MyCare Ohio: Information for Consumers

MyCare Ohio logo

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. 

  • A single point of contact: MyCare Ohio coordinates your Medicare and Medicaid services together under one health insurance plan.  You become a member of that health plan. This way you only have to call one phone number at your health plan to talk with someone about your Medicare and Medicaid benefits. 
  • Care focused on you: Your MyCare Ohio plan will provide information and help you make choices about your health care, provide support for you to remain independent and in the community, and provide care management that includes face-to-face visits in your home.

Your MyCare Ohio plan includes all standard benefits available through traditional Medicare and Medicaid programs, including:

  • doctor and hospital visits, 
  • mental health services, 
  • and long-term care services provided in nursing or assisted living facilities or in the home (via services such as home-delivered meals, medical transportation, and help with personal care), if applicable.

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MyCare Ohio Health Plans

In our region (Butler, Clermont, Clinton, Hamilton and Warren counties), you have two MyCare Ohio health plans to choose from:

  1. Aetna Better Health of Ohio
  2. Molina Healthcare

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 Information

Enrollment in MyCare Ohio is mandatory for people who:

  1. are 18 or older; and 
  2. live in Butler, Clermont, Clinton, Hamilton or Warren counties; and 
  3. currently receive services from BOTH Medicaid and Medicare.

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.

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Council on Aging's role in MyCare Ohio

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.

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MyCare Ohio and Medicare

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:

  1. Medicare Opt-in: have the plan provide your Medicare benefits (either Aetna or Molina). This option leaves you with a single point of contact for all your Medicare and Medicaid services. OR
  2. Medicare Opt-out: stay with your current Medicare Advantage plan or traditional Medicare. You must still choose a MyCare Ohio managed care plan for you Medicaid benefits. This plan will provide and pay for all your Medicaid services.

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.

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Help with MyCare Ohio 

Ohio Medicaid Consumer Hotline
(800) 324-8680
(800) 292-3572 TTY
http://ohiomh.com/MyCareOhio.aspx

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:

  • find MyCare Ohio plans in your county
  • use the provider search to find out which MyCare Ohio plans are accepted by your doctor and other healthcare providers
  • enroll in or change plans (online or print a paper form)

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.


 

MyCare Ohio Ombudsman

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: 

Pro Seniors Inc.
Ms. LeVon Pressley
Lpressley@proseniors.org
Direct Dial: 513-458-5536
Toll Free: 800-488-6070

To speak with a local Ombudsman about issues NOT related to MyCare Ohio: 

Pro Seniors Inc.
513-345-4160
Toll Free: 800-488-6070
To bypass the receptionist and reach the ombudsman intake desk,  press #7##

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.


Ohio Consumer Voice for Integrated Care Conference Calls

The Ohio Consumer Voice for Integrated Care is convening monthly statewide conference calls to hear from consumers and family caregivers about what is working or not working for them under MyCare Ohio. Calls occur on the last Friday of each month are staggered depending on the region you are calling from. Click here for more information.


 

Health Plan Contact Information

For questions about your Aetna coverage:

Aetna Better Health of Ohio 
855-364-0974 - Member Services

For qestions about your Molina coverage:

Molina Healthcare
855-665-4623 - Member Services

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