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Medicaid Enrollment Toolkit


Health care reform at both the state and federal level is creating new pathways to reduce the number of uninsured Ohioans. Uninsured Ohioans at varying income levels now have additional resources through which they can obtain coverage.  Ohio hospitals have the unique opportunity to help connect those individuals with these resources and to better assist them in getting coverage.


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Under the Affordable Care Act, which aims to decrease the number of uninsured Americans, Ohio took the additional step to extend Medicaid coverage to individuals with incomes below 138% of the federal poverty level (FPL).

The graph below illustrates the opportunities for Ohioans to obtain health insurance with government assistance and the table shows the Eligibility Levels as they relate to the 2016 Federal Poverty Levels.



Between the federally-facilitated Health Insurance Marketplace and Medicaid expansion, uninsured Ohioans have several avenues to obtain long-term coverage. In addition, the Ohio Department of Medicaid is also implementing Presumptive Eligibility for short-term Medicaid coverage.

Source: Health Policy Institute of Ohio              Source: “The New World of MAGI,” Assistor training by Tricia Brooks

Presumptive Eligibility

As part of the Affordable Care Act, hospitals have a new opportunity to better connect eligible patients to Medicaid. Using presumptive eligibility (PE), hospitals are able to enroll patients and their families who are likely to be eligible into Medicaid immediately, without waiting for an eligibility determination from the state. Patients provide basic information about their incomes and household size, and if the patient appears to be eligible for Medicaid based on this information, a hospital can determine that individual or family to be “presumptively eligible” for Medicaid. The hospital will receive payment for services provided, just as if the patient were already enrolled in Medicaid.

Qualified EntitiesPE Individuals  |    PE Process  |  PE FAQs & Resources

Ohio Benefits Online Eligibility System


As of Dec. 9, 2013, children or pregnant women with a family income up to 200%  FPL and adults with incomes up to 138% FPL can apply for Medicaid  benefits online via www.Benefits.Ohio.gov. This state system is designed to interact with the new federal eligibility system, healthcare.gov, to create a “no-touch” experience for the applicant.  The goal is for most Medicaid applications to be completed online; however, until the new federal system can function reliably and the connections to the state systems are fully tested, most cases will need to be resolved by county case managers.

www.ohiobenefits.org
Ohio Benefits Online Eligibility System FAQs & Resources

Health Insurance Marketplace

If an uninsured person is admitted to the hospital for treatment and does not meet the criteria to be eligible for Medicaid, either presumptively or fully, hospitals have the option to help them obtain coverage through the health insurance marketplace, or healthcare.gov. Hospitals may have a certified application counselor (CAC) on staff, or other knowledgeable staff, who can assist with this process. Volunteers do not have to be a CAC to assist an individual through the healthcare.gov process.

Healthcare.gov

Click here to download OHA’s Marketplace Enrollment Whitepaper.
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