Ohio Medicaid: coverage, eligibility, and how to apply

Last verified: June 2026

What is Ohio Medicaid?

Ohio Medicaid is the state's name for the federal-state Medicaid program, administered by the Ohio Department of Medicaid (ODM) — a standalone state agency, not a division of a broader health and human services department. That structure is relatively uncommon; most states house Medicaid within a larger agency. ODM answers directly to the Governor's office and operates the program for approximately 3 million Ohioans, per CMS enrollment data.

Ohio expanded Medicaid under the Affordable Care Act effective January 2014. Most adults ages 19–64 with household income at or below 138% of the Federal Poverty Level qualify. Children are covered at higher income levels. MAGI-based Ohio Medicaid has no asset test — a savings account, vehicle, or home does not disqualify an applicant from the income-based program. Long-term care has separate rules.

Applications go through the Ohio Benefits portal at benefits.ohio.gov. County Job and Family Services (CJFS) offices process eligibility decisions — Ohio's eligibility system is county-administered, though ODM sets statewide policy.

How Ohio delivers Medicaid: five managed care plans

Most Ohio Medicaid enrollees receive their care through one of five managed care organizations (MCOs) under contract with ODM. The five plans are: Buckeye Health Plan (a Centene subsidiary), CareSource, Molina Healthcare, Paramount Advantage, and UnitedHealthcare Community Plan. Each enrollee must select an MCO or be auto-assigned to one. Plan choice depends on county of residence — rural counties may offer fewer options than urban ones.

MCOs coordinate primary care, specialist referrals, behavioral health, pharmacy, and most other covered services. If you have Ohio Medicaid and receive care from a provider outside your MCO's network, you may be responsible for those costs unless it's an emergency. Switching MCOs is allowed during open enrollment periods or for qualifying reasons such as a move or provider network change.

Dual eligibles — people enrolled in both Medicare and Ohio Medicaid — may participate in MyCare Ohio, an integrated care program operating in 29 counties that coordinates both programs through a single MCO. More detail on the seniors and long-term care page.

OhioRISE: intensive support for children with complex needs

OhioRISE (Resilience through Integrated Systems and Excellence) launched November 2022 as Ohio Medicaid's program for children with complex behavioral health needs. It covers intensive behavioral health services, care coordination, and wraparound support for children who require more than standard Medicaid-covered services can provide. ODM administers OhioRISE through a single MCO — Aetna Better Health of Ohio — rather than through the five standard MCOs.

Eligibility for OhioRISE is determined through a clinical screening process. Children enrolled in OhioRISE retain their standard Ohio Medicaid benefits; OhioRISE adds intensive community-based services on top. Families seeking OhioRISE services should ask their child's pediatrician or behavioral health provider about a referral.

Who Ohio Medicaid covers

Ohio Medicaid serves several distinct coverage groups, each with its own income rules. Adults 19–64 (the ACA expansion group, called Group VIII) qualify up to 138% FPL. Children qualify for Ohio Medicaid up to 211% FPL; above that income level, they may qualify for Healthy Start, Ohio's CHIP program. Pregnant women qualify up to 200% FPL. Seniors and people with disabilities who meet both financial and functional criteria qualify under separate rules, and long-term care applicants face an asset limit of $2,000 for an individual.

See the income limits page for current threshold figures and a full breakdown by household size.

Ohio Medicaid eligibility at a glance

Source: Ohio Department of Medicaid; HHS 2025 Federal Poverty Guidelines. Dollar figures update each January.

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