Aged, Blind, and Disabled Medicaid (ABD)

 

ABD Medicaid is for adults 65 and older or anyone who is disabled according to Social Security. The ABD Medicaid program is an income and resource based program. Medicare eligible people may qualify to have their Medicare premium paid each month through other Medicaid programs. Click here for the Medicaid Application.

Frequently Asked Medicaid Questions:

  1. What is Medicaid?
    Medicaid is like health insurance. It provides health coverage to eligible people of all ages.
  2. What is the difference between Medicaid and Medicare?
    Medicare is an insurance program serving people with disabilities or who are 65 or older who have worked and “earned qualifying quarters” and are now eligible for medical coverage regardless of their income. Medicare is federally funded and administered by the Social Security Administration. Ohio’s Medicaid program is a health coverage program serving eligible low income people of all ages who do not have enough money or health insurance coverage for medical care. Medicaid is funded by both the federal government and the State of Ohio and is administered by Ohio Department of Job and Family Services.
  3. If I have medical coverage through Medicare or private insurance can I get Medicaid too? Should I cancel my private insurance?
    Yes, you may be eligible for both Medicare and Medicaid. Medicaid may pay what Medicare does not cover. You may be eligible for Medicaid coverage even if you have other health insurance. Because Medicaid is based on income it is a good idea to keep your private health insurance.
  4. How long can I continue to get Medicaid coverage?
    There is no time limit for most Medicaid categories. You can be covered by Medicaid as long as you meet eligibility guidelines.
  5. What is Medicare Premium Assistance Program (MPAP)?
    The Medicare Premium Assistance Program helps Ohioans pay for the cost of Medicare premiums, deductibles, coinsurance and copayments.  Medicare is a federal health insurance program for people age 65 or older, certain disabled people under age 65, or people under age 65 with end-stage renal disease. You can apply for the Medicare Premium Assistance Program like other Medicaid programs.
  6. What is Estate Recovery?
    Estate recovery seeks repayment for the cost of Medicaid benefits once a person enrolled in Medicaid is deceased.  This happens after the death of a Medicaid individual who was permanently institutionalized or who was 55 years or older. An estate is all the property owned by a Medicaid individual at the time of their death, whether or not it passed through probate court.  A person’s house may be subject to estate recovery. After a Medicaid individual dies, the Attorney General’s Office will send a notice to the estate’s executor requesting repayment for the cost of the Medicaid benefits.  If the executor is not known to the Attorney General’s Office, they may need to contact the individual’s family members.
  7. How do I arrange transportation?
    If you have full Medicaid eligibility and you are having difficulty in getting to a medically necessary service, then you may request transportation assistance. The type of assistance available may depend on whether you are a member of a Medicaid managed care or MyCare Ohio plan, which county you live in, and whether you are bringing along a non-folding wheelchair or power scooter that doesn’t fit easily in a standard vehicle. Medicaid managed care and MyCare Ohio plans can offer free transportation to their members as an additional benefit above and beyond what the state requires. This “value-added” benefit can be limited to a specific number of trips a year. Members may take these trips to get to healthcare appointments and other services as well, but no one is required to use them up or even to use them at all. Click here for more information on our NET plan.

Application Requirements:

Ohio Medicaid offers a span of programs for older adults and people with disabilities to assist with medical expenses. These programs provide health care coverage consisting of primary and acute-care benefit packages along with long-term care.

* Please note: Applications for Medicaid only can be completed via phone at 1-844-640-6446 between 8:00am and 10:00am.  

Medicare Premium Assistance Program (MPAP):

This program helps people eligible for Medicare who have limited income and assets get help with paying the cost of one or more of the following: Medicare premium(s), Medicare deductibles, and Medicare coinsurance.

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:

To qualify for MPAP, applicants must be eligible for Medicare:

Types of MPAP:

  1. QMB (Qualified Medicare Beneficiary): QMB covers Medicare Part A & B premiums as well as Medicare deductibles, co-insurance, and co-payments
  2. SLMB (Specified Low-Income Medicare Beneficiary): SLMB pays a Medicare recipient’s Part B premium only
  3. QI-1 (Qualifying Individual: QI-1 pays the Medicare Part B premium only

Resource limit:

When applying for MPAP, proof of income, resources, age or disability, citizenship or non-citizen status, and other health insurance is required.

Applicants can ask an authorized representative to apply on their behalf.

Medicaid for Older Adults and People with Disabilities:

Medicaid Buy-In for Workers with Disabilities (MBIWD) is an Ohio Medicaid program that provides health care coverage to working Ohioans with disabilities. Working Ohioans with disabilities may be interested in the Medicaid Buy-In for Workers with Disabilities program.

Historically, people with disabilities were often discouraged from working because their earnings made them ineligible for Medicaid coverage. MBIWD was created to enable Ohioans with disabilities to work and still keep their health care coverage.

When applying for this type of Medicaid, proof of income, resources, age or disability, citizenship or non-citizen status, and other health insurance is required. Applicants can ask an authorized representative to apply on their behalf.

To qualify for MBIWD, a person must:

  • Be 16 to 64 years old
  • Be disabled as per the Social Security Administration or as determined by Ohio Medicaid or eligible under the MBIWD medically improved category
  • Be employed in paid work (includes part-time and full-time work)
  • Pay a premium (if applicable)
  • Meet certain financial requirements including a monthly income less than or equal to 250% of the federal poverty level); and
  • Comply with annual MBIWD Resource Eligibility Limits.

Premiums:

Monthly premiums are required for those eligible for MBIWD with an annual gross income greater than 150% of the federal poverty level (FPL). To obtain and maintain health coverage, the full amount of the premium must be received by the due date or it will be considered non-payment. For more insight into monthly premiums please refer to the MBIWD Premiums overview.

Nursing Home and Long-Term Care (LTC):

Ohio Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Ohio seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

To qualify for LTC:

Medicaid Nursing Homes:

Home and Community Based Services (HCBS) Waivers:

Home and Community Based Service Waivers to help consumers stay in their homes instead of in nursing homes, hospitals, or institutions for persons with mental retardation and developmental disabilities. Medicaid health care also includes long-term care benefits if a person has a medical need for 24 hour supervision and support.

Ohio Home and Community Based Services (HCBS) Waivers will pay for long-term care goods and services that help financially limited Ohio seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Ohio residents who live in their home, the home of a loved one, a residential care facility or an assisted living residence. While Ohio’s HCBS Waivers programs will cover some long-term care benefits in those settings, they will not cover room and board costs.

There are three HCBS Waivers programs that will provide long-term care benefits to Ohio seniors:

  1. PASSPORT Waiver – offers long-term care services in the beneficiary’s home or the home of a loved one
  2. Assisted Living Waiver – delivers long-term care services in residential care facilities and assisted living residences
  3. MyCare Ohio Plan (MCOP) – managed care program for Ohio residents who are both Medicaid and Medicare eligible

Managed Care Plans:

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.

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.

For more detailed explanations of these programs, visit:

Additional Resources:

The Medicaid Consumer Hotline: 1-800-324-8680 (TDD 1-800-2923572) – You can call this number for any questions regarding your managed care plan.

Medicaid Inquiries: Clermont_Medicaid@jfs.ohio.gov

Federal Medicare Information: https://www.medicare.gov/

Prescription Drug and other Assistance Programs: https://www.medicare.gov/plan-compare/#/?year=2024&lang=en

Submit an application online or download the Medicaid Application or Waiver Application. 

Need to check the status of your case or application? 

Need to report a change?

Not only do you need to your report your change(s), within 10 days, you need to verify the change(s) as well. You may report and verify the change in the lobby, via phone, fax, email or mail. Our drop box remains accessible 24 hours a day and all documents will be processed in date order. Our lobby is open 8:00am – 4:00pm so that you may access hard copy forms. You may also report and verify changes to clermontcasebank3@jfs.ohio.gov.

Visit our Forms page here for change reporting forms. Please allow up to 10 business days for processing. 

WARNING: Criminals are targeting Medicaid recipients to obtain sensitive, personally identifiable information such as your Social Security Number, bank account numbers, and more.  If you receive a call, email, or text about your Medicaid benefits that ask for payment, banking, or credit card information, please ignore.  These are NOT generated by the State of Ohio or any of its agencies.  Please report these calls to the State of Ohio Attorney General’s office at 1-800-282-0515 or https://www.ohioprotects.org.