Ohio Medicaid: Medical coverage for specialty and emergency care

Let us help you achieve your best health. Learn about your medical coverage, find healthcare providers, and more.

Helping you stay healthy is important to us.

We cover all medically necessary Medicaid-covered services for our Humana Healthy Horizons^® in Ohio members. These services should:

• Meet your medical needs as ordered by your healthcare provider
• Help you achieve age-appropriate growth and development
• Help you attain, maintain, or regain functional capacity

See your Member Handbook for a full list of your coverage and benefits

Humana Healthy Horizons in Ohio members get all medically necessary Medicaid-covered services at no cost to you. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition. The following services are covered. See your Member Handbook for information about:

• When prior authorization (preapproval) is needed
• When a referral is needed
• Service definitions
• If the service has eligibility requirements (e.g., some services may be available only to members under age 21, etc.)

Covered services include:

• Acupuncture—to treat certain conditions
• Allergy services
• Ambulance and wheelchair van transportation
• Behavioral health services (including mental health and substance use disorder treatment)
• Certified nurse midwife services
• Certified nurse practitioner services
• Chemotherapy services
• Chiropractic (back) services
• Dental services
• Developmental therapy services for children aged birth to 6 years
• Diagnostic services (e.g., X-ray, lab work, etc.)
• Durable medical equipment (e.g., breast pump, breast milk storage bags, walking aid, blood pressure equipment, etc.)
• Emergency services (e.g., procedures, treatments, or services needed to evaluate or stabilize an emergency) you get in the emergency department, in an inpatient hospital room, or in another setting
• Family-planning services and supplies
• Free-standing birth center services at free-standing birth centers
• Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) services
• Gynecological (OB-GYN) services
• Home health services
• Hospice care
• Inpatient hospital services
• Maternity care (prenatal and postpartum care, including services for members with pregnancies deemed at risk)
• Medical nutrition therapy (MNT) services
• Nursing facility services
• Outpatient hospital services
• Pharmacist services
• Physical and occupational therapy
• Physical exam required for employment or for participation in job training programs (if the exam is not provided free of charge by another source)
• Physician services
• Podiatry (foot) services
• Prescription drugs, including certain prescribed over-the-counter drugs
• Preventative breast cancer and cervical cancer screenings
• Primary care provider/physician services
• Renal dialysis (kidney disease) services
• Respite services (for members under 21 years of age who have long-term care or behavioral health needs)
• Screening and counseling for obesity
• Services for children with medical handicaps
• Shots (immunizations)
• Specialist services
• Speech and hearing services, including hearing aids
• Telehealth services (virtual care available through Doctor On Demand^®)
• Tobacco-cessation services, including tobacco-cessation counseling and medications for tobacco cessation approved by the U.S. Food and Drug Administration
• Vision (optical) services, including eyeglasses
• Well-child (Healthchek) exams, PDF for children under the age of 21
• Yearly well-adult exams

Services covered only if medically necessary:

• Abortions
  • In the event of reported rape or incest, abortions are covered regardless of a medical necessity.
• Biofeedback services
• Experimental services and procedures, including drugs and equipment, not covered by Medicaid and not in accordance with customary standards of practice
• Infertility services for males or females, including reversal of voluntary sterilizations
• Inpatient treatment to stop using drugs and/or alcohol (in-patient detoxification services in a general hospital are covered)
• Plastic or cosmetic surgery
• Services determined by Medicare or another third-party insurance company
• Services for the treatment of obesity
• Sexual or marriage counseling
• Voluntary sterilization if under 21 years of age or cannot legally consent to the procedure

We will not pay for services or supplies you receive that Medicaid does not cover, including:

• Assisted suicide services, defined as services for the purpose of causing, or assisting to cause, the death of an individual
• Paternity testing
• Services or supplies that are not medically necessary
• Services to find cause of death (autopsy) or services related to forensic studies

You may need to get approval before getting any of the above screenings and diagnostic testing services. This preapproval is called prior authorization.

To learn more about prior authorization:

• Refer to your Member Handbook
• Call Member Services at 877-856-5702 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., Eastern time

You, your authorized representative, or a provider can submit a prior authorization request on your behalf.

Where should you go to see a provider? You have choices. Learn where to get care depending on the care you need.

To find a healthcare provider, specialist, hospital, healthcare facility, or other type of in-network service provider:

• Use our Find a Doctor service

• Call Member Services at 877-856-5702 (TTY: 711), Monday – Friday, 7 a.m. – 8 p.m., Eastern time