Visit Us
1350 Euclid Ave., #280 Cleveland, OH 44115
Navigating healthcare in the United States can be complex, especially for seniors and their caregivers, given the frequently changing landscape. Alongside Medicare, Medicaid serves as a lifeline for those who may otherwise struggle to afford health care services.
Though Medicaid exists to help those who need it, understanding the specifics of what it covers and does not cover can be challenging. In this blog post, we answer the question of what does Medicaid cover for Ohio seniors, and shed light on its benefits and limitations.
Established in 1965 as a joint federal and state program, Medicaid provides healthcare coverage to millions of low-income individuals and families, including seniors. Covered services include a wide range of medical services, such as doctor visits, hospital stays, prescription drugs, and preventive care.
While the program is federally funded, each state has the flexibility to administer its own Medicaid program as long as the program remains compliant with the broad federal guidelines. In practice, this means there are variations in coverage and eligibility criteria from state to state. In Ohio, Medicaid covers approximately 3 million residents, accounting for almost 26% of the state’s population. Notably, 1 in 10 older adults (65+) in Ohio are covered by Medicaid, underscoring the program’s significance for seniors.
Generally, Medicaid eligibility criteria relate to factors such as income, household size, disability status, and age. Some groups, such as children and pregnant women, may qualify based solely on income. Others, such as seniors and people with disabilities, may need to meet additional criteria.
Eligibility for Medicaid in Ohio is determined by such factors, including income, assets, age, and medical necessity. For seniors seeking long-term care coverage in 2025, the criteria are as follows:
It’s important to note that specific programs, such as Home and Community-Based Services (HCBS) waivers, may have additional requirements.
As mentioned earlier, services covered by Medicaid can vary from state to state. Each state is required by federal law to provide Medicaid’s mandatory benefits. However, you cannot necessarily assume your state will cover the specific medical care you need.
Ohio Medicaid offers a comprehensive range of services to eligible individuals. Understanding these can help seniors and their caregivers make informed decisions about healthcare options. We present the following benefits as a guideline only. It’s important that you work with a professional with strong familiarity with Ohio’s Medicaid rules to ensure you get the most suitable coverage. At Rhodium Law, we offer Ohio seniors and their loved ones certain elder law services that include assistance with helping you navigate the Medicaid application process, as well as guidance on how to proactively take steps to protect assets at least 5 years before any actual need for Medicaid benefits.
Ohio Medicaid covers visits to primary care physicians and specialists, including preventive services like vaccinations, screenings, and wellness exams. These services are vital for early detection and management of health conditions.
Inpatient and outpatient hospital services are covered, encompassing emergency room visits, surgeries, and medically necessary treatments. This ensures that beneficiaries receive essential care during acute health episodes.
Ohio Medicaid provides coverage for a wide array of prescription medications deemed medically necessary. The program utilizes a Unified Preferred Drug List (UPDL) to manage covered medications.
Coverage includes laboratory tests, diagnostic imaging, and other necessary medical tests for diagnosis and treatment planning.
Comprehensive prenatal, delivery, and postpartum care are provided for pregnant women, along with coverage for newborn care, ensuring the health of both mother and child.
Ohio Medicaid members have access to a variety of behavioral health services. Behavioral health services covered by Ohio Medicaid include counseling, therapy, psychiatric care, and treatment for substance use disorders.
Ohio Medicaid covers long-term care services, including nursing facility care and home health services for eligible individuals requiring assistance with daily activities due to age, disability, or chronic illness.
Dental services are covered, with preventive and basic dental care available for children and limited coverage for adults. Vision care includes exams and eyeglasses, particularly for children and adults over 60.
Ohio Medicaid provides non-emergency transportation services to and from medical appointments so that Medicaid beneficiaries can access to covered healthcare services. This service is coordinated through County Departments of Job and Family Services.
While Ohio Medicaid offers extensive coverage, certain services are typically excluded:
It’s essential to consult with Medicaid representatives, healthcare providers, or other professionals who are familiar with the complex rules and regulations of Ohio Medicaid to understand specific coverage details.
Consider the story of Margaret, a 72-year-old Ohio resident living on a fixed income. After developing mobility issues, she required regular medical appointments and assistance with daily activities. Through Ohio Medicaid, Margaret accessed home health services, transportation to her appointments, and necessary medical equipment. This support allowed her to maintain independence and improved her quality of life significantly.
Medicaid plays a crucial role in ensuring access to health care for millions of vulnerable individuals and families in Ohio. By covering a wide range of essential medical services, Medicaid helps improve the health of eligible beneficiaries. It also alleviates financial burdens for people with low income who may otherwise struggle to afford care.
Though Medicaid covers many services, exclusions and limitations could result in unexpected costs or denials of coverage. Be sure you understand the scope and limitations of Ohio Medicaid coverage so you can make informed decisions about your health care needs and costs.
Understanding and applying for Medicaid can be overwhelming. At Rhodium Law, elder law is a cornerstone of our practice. We are dedicated to assisting seniors and their families in navigating the complexities of Ohio Medicaid through our long-term care planning services. Our team can help you:
Don’t walk this road alone. Schedule a consultation or call Rhodium Law today to ensure you or your loved ones receive the care and support you deserve.
