ACT Ohio Medicaid Eligibility Criteria


This four-page resource created by CEBP and published by the Ohio Department of Medicaid is designed to help service providers determine whether a Medicaid recipient (person who receives Medicaid) in the State of Ohio is eligible to receive ACT services that are billable to Medicaid. This version of the "Ohio Medicaid ACT Eligibility Criteria" is based upon "OAC 5160-27-04: Mental Health Assertive Community Treatment Service" (ver. 8/29/2017). The document includes notes in text boxes with examples or possible sources of information and documentation that may help determine whether a person meets a specific criterion or not.

Examples of criteria addressed in this tool include the following:

  • Diagnosis(es)
  • Benefits such as SSI & SSDI
  • Adult Needs and Strengths Assessment (ANSA)
  • Institutional utilization and other functional criteria
  • Persistent or recurrent severe psychiatric symptoms
  • Coexisting substance use disorder
  • Housing: residing in an inpatient or supervised residence
  • At risk of psychiatric hospitalization, institutional, or supervised residential placement
  • Has been unsuccessful in using traditional office-based outpatient services

Download this four-page resource.