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Friday, April 26, 2013

State partners continue to work toward ICDS implementation

State of Ohio officials, health insurance companies, and Area Agencies on Aging continue to move forward toward implementing Ohio`s new system of care for people who are eligible for both Medicare and Medicaid. In our region, voluntary enrollment in the system is expected to begin in September with mandatory enrollment to begin in November.

Called the Integrated Care Delivery System (ICDS), the three-year pilot project is a joint federal and state effort to improve health outcomes while saving taxpayers` money. The system of health plans recently has been named MyCare Ohio: Connecting Medicare and Medicaid.

Via contracts with two health insurance companies, Council on Aging will work as part of a team of professionals. The two companies are Aetna Better Health of Ohio and Molina Healthcare of Ohio. They will be serving the five counties of COA`s region, as well as other parts of Ohio.

MyCare Ohio will change the way care is delivered and paid for by better coordinating the long term care, behavioral health and physical health services provided to the plan`s participants. Examples include eliminating unnecessary medical tests, reducing medication errors that can lead to hospitalizations, and connecting people with community-based services that help them stay in lower cost care settings, such as their own homes.

Statewide, the ICDS will be launched in seven regions covering 29 counties and approximately 114,000 individuals. In our five-county region, those enrolling in the ICDS are expected to include most PASSPORT clients (more than 2000 people) and thousands of others, including adults under the age of 60 with disabilities, and many nursing home residents.

The ICDS is designed for "dual-eligibles," people eligible for both Medicare and Medicaid, because they often require more care than other beneficiaries. According to the Ohio Office of Health Transformation, Ohio`s 182,000 dual-eligibles account for 14percent of the state`s Medicaid enrollment, but nearly 40percent of total Medicaid spending. In light of the aging population, Ohio must act to contain health care spending.

An advisory workgroup has been meeting for several months to help prepare for a smooth process for enrolling people in the MyCare Ohio plans. The workgroup includes representatives from state agencies, health insurance companies, Area Agencies on Aging, and consumer advocacy organizations. The group has been working on documents that will explain MyCare Ohio to PASSPORT clients and to providers of health care and long-term care.

An advisory workgroup has been meeting for several months to help prepare for a smooth process for enrolling people in the MyCare Ohio plans. The workgroup includes representatives from state agencies, health insurance companies, Area Agencies on Aging, and consumer advocacy organizations. The group has been working on documents that will explain MyCare Ohio to PASSPORT clients and to providers of health care and long-term care.

The enrollment process will include public education and outreach efforts. Enrollment will begin with a two-month voluntary period, followed by mandatory enrollment. It is also anticipated that help will be available for people who want guidance on selecting one of the two health plans. 

Participants will receive a letter informing them of the voluntary enrollment period as well as the date for mandatory enrollment. It will include instructions for how to enroll and select a health plan. Those who do not select a plan will be automatically enrolled in either Aetna or Molina, based on whichever plan best meets their needs.

Features of MyCare Ohio include:

  • Mandatory enrollment for people who are age 18 or older, and live in one of the pilot project counties; and currently receive services from both Medicare and Medicaid.
  • In our region, participants may choose either Aetna or Molina as their health plan.
  • The health plans will provide participants` Medicare and Medicaid services as well as community-based waiver services such as PASSPORT, for those who are eligible.
  • Participants will be allowed to opt out of the Medicare portion of the program, but for Medicaid services, they must remain with one of the MyCare Ohio plans (Aetna or Molina in our region).
  • Participants will have a care team that may include a family member/caregiver; a care manager from their selected health plan; a waiver services coordinator (for people on PASSPORT, for example); a primary care doctor; any specialty doctor(s); and other providers as needed.

Council on Aging will report on progress toward implementation of the ICDS as more information becomes available. To learn more, also visit the Web site for the Office of Health Transformation.

For more information:

Ohio Office of Health Transformation

New: MyCare Ohio Fact Sheet

Past Newsletter: New managed care system to coordinate medical and long-term care for SW Ohio adults

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