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Vorys Health Care Advisors

Ohio Makes Medicaid Eligibility Easier for Children and Pregnant Women

Posted in Health Care, Medicaid

The Ohio Department of Job and Family Services this week announced an initiative that will have a profound impact on Ohio’s most vulnerable citizens.

In collaboration with Ohio Medicaid’s ongoing effort to simplify and streamline the eligibility process for all Medicaid-eligible individuals, the State is implementing presumptive eligibility for certain groups of individuals.  Presumptive eligibility allows prospective Medicaid consumers to receive immediate, time limited (60-day) medical services, while a full eligibility determination is processed.

In 2010, following a change to federal Medicaid law, Ohio implemented a limited version of Medicaid presumptive eligibility.  At the time, only children were eligible, and presumptive eligibility determinations were only made at county departments of job and family services.

But this week, the Kasich administration and stakeholders announced that presumptive eligibility will be extended to pregnant women.  Additionally, certain qualified providers—federally qualified health centers (FQHCs), FQHC look-alikes, children’s hospitals, and other appropriate entities—will be able to perform a simplified eligibility check and grant immediate medical assistance to children and pregnant women where they receive their health care.  This will eliminate the need for the individual to first have to go to the county department of job and family services.

The State will begin testing the enhanced presumptive eligibility program in three pilot sites this month, with the goal of implementing the program statewide by January 2013.  The three sites are Nationwide Children’s Hospital in Columbus, The MetroHealth System in Cleveland, and the Community Action Committee of Pike County.

Ohio is using a $2.75 million Children’s Health Insurance Program Reauthorization Act performance bonus award it earned to facilitate systems updates and train community partners to implement the enhanced presumptive eligibility program.