Covered Services

CareSource covers the same services as traditional fee-for-service Medicaid. Our members do not have co-payments for medical services. In addition to traditional benefits, we cover some adult chiropractic care and private, adult outpatient psychology services.

Members can get many services without a referral from their Primary Care Provider (PCP). They can simply call for an appointment. For more information, please visit the section No Referral Required.

Members must receive a Prior Authorization from their PCP to receive some services. For more information, please visit the Prior Authorization section. Also, our Covered Services Grid indicates which services require Prior Authorization.

For additional questions, please see the Provider Manual.

Members may go to Non-Participating Providers for:

  • Emergency care
  • Care at community mental health centers
  • Family planning services provided at Qualified Family Planning providers (Planned Parenthood)
  • Care at Federally Qualified Health Centers (FQHCs)
  • Care at Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers

Services not covered

CareSource will not pay for the following services that are not covered by Medicaid:

  • All services or supplies that are not medically necessary
  • Experimental services and procedures, including drugs and equipment, not covered by Medicaid
  • Organ transplants that are not covered by Medicaid
  • Abortions except in the case of a reported rape, incest or when medically necessary to save the life of the mother
  • Infertility services for males or females, including reversal of voluntary sterilizations
  • Voluntary sterilization if legally incapable of consenting to the procedure Cosmetic surgery that is not medically necessary
  • Inpatient treatment to stop using drugs and/or alcohol (In-patient detoxification services in a general hospital are covered)
  • Services for the treatment of obesity unless determined medically necessary
  • Inpatient hospital custodial care
  • Acupuncture and biofeedback services
  • Services to find cause of death (autopsy)
  • Comfort items in the hospital (e.g. TV or phone)
  • Paternity testing

This is not a complete list of the services that are not covered by Medicaid or CareSource. If you have a question about whether a service is covered, please call Member Services at 1-800-993-0780 (TTY 1-800-750-0750 or 711).