MyCare Ohio: Information for Providers
MyCare Ohio represents a big change in the delivery of health care, long-term care and behavioral health services to people who are eligible for both Medicare AND Medicaid.
For providers who are accustomed to working with Council on Aging to enroll clients in waiver programs (PASSPORT, Assisted Living Waiver) or to request additional waiver services, MyCare Ohio means adjusting to new processes and time tables.
The information on this webpage is intended to help providers better understand MyCare Ohio – particularly Council on Aging’s role. You may also want to visit our MyCare Ohio consumer page.
MyCare Ohio is Ohio's Integrated Care Delivery System (ICDS) - a system of managed care plans designed to coordinate physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults, and individuals who receive behavioral health services. The program is administered by the Ohio Department of Medicaid (ODM).
In general, those benefitting from MyCare Ohio have complex medical needs and significant social, residential and other barriers to meeting their daily living needs.
Hospice patients will continue to receive their Hospice benefits separately from MyCare Ohio.
In our region (Butler, Clermont, Clinton, Hamilton and Warren counties), consumers can choose between two MyCare Ohio health plans:
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.
The health plan is the consumer’s point of contact for all their Medicare and Medicaid services and questions. Consumers work with their health plan to make decisions about their care and services.
Under MyCare Ohio, consumers are required to enroll in one of the health plans for their Medicaid benefits, but have the option to keep their Medicare services separate. This option is called:
Enrollment in MyCare Ohio is mandatory for people who:
The following groups are not eligible for MyCare Ohio.
Consumers who are eligible for MyCare Ohio will receive a letter from the Ohio Department of Medicaid explaining how to enroll in the program and choose a health plan.
Providers with questions about enrollment and eligibility should contact Ohio Department of Medicaid Provider Hotline.
Council on Aging’s role in Ohio’s Medicaid waiver programs (PASSPORT, Assisted Living, and Ohio Home Care) has changed as a result of MyCare Ohio.
Like you, we now serve in a provider capacity. We have contracts with our region’s MyCare health plans – Aetna and Molina – to provide care management and/or wavier service coordinator services for MyCare Ohio consumers who are enrolled in a waiver program. (see related FAQ)
In these roles, we assess people’s level-of-care for waiver programs and manage or coordinate their long-term care services. We also visit individuals in their homes to monitor how they are doing. But our contracts with Aetna and Molina are different.
For Aetna plan members, COA establishes the waiver care plan and services and authorizes services with Aetna’s approval. For Molina plan members, COA’s role is more limited. Molina develops the care plan. COA makes recommendations for the service plan and authorizations, but Molina must approve units over a certain level.
If a MyCare Ohio member is applying to a waiver program for the first time, the person must contact his or her health plan first. After a phone screening, the health plan may make a referral to Council on Aging, which handles assessments and determines level of care eligibility.
Management functions of MyCare Ohio belong to the two health plans. Aetna and Molina manage their respective provider networks, operate their own IT systems which COA must use, and pay claims to providers for services that have been authorized.
Click here to see a table that describes our different roles and responsibilities for the 1) Elderly Services Programs, 2) for traditional Medicaid waiver programs, and 3) for the Medicaid waiver services provided to MyCare Ohio members enrolled in Aetna or Molina. The following flow charts may also help in understanding COA's roles and responsibilties within MyCare Ohio.
Council on Aging Contacts
Council on Aging's Aetna Team: (513) 827-3441
Council on Aging's Molina Team: (513) 827-3443
Health Plan Contacts
Southwest Region Provider Relations
Southwest Region Community Liaison
Ohio Department of Medicaid
The Ohio Department of Medicaid (ODM) has compiled a special section on its website specifically for providers affected by MyCare Ohio.
ODM’s Provider Hotline, 1-800-686-1516, may also be able to provide assistance. The automated hotline is available 24/7 and representatives are available Monday – Friday, 8am – 4:30pm.
MyCare Ohio Ombudsman
With the launch of MyCare Ohio, Ohio's Long-term Care 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).
Additionally, the MyCare Ombudsman will work as the Long-term Care Ombudsman does, offering consultation to providers related to general issues, with a focus on benefit to the consumer.
To reach the MyCare Ohio Ombudsman for Butler, Clermont, Clinton, Hamilton and Warren counties:
The following FAQs have been compiled from questions we have received and researched answers to, as well as questions generated after the member and provider forums that were held across the state early in 2014.
Answers to questions from the member/provider forums have been provided by the Ohio Department of Medicaid. Click here for a complete list of these FAQs. We are sharing the more relevant FAQs here for your convenience.
FAQs from Ohio Department of Medicaid
I am a provider, will I be required to get a prior authorization for services. If so, how long will that take?
What is the difference between the waiver service coordinator and the MyCare Ohio Plan care manager?
FAQs from Council on Aging:
Regarding scheduling transporation for Molina consumers:
Updated 1/13/2016: Effective Jan 1. 2016 Secure Transportation with be Molina’s transportation vendor for MyCare and Medicare. The new MyCare Ohio transportation number (Secure) is (844) 491-4761. Members who call the Logisticare phone number to schedule transportation should be automatically redirected to Secure.
Regarding continuation of services for providers who are not contracted with Aetna or Molina:
Click here for an e-mail explanation that was sent to service providers from COA's Provider Services Department on June 2, 2014.
According to the Memorandum of Understanding (MOU) between Ohio and the Centers for Medicare and Medicaid Services (CMS), each MyCare Ohio plan is required to obtain beneficiary and community input on issues of program management and enrollee care through a range of approaches.
Each MyCare Ohio plan must establish at least one beneficiary advisory committee and a process for that committee to provide input to the governing board. The plan must also demonstrate that the advisory committee composition reflects the diversity of the MyCare Ohio enrollee population, and participation of individuals with disabilities, including enrollees, within the governance structure of the plan.
Additionally, Ohio must maintain additional processes for ongoing stakeholder participation and public comment.
As a provider, if you work with consumers you feel would be a good fit for one of the advisory committees, please contact the Universal Health Care Action Network's (UHCAN) Ohio Consumer Voice for Integrated Care by e-mail or (614) 456-0060 x237.
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