MyCare Ohio: Information for Consumers
MyCare Ohio is a managed care program for Ohioans who receive BOTH Medicare and Medicaid benefits. The program is administered by the Ohio Department of Medicaid (ODM). Council on Aging works as part of a team of professionals to deliver services to some MyCare Ohio participants.
MyCare Ohio offers a more coordinated way to get the care you need.
Your MyCare Ohio plan includes all standard benefits available through traditional Medicare and Medicaid programs, including:
In our region (Butler, Clermont, Clinton, Hamilton and Warren counties), you have two MyCare Ohio health plans to choose from:
These health plans have contracts with the Ohio Department of Medicaid to operate in our 5-county region as part of the new MyCare Ohio system.
Your plan is your point of contact for all your Medicare and Medicaid services and questions. You will work with your health plan to make decisions about your care and services.
Enrollment in MyCare Ohio is mandatory for people who:
If you are eligible for MyCare Ohio, you should have received a letter in the mail from the Ohio Department of Medicaid. Everyone who received a letter was required to enroll in a MyCare Ohio plan. Subsequent letters provided additional information about the enrollment process and plan choice.
In our region (Butler, Clermont, Clinton, Hamilton and Warren counties), enrollment ended and plans became effective on June 1, 2014.
Aetna and Molina have contracted with Council on Aging for two functions: 1) to assess people’s level-of-care for waiver programs (PASSPORT, Assisted Living, Ohio Home Care, or Transitions Carve-out) and 2) to manage or coordinate their long-term care services. We also visit individuals in their homes to monitor how they are doing.
As a contractor for the health plans, our role is somewhat different than it has been in the past. We are still the same Council on Aging, providing the knowledgeable and compassionate care we always have. But now, we are a provider for MyCare Ohio and the management functions belong to the two health plans. This means we no longer have the authority to make certain decisions about individuals’ care and services that we once had.
For example, if a MyCare Ohio member needs new services, additional hours or service changes, Council on Aging care managers make recommendations to the health plans, but the health plans decide whether to act on those recommendations. It works like other insurance you’re familiar with for medical care. Your doctor can recommend a certain treatment, but the insurance company decides whether that treatment will be covered.
NOTE: If you are currently enrolled in a MyCare Ohio health plan and are applying to a waiver program for the first time (PASSPORT, Assisted Living Waiver, or Ohio Home Care), you must contact your health plan to apply. Council on Aging cannot enroll MyCare Ohio consumers in a waiver program without health plan approval.
Under MyCare Ohio, you are required to enroll in one of the health plans for your Medicaid benefits, but you have the option to keep your Medicare services separate. This option is called:
Participants have until January 1, 2015 to decide if they would like to include their Medicare benefits in their MyCare Ohio plan or keep them separate.
Ohio Medicaid Consumer Hotline
MyCare Ohio is administered by the Ohio Department of Medicaid. If you have questions about enrollment or your plan options, the first place you should turn is the Ohio Medicaid Consumer Hotline. The hotline is available Monday – Friday, 7am - 8pm and Saturdays, 8am - 5pm.
From the hotline's website, you can:
The hotline website is available 24/7.
Once you are enrolled in a MyCare Ohio plan, your assigned care manager will be your primary contact for your all health care, behavioral health and long-term care needs.
In Ohio, when consumers have concerns about their long-term care services - at home, in a nursing home, assisted living or other skilled care facility - they can turn to their local Long-term Care Ombudsman.
Ombudsmen field complaints about long-term care services, voice clients' needs and concerns to nursing homes, home health agencies, and other providers of long-term care. They work with you, your family or other representatives, and your care providers to resolve problems and concerns you may have about the quality of services you receive.
Ombudsmen link you with the services or agencies you need to live a more productive, fulfilling life, advise you on selecting long-term care in Ohio, inform you about the rights of consumers and provide information and assistance with benefits and insurance.
With the launch of MyCare Ohio, Ohio's Ombudsmen are now available to help consumers with questions or concerns related to any of their MyCare-covered services (transportation, physician services, prescription issues, hospital issues, and more).
To reach the MyCare Ohio Ombudsman for Butler, Clermont, Clinton, Hamilton and Warren counties:
To speak with a local Ombudsman about issues NOT related to MyCare Ohio:
Pro Seniors Inc.
If you live outside our area, you can locate the Long-Term Care Ombudsman Program serving your county in Ohio at the Office of the State LTC Ombudsman website.
For questions about your Aetna coverage:
Aetna Better Health of Ohio
For qestions about your Molina coverage:Molina Healthcare
855-665-4623 - Member Services
Help with MyCare Ohio