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Thursday, May 30, 2013

ICDS enrollment delayed until March 2014

State of Ohio officials, health insurance companies, and Area Agencies on Aging have been working toward implementing Ohio`s new system of care for Ohio`s "dual-eligibles," people who are eligible for both Medicare and Medicaid. In our region, voluntary enrollment in the system was expected to begin in September 2013, but new information released this week from the Ohio Office of Health Transformation pushes the date when people would begin enrolling voluntarily to March 1, 2014.  Mandatory enrollment will begin May 1.

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 has been named MyCare Ohio: Connecting Medicare and Medicaid.  Ohio`s dual-eligibles are the target of the new system because they often require more care than other beneficiaries, at a higher cost. According to the Ohio Office of Health Transformation, Ohio`s 182,000 dual-eligibles account for 14 percent of the state`s Medicaid enrollment, but nearly 40 percent of total Medicaid spending.

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 2,000 people) and thousands of others, including adults under the age of 60 with disabilities, and many nursing home residents. Via contracts with two health insurance companies, Council on Aging will work as part of a team of professionals to enroll and deliver services to participants. 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.

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 and where to get help with questions. 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

Past Newsletter: State partners continue to work toward ICDS implementation

 

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