Applications, Case Status & Change Reporting

Important Note: We strongly encourage you to use the More Information links to find complete eligibility information, information about other community resources, and complete application procedures.

View Case Information for Current Child Support Customers:

You can now access the Ohio Child Support Customer Service Portal which provides customers with an active child support case a secure environment in which you are able to view and print up to two years of child support payment data, as well as view address, employment, health insurance and support order information that is on file with the child support agency.

For more information on Child Support, go to our Child Support Page.

View Case Status and Report Changes for Current Food Assistance & Medicaid Recipients:


Help Paying Medicare Premiums, Deductibles, and Coinsurance

You can receive assistance for paying your Medicare premiums, deductibles, and coinsurance through the "Medicare Premium Assistance" Medicaid program.

What is the Medicare Premium Assistance Program?

The Medicare Premium Assistance Program is for certain people eligible for Medicare. Sometimes it is also called the "Medicare Buy-In" program.

This program helps people eligible for Medicare who have limited income and resources get help in paying the cost of one or more of the following:

  • Medicare premium(s)
  • Medicare deductibles
  • Medicare coinsurance
 


 

What types of assistance are available?

The Medicare Premium Assistance Program offers four types of assistance. These types are:

1. Qualified Medicare Beneficiary (QMB)

A Qualified Medicare Beneficiary (QMB) is a Medicare consumer who is eligible for payment of his/her Medicare premium(s), coinsurance and deductibles.

QMB is for individuals who:
  • are eligible for Medicare Part A (hospital insurance);
  • meet the general eligibility requirements for Medicaid (e.g. social security enumeration, citizenship, residency, etc.) and;
  • do not exceed resource limit of $4,000 for an individual and $6,000 for a couple and;
  • have countable monthly income that does not exceed 100% of the Federal Poverty Level.
100% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$11,670
2$15,730
3$19,790
4$23,850
5$27,910
6$31,970
7$36,030
8$40,090
Each Add'l PersonAdd $4,060

Eligibility based on the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

An individual may be dually eligible for QMB and other Medicaid programs, such as Medicaid for the Aged, Blind or Disabled; Spenddown Medicaid; or Home and Community based Waiver Services. The QMB program does not provide retroactive payments to participants.

2. Specified Low-Income Medicare Beneficiary (SLMB)

A Specified Low-Income Medicare Beneficiary (SLMB) is a Medicare consumer who is eligible for payment of their Medicare Part B (Supplemental Medical Insurance) premium only.

To be eligible for SLMB, a consumer must:
  • be eligible for Medicare Part A (hospital insurance);
  • meet the general eligibility requirements for Medicaid and;
  • not exceed resource limit of $4,000 for an individual and $6,000 for a couple and;
  • have countable income  that is over 100% FPL but less than or equal to 120% Federal Poverty Level.
100% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$11,670
2$15,730
3$19,790
4$23,850
5$27,910
6$31,970
7$36,030
8$40,090
Each Add'l PersonAdd $4,060

Eligibility based on the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

120% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$14,004
2$18,876
3$23,748
4$28,620
5$33,492
6$38,364
7$43,236
8$48,108
Each Add'l PersonAdd $4,872

Eligibility based on 120% of the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

Retroactive SLMB payments are available for up to three months prior to the month of application. In addition, an individual may be dually eligible, for SLMB and other Medicaid programs, such as Healthy Families; Medicaid for the Aged, Blind or Disabled; Spenddown Medicaid; or Home and community Based Waiver Services.

3. Qualified Individual-1 (QI-1)

A Qualified Individual-1 is a Medicare consumer who is eligible for payment of their Medicare Part B (Supplemental Medical Insurance) premium only.

QI-1 is for individuals who:
  • meet the general eligibility requirements for Medicaid and;
  • do not exceed resource limit of $4,000 for an individual and $6,000 for a couple and;
  • have countable monthly income between 120% and 135% Federal Poverty Level.
120% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$14,004
2$18,876
3$23,748
4$28,620
5$33,492
6$38,364
7$43,236
8$48,108
Each Add'l PersonAdd $4,872

Eligibility based on 120% of the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

135% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$15,755
2$21,236
3$26,717
4$32,198
5$37,679
6$43,160
7$48,641
8$54,122
Each Add'l PersonAdd $5,481

Eligibility based on 135% of the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

Retroactive QI-1 payments are available for up to three months prior to the month of application, but not prior to January 1st of each year. Also, an individual may be dually eligible for the QI-1 program and Delayed or Pay-In Spenddown Medicaid.

4. Qualified Working Disabled Individual (QWDI)

This program pays for Medicare Part A premium only. QWDI can help individuals if they lose eligibility for Title II disability benefits due to earnings.

QWDI is for individuals who:
  • meet the general eligibility requirements for Medicaid (e.g. social security enumeration, citizenship, residency, etc.) and;
  • do not exceed resource limit of $4,000 for an individual and $6,000 for a couple and;
  • have countable monthly income that does not exceed 200% of the Federal Poverty Level.
200% Federal Poverty Level
Persons in Family
or Household
Family Income
Threshold
1$23,340
2$31,460
3$39,580
4$47,700
5$55,820
6$63,940
7$72,060
8$80,180
Each Add'l PersonAdd $8,120

Eligibility based on 200% of the
2014 Health and Human Services Poverty Guidelines
published March27, 2014

How do I Apply?

You may apply by mail. No office visit is necessary.

1) Obtain & Complete an Application

Print an application at the following links,Application for Help with Medicare Expenses or Spanish Application for Help with Medicare Expenses.

Or, You may call our office at 419-447-5011 or 800-825-5011 to have an application mailed to you.  Ask for the Intake Screening Department.

Or, you may come to our office and pick up an application.  Click here for our hours and location.

A case worker at Seneca County DJFS can help you if you are having problems getting needed information.

2) Return the Application

By Mail to:
Seneca County DJFS
900 E CR 20
Tiffin, OH 448830

By Fax to:  419-447-5345

Or come to our office.    Click here for our hours and location.  You may also place your application in our drop-box next to the main entrance (at the back of the building), after hours.

At the time of application items such as citizenship, income, resources and expenses must be verified.  Normal processing requires that benefits be issued or the application be denied within 30 days after the date the application is filed.


For More Information:


To learn more about help with Medicare Expenses call the Ohio Department of Job and Family Services Medicaid Hotline at 1-800-324-8680 / TDD: 1-800-292-3572, or log on to the Ohio Health Plans website.



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