MedicaidCoverageMedium impact
5160-1-11 - Out-of-state coverage. (New/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Apr 4, 2021
We identified it
Jun 20, 2026
Summary
Ohio Medicaid updated Rule 5160-1-11 regarding out-of-state coverage, removing the previous exception for Medicaid Contracting Managed Care Plans (MCPs). This expands out-of-state coverage eligibility for Ohio Medicaid beneficiaries by eliminating the MCP restriction.
Action Required
Billing team should verify that out-of-state services for Ohio Medicaid patients are now eligible for coverage without MCP restrictions. Update billing procedures to process out-of-state claims for Ohio Medicaid beneficiaries. Contact Ohio Medicaid at 614-752-3877 for specific coverage verification questions.