a job. SRS puts recipients in touch with others who have had similar life experiences who can provide guidance and support.

Medicaid Helps Pay for Long-Term Care at Home, in Assisted Living, or in a Nursing Home

Most people don’t realize that Medicaid pays for most of the Nursing Home care in Ohio. With monthly rates as high as $9,000.00, few families can afford to pay for that care. Long-Term Care (LTC) Medicaid is available to nursing home residents and some assisted living facilities. PASSPORT and Ohio Home Care are programs to help individuals who live at home. All LTC Medicaid programs have the same eligibility requirements; an individual must need help with basic daily activities, need help managing medication, and/or have a cognitive impairment. They can have up to $2,382.00 in monthly income and if their income is higher, they are still eligible if they have a Qualifying Income Trust. The person who needs care can have up to $2,000.00 in assets and if they have a healthy spouse, the spouse will have an asset allowance between $26,076.00 and $130,380.00. The spouse’s home and one car do not count toward their resource limit. Medicaid penalizes an individual who gives away their assets to qualify. When a person applies, Medicaid looks at the previous five years of financial history. If the person gave away assets during that time, Medicaid imposes a penalty period. The length of the penalty period depends on the amount the person gave away. During the penalty period, Medicaid won’t pay for long-term care. The individual must pay out of pocket for any long-term care during that time. The LTC program has the most complex and difficult rules of any Medicaid program.

Medicaid can be confusing and overwhelming. These five facts are geared toward clearing up that confusion as you start to think about Medicaid, decide what’s right for you and plan for the care you need.

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