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OPTIMA HEALTH COMMUNITY CARE
(MEDICAID)
PHARMACY/MEDICAL PRIOR AUTHORIZATION/STEPPED* REQUEST
Directions: The prescribing physician must sign and clearly print name (preprinted stamps not valid) on
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Home OhioHealthy is a state-based health insurance program in Ohio designed to provide affordable health coverage to residents.
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Individuals and families who are applying for or renewing their health coverage under the Home OhioHealthy program are typically required to file.
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Applicants must report personal information such as name, address, social security number, household income, and family size on their Home OhioHealthy application.
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