Questions & Answers
Who can I call for more information or to answer my questions? Click here to learn more about Molina Healthcare. I want to switch health plans so my child can become a Molina Healthcare member. How do I select Molina Healthcare? Ohio Medicaid members can change their managed health care plan once a year during Open Enrollment, which is usually in November. You will receive a notice from the Ohio Department of Medicaid about your child's options. Click here to learn more about how to select Molina Healthcare. Does Molina Healthcare provide information on other community resources or other supportive services available to my child? Yes. Click here to view a list of community resources available for members.
- Medicaid Eligibility
Do I have to renew my child’s Medicaid eligibility? Yes, Medicaid eligibility is renewed every 12 months. This is also called Medicaid redetermination. In order to keep your child’s Medicaid benefits, you must report your income to your child's local County Department of Job and Family Services (CDJFS) office. Learn more. What if my income changed or my family size changed? Do I need to do anything? Please contact your child's County Department of Job and Family Services caseworker and give him or her this information right away.
- Getting Care
Will my child be able to see the same providers?
Molina Healthcare contracts with primary care providers (PCPs), specialists and pediatricians all over Ohio. These are called our network providers. We want your child to have as few changes as possible when he or she joins Molina Healthcare. If your child’s doctor is not in our network, we will help him or her find other high-quality providers that can meet his or her needs.
View our Provider Directory to see if your child’s pediatrician and other health care providers are part of our provider network.
Does Molina Healthcare require a referral to see a specialist? No. However, some specialists do require a referral from a PCP before they will see your child. A referral is when a member’s provider or PCP recommends that he or she visit another provider for a specific service. What if I need care after my child’s PCP’s office is closed?
If your child's PCP’s office is closed or he or she cannot be seen right away, your child may go to an urgent care center or CVS MinuteClinic. Visit our Provider Directory to find an urgent care center in your area.
If you are is not sure where your child should go for care, you can call our 24-hour Nurse Advice Line for help. Learn more.
If your child has an emergency, you should call 911 or go to the nearest emergency room. Emergency care is provided when a medical problem is so serious that it must be treated right away. Your child can go to any emergency room without a referral or prior authorization for emergency treatment.
Are there co-pays or out-of-pocket costs for services and prescription medications? Molina Healthcare covers all medically necessary Medicaid covered services, prescription medications and durable medical equipment (DME) at no cost to the member. We also cover transportation. That means $0 co-pays and no out-of-pocket costs. View “What’s Covered” to learn more about member benefits and services, including the prescription drugs that we cover.
- Care Management
What is Care Management?
Molina Healthcare’s care management program provides a family-centered way of connecting members to the quality care and services your child needs. We work together with the member, our medical directors and the member’s providers for a smooth coordination of all the services your child needs.
Our Care Management team includes nurses, social workers, pharmacy technicians and dieticians. As a member, your child’s Care Manager who will stay in contact with you and help your child with his or her health and well-being. Learn more.
What is the role of a Care Manager?
A Care Manager is a member’s Molina Healthcare point-of-contact. He or she will help members in coordinating care. The Care Manager will:
- Coordinate easier access to needed quality care
- Help members find a provider
- Arrange transportation to appointments
- Help members navigate the health care system
- Help members understand their medication
- Develop, with the member, a personal care plan
- Work with the member's doctor to give him or her the best care.
Learn more about care management.
- Coordinate easier access to needed quality care
- Benefits & Services
Will my child's benefits and services stay the same?
As a managed care plan, we cover all medically necessary health care benefits and services that are covered by Ohio Medicaid Fee-for-Service (FFS). This includes your child's:
- Provider appointments
- Dental and vision care
- Prescription medications
- Durable medical equipment (DME)
- Treatments needed to receive quality care for your child's medical conditions
- 24-Hour Nurse Advice Line
We also help to remove barriers to getting your child's services and consider his or her needs as we work toward healthier outcomes. View “What’s Covered” to learn more about benefits and services.
How many dental cleanings does Molina Healthcare cover per year? We cover one cleaning/checkup once every 6 months. Does Molina Healthcare cover vision benefits?
Yes. We cover:
- Eye Exams
- One every 12 months
- Eyeglasses - One complete frame and pair of lenses, just lenses or just frames. Contact lenses require prior approval. We also offer an expanded selection of frames to choose from at no cost to you.
- One every 12 months
Does Molina Healthcare cover transportation?
Yes, members get an extra transportation benefit with Molina Healthcare. Members get 30 one-way trips (15 round-trips) every calendar year at no cost to them. This benefit will get members to and from places where they get covered health care services. This includes:
- Doctor visits
- Dentist visits
- Hospital visits
- Women, Infants and Children (WIC) program appointments
- Appointment to renew the member's Medicaid coverage at his or her local County Department of Job and Family Services (CDJFS) office
- Stops at the pharmacy after a medical visit. This will not be counted as a separate trip
In addition to your 30 trips, our plan covers unlimited rides for members who get these services:
- Radiation therapy
- Wheelchair vans
Additionally, transportation is always available if a member must travel 30 miles or more from his or her home to get covered health care services. These rides are unlimited for services that are medically needed, but only if there is not a provider closer to the member's home. Click here to learn more.
Does Molina Healthcare cover home health services? Yes. All home health services must be ordered by a provider. Also, an assessment by a registered nurse must be done before the service begins or any changes are made to the service package. Prior authorization may also be needed. Does Molina Healthcare cover behavioral health services? Members may self-refer to community mental health centers for services they may need. If a member prefers to see a private provider, he or she may choose a behavioral health provider within Molina Healthcare’s network for up to 25 office visits in a 12-month period without a prior authorization. This means that the member may visit a provider up to 25 times in the 12 months after the date of his or her first visit with that provider. These 25 visits do not need prior authorization from Molina Healthcare.
- Provider appointments
Does Molina Healthcare cover prescription drugs?
Yes. As a member of Molina Healthcare, your child has no co-pays or out-of-pocket costs for prescription medications. A member should never pay for his or her prescriptions. Go to the Prescription Drugs page to learn more. Our Pharmacy Department can help your child get the prescription medications he or she needs. For some medications, members will need to get prior authorization. Learn more.
To find out what drugs are covered under the member plan, view the Molina Healthcare Preferred Drug List (Formulary) for the plan in “What’s Covered”.
What is the Preferred Drug List? Molina Healthcare’s preferred drug list is a specific list of drugs Molina Healthcare has approved. Providers use it when prescribing a drug. If a member uses a drug on the list, Molina Healthcare will pay for it. This means members can get their medicine at no cost to them. What drugs are on the Preferred Drug List? There are many drugs on the Preferred Drug List. The list includes both brand-name and generic drugs. Click here to view the Preferred Drug List. To get a printed copy, call Member Services. What is Molina Healthcare’s policy on brand name drugs? Generic drugs have the same ingredients as brand name drugs. At Molina Healthcare, we call generic drugs our preferred drugs. We require the use of a preferred drug from our preferred drug list (PDL) if one is available. Our Pharmacy Department will work with a member’s provider if he or she says the member needs the brand name instead of the preferred drug. The provider will submit a prior authorization request to our Pharmacy Department explaining why the preferred medicine will not work. We review each prior authorization request carefully, considering the member’s needs first, and let the member and his or her provider know of our decision. Learn more. How will my child continue to receive his or her durable medical equipment (DME)? Molina Healthcare works with durable medical equipment (DME) companies. These companies provide all the equipment and supplies for your child's medical needs. View our Provider Directory to see the DME suppliers in our provider network.