Ohio Launches Initiative to Expand and Improve Medicaid Presumptive Eligibility for Pregnant Women and Children


Eric Poklar, Director of Government Affairs and Communications
614-752-1554 | eric.poklar@governor.ohio.gov

Ohio Launches Initiative to Expand and Improve Medicaid Presumptive Eligibility for Pregnant Women and Children

COLUMBUS – John McCarthy, Director of the Office of Ohio Health Plans (Ohio Medicaid), was joined today at the Statehouse by advocates for children and families, clinicians, children’s hospitals, federally qualified health centers, legislators and other partners to launch an initiative to increase the efficiency of the Medicaid eligibility-determination process and improve health outcomes for pregnant women and children.

Ohio Medicaid will expand presumptive eligibility for Medicaid to pregnant women and allow certain qualified providers—federally qualified health centers (and look-alikes), children’s hospitals and other providers—to perform a simplified check and grant immediate medical assistance to both children and pregnant women. Ohio will begin testing the enhanced presumptive eligibility program this month at Nationwide Children’s Hospital in Columbus, MetroHealth System in Cleveland and the Community Action Committee of Pike County, with implementation statewide by January 2013.

“Presumptive eligibility is an important tool that allows vulnerable individuals to begin receiving Medicaid-funded services without having to wait for the completion of a full Medicaid eligibility determination,” said Director McCarthy. “With these enhancements to the program, pregnant women and children will be able to obtain a presumptive eligibility determination where they receive their health care, rather than having to go first to a county office of job and family services.”

“We applaud the Kasich Administration and the legislature for these improvements to Ohio’s presumptive eligibility process,” said Amy Swanson, CEO of Voices for Ohio’s Children. “This new methodology will increase the efficiency of the eligibility-determination process and improve health outcomes for at-risk pregnant women. Research has shown that access to early prenatal care can lead to better birth outcomes and reduce the incidents of premature and low-birth- weight babies, which is better for the mother, child and Ohio taxpayers.”

Ohio implemented presumptive eligibility for Medicaid in 2010, but the program was limited to children and could only be administered at county job and family services offices, reducing the effectiveness for individuals with immediate medical needs.

Under the enhanced presumptive eligibility program, which was authorized in the state’s biennial budget bill (HB 153), qualified providers will be able to access the new Medicaid Information Technology System (MITS), and by verifying basic biographical information, residency and other pertinent data, an individual will be able to access services immediately. The system will generate a document an individual can take with them and use with any Medicaid provider. The qualified provider will also share the responsibility to assist the individual in completing their traditional Medicaid application.

“Nationwide Children’s Hospital is honored to be a test site for enhanced Medicaid presumptive eligibility for children and adolescents,” said Kelly J. Kelleher, MD, vice president for health services research at Nationwide Children’s Hospital. “This program will allow preventive and treatment services to begin immediately for children and adolescents who might otherwise delay prescriptions or other therapies after an initial visit without insurance. It will also provide greater choices for a family that is seeking a medical home for their child or teen by offering immediate coverage. We look forward to working with the state of Ohio and other partners to increase access, improve outcomes and reduce health-care costs for Ohio’s children through this program.”

“The current eligibility-determination system for Medicaid coverage is complex and time- consuming for individuals in need of medical care, with full eligibility determination taking as long as 45 days,” said Greg Moody, director of the Governor’s Office of Health Transformation. “We are working to develop a comprehensive solution that will simplify and streamline the eligibility system for all potential enrollees. In the meantime, presumptive eligibility provides a short-term solution for the most vulnerable individuals that we serve.”

For more information about Ohio’s efforts to modernize eligibility for Medicaid and other health and human services programs, see: http://www.healthtransformation.ohio.gov/CurrentInitiatives/ModernizeEligibilityDeterminationSy stems.aspx


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Click here to download this press release as a PDF.

Click here for a summary of the presumptive eligibility for children and pregnant women program.