Ohio Medicaid offers medical coverage for:

• Children up to the age of 19
• Pregnant women
• Families with children younger than age 19
• People with disabilities
• Older adults (age 65 and older)

To qualify, the basic requirements are:

• U.S. citizen
• Resident of the State of Ohio
• Have or obtain a Social Security number
• Meet financial requirements.

There are two steps you must take to request financial assistance:

Step 1: Fill out and submit this form.

• After you submit the form, the screen will display a reference number.
• Print the page or write this reference number down. You will need it for step 2.

Step 2: Gather these important documents and call the MetroHealth Eligibility Call Center at 216-957-2325, Monday - Friday, 8 a.m. - 5 p.m.

• Give the eligibility specialist the reference number you received in Step 1.
• At that time, the eligibility specialist can schedule you for either a telephone interview or an in-person interview with a financial counselor.
• During that interview, the financial counselor will review your information and may ask you additional questions. The counselor will determine which financial assistance program you may join.