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.
The 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.
Hospitals are able to access this system and walk a patient through the steps to get him or her enrolled, or at least start the process.
Click here for a Benefits.Ohio.gov tutorial video
The more detailed information entered into benefits.ohio.gov, the most likely the process is to be “no touch.” For example, by federal law, a Social Security number is not required; however, that unique identifier will greatly increase the chances of a real-time determination or at least an application that doesn’t require a great deal of follow up. We recommend hospital staff strongly encourage patients to use their SSN in this process.
Why do we still need PE if individuals can receive real-time Medicaid eligibility determinations online?
Although most if not all Ohio hospitals will be qualified entities for PE starting February 2014, the ultimate goal for each case is full Medicaid eligibility. Real-time eligibility determinations make the role of PE different than it has been in the past. In situations in which the individual files a full application right away, the PE period would be considerably shorter – and eliminated altogether , as a practical matter, if a real-time determination is made. However, even with the most modernized systems, there invariably will be individuals for whom a real-time eligibility determination will not be possible. There also be individuals who will not be comfortable with the online application or ready with the needed information to complete a full application and will instead opt to apply later or use a paper application. In such situations, PE remains a useful tool to facilitate prompt coverage and enrollment.
Is coverage retroactive when using benefits.ohio.gov?
Yes. For the expansion population, coverage is retroactive 90 days effective Jan., 2014. Coverage for that population cannot go back further than Jan. 1, 2014. For other covered populations, coverage is retroactive for three months for allowable Medicaid expenses incurred during that time.
What do I do if a patient comes into my hospital who says they have already completed an application online, but they do not have a card yet?
First check MITS. If you do not see that the individual is enrolled in Medicaid or has PE status, complete the PE process. This may result in duplicate records being created, but for now, it is the best solution we have heard.