ABD Medicaid assists with medical expenses for Ohioans who are Aged 65 years or older, Blind, or Disabled (disability as classified by the Social Security Administration for an adult or child).
ABD Medicaid is a health care coverage program funded by both federal and state monies. Ohioans who are aged, blind or have a disability must meet established financial guidelines in order to be eligible. Consumers in the ABD Medicaid program access services through the Fee-for-Service delivery system, or are enrolled in a Managed Care Plan.
Currently, there are two participating plans in Lorain County for ABD Medicaid - Caresource and Buckeye Community Health Plan. To enroll or change plans, please contact the Ohio Medicaid Managed Care Enrollment Center at 1-800-605-3040 (1-800-292-3572 TTY) Monday thru Friday from 8:00 a.m. to 8:00 p.m., or visit their website at http://ohiomcec.com/. Or you may contact Caresource at 1-800-488-0134 (1-800-750-0750 TTY) Monday thru Friday from 7:00 a.m. to 7:00 p.m. or visit their website at www.caresource.com, or Buckey Community Health Plan at 1-866-246-4358 (1-800-750-0750 TTY) Monday thru Friday from 7:00 a.m. to 7:00 p.m., or visit their website at www.bchpohio.com.
ABD Consumer
Basic Requirements
Countable Monthly Income Standards *
Resources **
Individuals & couples 65 and over
Documentation Of Age
Individuals $622
Couples $1,066
Individuals $1,500
Couples $2,250
Individuals & couples under 65
Medical proof of Physical or mental impairment that prohibits work and that has lasted or will last 12 months or longer
*SSI is not counted; certain deductions such as medical expenses may be allowed by a process called "Spenddown" ** Some resources are exempt from asset test such as home, 1 car.
What if an Ohioan meets ABD eligibility except that their income is too high?
Ohioans who are aged, blind or have a disability may qualify for Medicaid after they have incurred or paid a specific amount of medical bills. This is called Medicaid "Spenddown." Spenddown allows individuals to deduct medical expenses from their income so that income will fall within Medicaid income guidelines (see example below). The Spenddown amount is the difference between the ABD monthly income standard and an applicant's countable monthly income.
If eligible for Spenddown, the consumer is required to submit proof of medical expenses that meet or exceed the Spenddown amount. Once the Spenddown amount has been met, the consumer is then eligible for Medicaid. The date of Medicaid eligibility depends on the date the consumer reaches his or her Spenddown amount. Spenddown eligibility is a monthly process.
The Spenddown amount can be met in three ways:
1. If the consumer has monthly medical expenses (i.e., medical premiums or unpaid past medical bills) that meet or exceed the Spenddown amount consistently each month, they receive a monthly Medicaid card. This situation is referred to as "on-going" Spenddown.
2. If the consumer does not have monthly medical expenses that meet or exceed the Spenddown amount each month, then the consumer can submit medical expenses until the Spenddown is met. Medicaid eligibility begins on the day the Spenddown amount is met and is valid until the end of the month. This situation is commonly referred to as "delayed" Spenddown.
3. The consumer also has the option to pay the Spenddown amount directly to the county department of job and family services. This type of Spenddown is referred to as "pay-in" Spenddown.
Medicaid Spenddown Example
Monthly Income for Individual
$ 800
Subtract $20 Income Disregard*
- 20
Subtract Countable Monthly Income Standard
- 622
Result equals the Spenddown amount ** to be met every month
$ 158
*$20 of income is automatically disregarded for every ABD Medicaid applicant
**$191 is the Spenddown amount so $191 of medical expenses would need to be paid or incurred by the individual in order for the individual to be eligible for Medicaid.
To learn more about ABD Medicaid call the Ohio Department of Job and Family Services Medicaid Hotline at 1-800-324-8680,
TDD: 1-800-292-3572, or view the Ohio Health Plans website at http://jfs.ohio.gov/ohp/
Lorain County residents may call 440-323-5726 or 440-244-4150 to request an application be mailed to you. Ask for the Intake Screening department, or come to the agency during regular business hours to complete an application.
An appointment will be scheduled for you to complete a face-to-face interview with an eligibility worker as soon as possible, maybe even the same day.
Lorain County Job & Family Services
42485 North Ridge Road
Elyria, OH 44035-1057
Main Phone: (440) 323-5726
Lorain: (440) 244-4150
Fax: (440) 323-3422
TTY/TDD: (440) 284-4125
Cash/Food/Medical Call Center: (440) 284-4300
Child Support Call Center: (440) 284-4401
