MyCare Ohio

Coordinated care for Ohioans who receive Medicare and Medicaid benefits.

MyCare Ohio logo

MyCare Ohio is a managed care system 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 members.


Who must participate in MyCare Ohio?

MyCare Ohio is mandatory for most people who receive services through Medicare and Medicaid. This may include people who are already enrolled or thinking about enrolling in a waiver program such as PASSPORT, the Assisted Living Waiver, or Ohio Home Care Waiver. 

In southwestern Ohio, 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. are eligible for BOTH Medicaid and Medicare.

If you are eligible for MyCare Ohio, you will receive a letter from the Ohio Department of Medicaid explaining how to enrol in the program and choose a health plan. 

Medicare Opt-out
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 (opt-out).  This will be explained to you during the enrollment process. Click here for a fact sheet about MyCare Ohio and Medicare.

[return to top]


What are the benefits of MyCare Ohio? 

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.

[return to top]


Which MyCare Ohio health plans can I choose from?

The Ohio  Department of Medicaid has awarded contracts to two health palns to serve MyCare Ohio members who live in Butler, Clermont, Clinton, Hamilton and Warren counties:

  1. Aetna Better Health of Ohio
  2. Molina Healthcare

When you choose a plan and enroll in MyCare Ohio, you become a member of that plan and receive a member card. Your plan is your point of contact for all your services and questions related to your care.  You can change plans on a monthly basis. 

Things to think about when choosing a plan:
Think about which of your services and providers are most important to you. Then, contact each health plan to find out if your preferred providers are part of their coverage network. Be sure to consider:

  • Primary care physician
  • Medical specialists
  • Hospitals
  • Long-term care providers


 

What is 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, or Ohio Home Care), 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 can make recommendations about a member's care, but we cannot approve or authorize services.  That is done by the health plans. 

Here's an 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 members in a waiver program without their health plan's approval.

[return to top]


Who to call when you need help with MyCare Ohio

Enrollment Assistance
For assistance with selecting the right plan or for help with enrollment, conctact:

Ohio's Medicaid Consumer Hotline
(800) 324-8680
(800) 292-3572 TTY
w
ww.ohiomh.com

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.

 

Plan Benefits and Provider Network
Learn about Aetna and Molina's covered services and provider networks:

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

 

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.

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.

 

[return to top]

 |  CMS Login
175 Tri County Parkway | Cincinnati, OH 45246 | (513) 721-1025