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The form explains who can apply, what information is needed (identity documents, Social Security or document numbers, employer and income data, policy numbers), and how income details determine eligibility. 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Filling out this application does not mean you have to buy health coverage.\u003Cbr>• A tax credit that can help pay your premiums for private health coverage |\n| Who can use this application?\u003Cbr>• Use this application to apply for anyone in your family.\u003Cbr>• Apply even if you, your spouse, or your child already have health coverage. You could be eligible for lowercost or free coverage.\u003Cbr>• Families that include non-citizens can apply. You can apply for your child even if you’re not eligible for coverage. Applying will not affect your U.S. citizenship status or chances of becoming a permanent resident or citizen.\u003Cbr>• If someone is helping you fill out this application, you may need to fill out APPENDIX C. |\n| What you may need to apply\u003Cbr>• Social Security Numbers (or document numbers for any qualified non-citizens who need insurance)\u003Cbr>• Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements)\u003Cbr>• Policy numbers for any current health insurance\u003Cbr>• Information about any job-related health insurance available to your family |\n| Why do we ask for this information?\u003Cbr>We ask about your income and other information to let you know what coverage you qualify for and if you can get any help paying for it. We will keep all the information you provide private and secure, as required bylaw.\u003Cbr>ODM may use or disclose member information consistent with the notice of privacy practices, available on the ODM website.\u003Cbr>To view the ODM Notice of Privacy Practices, visit:\u003Cbr>[https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/coverage/already](https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/coverage/already)covered/rights/notice-of-privacy-practices |\n| What happens next?\u003Cbr>Send your completed, signed application to your local county JFS office.\u003Cbr>Find your county office here: [https://jfs.ohio.gov/about/local-agencies-directory](https://jfs.ohio.gov/about/local-agencies-directory)\u003Cbr>[If you do not have all the information we ask for](If you do not have all the information we ask for), sign and submit your application anyway. If you do not hear from us within 45 days, you may call 1-844-640-OHIO (6446) . |\n| Get help with this application\u003Cbr>• Online: [benefits.ohio.gov](benefits.ohio.gov) or [Healthcare.gov](Healthcare.gov)\u003Cbr>• Phone: 1-844-640-OHIO (6446) or TTY 1-800-292-3572\u003Cbr>• In Person: Contact your local county JFS office\u003Cbr>• En Español: 1-844-640-OHIO (6446)\u003Cbr>To help you understand this notice, language assistance, interpretation services, and auxiliary aids and services are available upon request at no cost to you. Services available include, but are not limited to: oral translation, written translation, and auxiliary aids. You can request these services and/or auxiliary aids by calling the Medicaid Consumer Hotline 1-800-324-8680; individuals with a hearing impairment may call TDD 7-1-1. |\n\nMedicaid Estate Recovery  \nIf you’re permanently institutionalized or age 55 or older when you receive Medicaid benefits, after your death the Estate Recovery Program may recover payments for the cost of your care paid by Medicaid from your estate. The cost of your care may include the capitation payments that Medicaid pays to your managed care plan, even if the capitation payments are greater than the cost of the services you actually received.  \n[https://medicaid.ohio.gov/static/Resources/Publications/Forms/ODM07400.pd","cbCaivQOxTKg3wBj","https://ap.wps.com/l/cbCaivQOxTKg3wBj","pdf",1558162,29,"English","# Apply faster online\n# Who can use this application?\n# What you may need to apply\n# Why do we ask for this information?\n# What happens next?\n# Get help with this application\n# Medicaid Estate Recovery\n# Your Civil Rights","[{\"question\":\"Who can use this Medicaid application?\",\"answer\":\"You can use it to apply for anyone in your family, including if you, your spouse, or your child already have health coverage. Families that include non-citizens can also apply.\"},{\"question\":\"What information is needed to apply?\",\"answer\":\"The application asks for Social Security Numbers (or document numbers for qualified non-citizens), employer and income information for everyone in your family, policy numbers for any current health insurance, and information about job-related health insurance available to your family.\"},{\"question\":\"What happens after submitting the completed application?\",\"answer\":\"Send the signed application to your local county JFS office. If you do not have all the requested information, you can still sign and submit; if you do not hear from Medicaid within 45 days, you may call 1-844-640-OHIO (6446).\"},{\"question\":\"What civil rights and language assistance are available?\",\"answer\":\"ODM does not discriminate and provides free aids and services, including qualified sign language interpreters and accessible formats. Language services are available for people whose primary language is not English, and you can request them by contacting the Medicaid consumer hotline or related grievance resources.\"}]","Ohio Department of Medicaid - Application for Health Coverage & Help Paying Costs | PDF",1789835640,10]