Ohio Healthy Start: the state's CHIP program for children

Last verified: June 2026

What Healthy Start covers and who it serves

Healthy Start is Ohio's implementation of Title XXI of the Social Security Act, enacted in 1997 to extend coverage to children in families that earn too much for Medicaid but too little to realistically buy private health insurance. Ohio operates Healthy Start as a Medicaid expansion CHIP — rather than a standalone program — which means Healthy Start uses Medicaid's rules and delivery infrastructure, with federal CHIP matching funds covering the additional cost.

Children qualify for Healthy Start when their family's income falls between the Ohio Medicaid limit for children (211% FPL) and approximately 300% FPL, and they are not already covered by creditable employer-sponsored insurance. Children at or below 211% FPL qualify for Ohio Medicaid itself, not Healthy Start. The distinction matters primarily for administrative tracking — from a child's perspective, covered benefits are similar in either program.

Healthy Start covers children through age 18. Age 19 is the cutoff — young adults who previously enrolled in CHIP as teenagers transition to Ohio Medicaid (if they remain income-eligible) or seek marketplace coverage.

EPSDT: why children's coverage is broader than adults'

Children enrolled in Ohio Medicaid receive the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, a federal mandate under 42 U.S.C. § 1396d(r). EPSDT requires Ohio to provide all medically necessary services for enrollees under 21 — not just services that Ohio has chosen to include in its adult benefit package. Dental, vision, hearing, mental health, and developmental services are all covered to the extent they are medically necessary for the child.

EPSDT also includes well-child visits on a schedule aligned with the American Academy of Pediatrics' Bright Futures guidelines — visits at birth, 2 weeks, and then at ages 1, 2, 4, 6, 9, 12, 15, 18, and 24 months, then annually. Providers are expected to screen for developmental delays, vision and hearing problems, and behavioral health conditions at each visit.

When a well-child screening identifies a problem, EPSDT requires treatment — not just a referral. That distinction is significant. An adult on Ohio Medicaid might face coverage limitations for a given service; under EPSDT, a child cannot.

Who qualifies for Healthy Start in Ohio

• Child under age 19
• Ohio resident
• Family income above 211% FPL and at or below approximately 300% FPL
• Not already enrolled in employer-sponsored insurance that meets minimum value standards
• U.S. citizen or qualified immigrant (lawfully present)

Children at or below 211% FPL qualify for full Ohio Medicaid — typically with more generous cost-sharing rules than Healthy Start. The Ohio Benefits portal determines the correct program automatically based on the income information you provide; you don't have to figure out which program to apply for separately.

Cost sharing for Healthy Start families

Healthy Start has no premium for most enrolled children — a significant difference from many private plans and even some other states' CHIP programs. Some families at higher income levels within the Healthy Start range may pay small co-pays for certain services; these are capped by federal rules under Title XXI, which prohibits cost sharing that exceeds 5% of a family's gross income for the year.

Preventive services for children — well-child visits, immunizations, developmental screenings — are provided without cost sharing under federal rules. If a Healthy Start provider charges a co-pay for a well-child visit, that's an error; contact your MCO or ODM at 1-800-324-8680.

What Healthy Start covers

Because Ohio operates Healthy Start as a Medicaid expansion CHIP (not a standalone program), Healthy Start enrollees receive the same benefits package as Ohio Medicaid enrollees. Benefits are delivered through the same five managed care organizations.

• Well-child visits and preventive care
• Primary care, specialist, and hospital visits
• Prescription medications
• Dental care through DentaQuest
• Vision care — eye exams and eyeglasses
• Mental health and substance use treatment
• Emergency and urgent care
• Physical, occupational, and speech therapy (when medically necessary)
• EPSDT — all medically necessary services for children under 21

Ohio Healthy Start vs CHIP in neighboring states