Coverage Under Ohio Medicaid?

[Kathulhu]

My wife and I just recently got approved for Ohio Medicaid, which is great news for both of us, however we now have to choose a provider who works with them and we're not coming up with a lot of information on which ones cover what as far as transition related coverage. All of the info we can find is extremely (and I'm sure intentionally) vague. My wife is currently seeking HRT. Does anyone have any experience with any of the Ohio medicaid providers?

Our options are:
Buckeye Community Health Plan
Caresource
Molina Heathcare of Ohio Inc
Paramount Advantage
United Heathcare Community Plan of Ohio, Inc

Also, if anyone has suggestions on the best place to go for estrogen therapy in the south western Ohio region, we'd greatly appreciate it!   We are in the Dayton area, but can easily go to Cincy or Columbus.

Thanks for any help!
Kat <3

[JeffJefftyJeff]

Hey Kat,
First, congratulations! It's a huge step just getting healthcare in the first place. I'm a transguy who has had Caresource the past year, so I'll speak from my perspective - your mileage may vary.

As far as coverage, Caresource will cover some therapy sessions - one diagnostic session and (I believe) up to one regular session every other week. They covered all my basic heathcare needs, including going to the doctor (I went to Cleveland Pride Clinic - regardless of where you are in the state, I *highly* recommend them) and getting initial tests. From what I understand, they don't always cover hormones; I was lucky in that I went to a mom-and-pop local pharmacy and they worked pretty hard to get both my T and my syringes covered, but apparently that's not always the case.

Bad news: they will not cover any surgeries for your wife if that's something she ends up wanting to pursue. I've tried every avenue possible, and Caresource doesn't consider top surgery or a hysto "medically necessary." If you call them, they will say they cover everything medically necessary - this isn't, unfortunately, something that just your doctor can decide, but that their board of physicians determines after getting documentation from your wife's doc.

Open enrollment is in November - that's the upside, so if you pick something now and hate it, you can shop around in November. I'm already looking myself; I know Paramount explicitly says they do *not* cover anything GRS related for Medicaid (the "Advantage" plan), but they may cover hormones - I'd call in advance and ask.

Sorry I couldn't be more help! Best of luck with your search - please let us know how it goes!

**Edited because I didn't see the bit about Paramount first. Bummer.

[Kathulhu]

Thanks so much for the information, Elliot! We will definitely dig deeper into what Paramount will cover as far as hormones go. At this point, she says she doesn't feel like she wants/needs surgery, so that's not a big deal to us, even though it totally should be covered anyway.

This is seriously the most frustrating thing we've ever dealt with (I'd go through the mortgage process a thousand times over if healthcare could just be simplified). It is absolutely ridiculous that she (and everyone else) can't simply get the care that's needed. I've spent hours nearly every day trying to gather information, scoured countless websites and I never feel like I know anything more than when I started. I can't even imagine how awful this must be for someone who is going at it alone.

Upon looking it up, we found that Caresource is headquartered in Dayton, so if it comes to it, I can just go down there and badger them for information in person!

I will certainly report back anything we do discover, so that hopefully I can save someone else the headache. Again, thanks so much for your input, it's much appreciated! Also, your little avatar guy is adorable!

[StormOfThorns]

I know this is a few weeks later, but I can confirm that Molina does cover the full cost of HRT. I've been getting T shots for almost 2 years and they've paid every bit of it. I totally recommend them if you have not chosen one. In the end, you'll find what fits best for you. But I have not experienced any problems.

As for surgeries, I am not sure it has not hit Ohio's Medicaid program yet. I plan on calling and will update my post about that. I go to some trans-related groups in RL and heard from another transguy beginning the process talk about top surgery and was surprised that they somehow got information that Molina would cover it. Though, the last time I called (approx over 2 years ago) at the time they were not, calling it a cosmetic surgery.

As the country gets more familiar with trans-related issues, perhaps they will eventually get the ball rolling in Ohio, as other states in the US has started covering the costs with Medicaid. Do not quote me for sure, it's what I've heard from the therapist I go to for GID.

P.S. Molina HAS covered my therapy costs as well.

[Kathulhu]

Awesome, thanks for that information! Since we only had a few days to choose one, we selected Paramount, since they were the only non-profit choice. But luckily, we have some time to switch if we run into problems or find a better choice.

We just got our cards and information about a week ago, so she hasn't made any appointments or anything yet. I thought she'd be on the phone as soon as we got our stuff, but I think she's kind of dragging her feet because she's afraid to take the first step. As much as we've talked about it, and as much as I know she wants to, I think she's scared that something will go wrong and she won't be able to go forward, which is an understandable worry. It's frustrating though, because I want to help, but am not sure how.

At the end of this month it will be one year since she came out to me. I made it a personal goal to have the ball rolling for her, but it seems to be taking forever to get started. It doesn't help that we don't have a lot of money, but the possibility of medicaid paying for even some things is a relief. Also, she's very reluctant to go to any groups, she's always been fairly anti-social and she says she doesn't like the atmosphere of "group therapy" but I think now days they are so much more than that. Attitudes have and are still changing, so it's less of a "woe is me" feeling that she is afraid of and more of a coming together in a positive way. At least, that's what I've gathered from talking to a few people at our local LGBT center.

I know it's a long road ahead, but I am happy to travel it with her if I could just get her feet on the road!

Thanks again for the information. Once I have anything of interest, I'll be sure to report back so we can continue to help each other!

[JennyBear]

Time to resurrect this one.

    Caresource was covering GRS under the Obama Administration. Shortly after Trump took office, that coverage was removed, much like it was in VA coverage. No coverage at all for electrolysis, including when medically necessary for diseases like folliculits or PCOS. I don't know much about the other providers and whether they have followed suit either positively or negatively. I do have Folliculitis, and it is fairly severe. Topical medications won't touch it. Granted I have a plan regarding hair removal costs, but anything that can save thousands would be better.

HUGS!