Covered Services

Ohio's Medicaid program provides a rich 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: Ambulatory Surgery Centers Certified family nurse practitioner services Certified pediatric nurse practitioner services  Family planning services & supplies Healthchek (EPSDT) program services (screening & treatment services to children 21 and younger) Home health services Inpatient hospital Lab & X-ray Medical & surgical dental services Medical & surgical vision services Medicare Premium Assistance Non-Emergency Transportation (NET) to Medicaid services Nursing facility care Outpatient services, including those provided by Rural Health Clinics & Federally Qualified Health Centers Physician services

Ohio also offers these services to Medicaid consumers: Ambulance/Ambulette Chiropractic services for children (under age 21) Community alcohol & drug addiction treatment Community mental health services Dental services Durable medical equipment & supplies Home and Community-Based Services Waivers Hospice Care Independent psychological services for children Intermediate Care Facility services for people with Mental Retardation (ICF-MR) Occupational therapy Physical therapy Podiatry Prescription drugs Private Duty Nursing Speech therapy Vision care, including eyeglasses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of Covered Services

Community alcohol & drug addiction treatment
Medicaid covers some alcohol and substance abuse treatment services. Call your caseworker at your County Department of Job & 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 except Disability Assistance	Every 180 days (6 months) for children (younger than age 21). Every 365 days (12 months) for adults (age 21 and older).
Fillings/Extractions	All recipients except Disability Assistance	As needed
Dentures	All recipients except Disability Assistance. Dentures and partial plates must be prior authorized by the state.	They 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	Adults may have Anterior (front teeth only) root canals. No restrictions on children. No coverage under Disability Assistance.	As needed

Emergency

Service	Who should have this service?	How often?
Emergency Room visits	All recipients except Disability Assistance	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 except Disability Assistance	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 need a Prior Authorization
Anesthesia	All recipients	If medically necessary – may need a Prior Authorization

Long-Term Care

Service	Who should have this service?	How often?
Home care	All recipients except Disability Assistance	In-home care and daily living services that are covered by Medicaid are provided based on need.
Facility-based care	All recipients except Disability Assistance	Available to individuals who need long-term care in a nursing home or intermediate care.
Home and community-based care	All recipients except Disability Assistance	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 year, eight hours of psychological testing per year.
Psychology services	Children younger than age 21	Children younger than age 21 and consumers enrolled in a managed care plan will continue to have these services if the managed care plan continues to cover these services.
Psychology services	Adults	Adults may be eligible for these services.  Contact your caseworker or your managed care plan for more information.

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 year
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	Eight visits by age two. Once a year after age two.
Chiropractor	Recipients younger than age 21	30 treatments per year and associated x-rays
Occupational therapy	All recipients	Covered only in a hospital setting.
Speech therapy	All recipients	Four visits per month
Physical therapy	All recipients	Up to 30 visits each year
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 a year
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 a year thereafter
Pap smears and pelvic exams	For adult women and young women who are sexually active	Once a year
Tetanus-Diphtheria (TD) booster shot	For all adults	Every 10 years
Flu shot	For adults, teens and children	Once a year, usually given in October- December
Pneumonia shot	For consumers age 65 and older or those with weak immune systems or chronic health problems	Once a year
Chest X-ray	For long-term care facility residents	Once a year
Physical exam	For residents in residential facilities licensed by the Ohio Department of Mental Retardation & Developmental Disabilities	Once a year
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 except Disability Assistance	Once every two years for consumers age 21-59. Once a year for consumers age 20 or younger and consumers age 60 or older.
Eye glasses	All recipients except Disability Assistance	Once every two years for consumers age 21-59. Once a year for consumers age 20 or younger and consumers age 60 or older.
Contact lenses, tinted lenses, Prosthetic eye, low-vision aids	All recipients except Disability Assistance	Must be prior-authorized and medically necessary.

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