Job & Family Services - Send Feedback to Ohio Medicaid Health Insurance
ODJFS  Ohio Medicaid Health Insurance Plan - Healthchek Inquiry Form

This web page is a secure document. Any information you see or enter is encrypted for privacy during transmission and will not be easily read by a third party.

Select a topic that best describes your inquiry:

Please type your Healthchek question here:

If you would like a reply to your message you must provide us with the necessary information to contact you. (* denotes a required field)
* Parent/Guardian/Custodian (First and Last Name):
* Child's Name (First and Last Name):
* At least one of the following are required:
  Child's - Case Number:   Medicaid Number:   SSN:

* E-mail Address:   
* Address:
* City:
* State:
* Zip:
* Home Phone:Please include your
Area Code for all
phone numbers provided.
  Cell Phone (optional):
  Work Phone (optional):
* County:
  Case Worker:
  Child's Birth Date:

By clicking the "I agree" button, I understand that ODJFS will contact the Parent/Guardian/Custodian named on the form above to answer and attempt to resolve his/her question or concern. ODJFS can inform the person submitting the request that the submission was received and that ODJFS will be completing a response to the named authorized representative.

Pursuant to section 5101.27 of the Revised Code and 45 CFR 431.300 through 431.306, ODJFS cannot provide constituent specific information to the person submitting this question or concern unless the person submitting the question or concern is the subject of the specific information provided or the person submitting the information provides to ODJFS a legally compliant release of information signed by the subject of the information or authorized representative. Copies of the legally compliant protected health information release form or the general release form can be downloaded from the constituent assistance page.