Ohio
This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.
Medicaid Coverage Information Published
State Contact Information
Maureen Corcoran
Director
Ohio Department of Medicaid
50 West Town Street, 4th Floor
Columbus, OH 43215
Phone: (614) 466-4443
https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf
General Genetic Testing Criteria
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Licensure is required. For more information visit: https://ohiogenetics.org/professional-resources/licensure/
Metabolic Formula Coverage Legislation
Ohio Administrative Code Rule 5160-10-26
Metabolic Formula Coverage & Criteria
To participate in the Ohio metabolic formula program, an individual must:
- Be a resident of the state of Ohio
- Receive care for PKU or another specified metabolic disorder at an approved Ohio Regional Comprehensive Genetics Center (For newly diagnosed infants/children) apply to the Children with Medical Handicaps (CMH) Treatment Program
- Consume the metabolic formula as directed by the metabolic dietitian
If the above conditions are met, the family will be provided with all of the required metabolic formula at no cost.
*For individuals eligible for Ohio Medicaid, the Medicaid program will cover the cost of their metabolic formula. Contact Medicaid directly for assistance.
Prior Authorization Requirements
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
Coverage is available, but criteria is unknown.
Requirements for BRCA
Cystic Fibrosis Screening
Coverage is available, but criteria is unknown.
Hereditary Cancer Testing Coverage
Coverage is available, but criteria is unknown.
Lynch Syndrome Testing Coverage
Coverage is available, but criteria is unknown.
Microarray Testing
Newborn Screening
Panel Testing
Coverage is available, but criteria is unknown.
Pharmacogenetic Testing
Coverage is available, but criteria is unknown.
Prenatal Testing Offered
Coverage is available, but criteria is unknown.
Whole Exome Sequencing
Other Tests Covered
See fee schedule for a list of all genetic tests covered.
Other Information
Resources
Newborn Screening Reimbursement
On this Page
Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.
The database contains links to third-party websites. These links are provided solely as a convenience to users and not as a guarantee, warrantee, or recommendation by NCC of the content on such third-party websites or as an indication of any affiliation, sponsorship or endorsement of such third party websites. NCC is not responsible for the content of linked third-party sites and does not make any representations regarding the privacy practices of, or the content or accuracy of materials on, such third-party websites. If you decide to access linked third-party websites, you do so at your own risk. Your use of third-party websites is subject to the terms of use for such sites.