MyCare Ohio implementation brings big changes to long-term care in our region
Wednesday, July 9, 2014
For Council on Aging, “business as usual” ended June 1 with the implementation of MyCare Ohio in our region. It also ended for hundreds of providers and for thousands of seniors and people with disabilities. (Click here to read how implementation is going across the state)
From many people on the PASSPORT in-home care program or who are applying for PASSPORT or another waiver program, the question we keep hearing is: Why is Council on Aging doing this? The “this” they’re asking about is change brought on by MyCare Ohio, the state’s new managed care system.
A changed role
Under MyCare Ohio, Council on Aging has a changed role in Ohio’s system of long-term care. 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 two health plans: Aetna Better Health of Ohio and Molina Healthcare. That means we no longer have the authority to make certain decisions about individuals’ care and services that we once had. Our role now is to provide level-of-care assessments, care management and waiver services coordination to people who are enrolled in MyCare Ohio and are on a waiver program (PASSPORT, Assisted Living, Ohio Home Care, or Transitions Carve-out) or are applying for one.
To fulfill this role, COA has contracts with Aetna and Molina. Approximately 19,000 people in our region who are eligible for both Medicare and Medicaid are required to enroll in one of these two health plans. The 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.
- For Aetna, we are the care manager for plan members on waiver programs.
- For Molina, we are the waiver service coordinator for plan members age 60 and older only.
So, what does this mean?
It means that Council on Aging continues to assess people’s level-of-care for waiver program and manages or coordinates their long-term care services. We continue to 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.
NOTE: For waiver consumers who are NOT enrolled in MyCare Ohio, our role has NOT changed. We continue to administer PASSPORT and the Assisted Living Waiver and provide care management for the Ohio Home Care Waiver for individuals who are not Medicare/Medicare eligible.
|Process to request additional/new waiver services for a MyCare Ohio consumer who is already enrolled in a waiver program such as PASSPORT, the Assisted Living Waiver or Ohio Home Care Waiver
|Process for MyCare Ohio consumers who are applying to a waiver program (PASSPORT, Assisted Living Waiver, Ohio Home Care Waiver) for the first time.
Who made this change and why?
The state of Ohio launched MyCare Ohio as a three-year demonstration project. MyCare Ohio is an Integrated Care Delivery System. It is designed to deliver better, more coordinated care at lower cost for “dual-eligibles” – people who are eligible for both Medicare and Medicaid. This population includes people who are elderly, frail and/or have disabilities. They tend to have high – and costly - health care and long-term care needs. Under the new system, they are required to enroll in a health plan (Aetna or Molina) which coordinates and manages their health care, long-term care, and behavioral health services. For MyCare Ohio members who are enrolled in a waiver program, such as PASSPORT, Council on Aging is one part of the care team.
Where to turn for information and help
If you have questions or concerns about the waiver services you receive through your MyCare Ohio health plan, contact your health plan or your care manager.
You can get assistance with choosing or changing plans through the Ohio Medicaid Consumer Hotline:
(800) 292-3572 TTY
Additionally, Ohio’s Long-term Care Ombudsman Program was recently expanded to include MyCare Ohio consumers. Ohio’s Ombudsmen field complaints about long-term care services and voice clients' needs and concerns to long-term care providers. They are available to help consumers with questions or concerns related to any of their MyCare-covered services (transportation, physician services, behavioral health services, prescription issues, hospital issues, and more). Click here for a related article.
To reach the MyCare Ohio Ombudsman for Butler, Clermont, Clinton, Hamilton and Warren counties:
Pro Seniors Inc.
Ms. LeVon Pressley
Direct Dial: 513-458-5536
Toll Free: 800-488-6070
We recently updated the MyCare Ohio pages on our website. The pages for consumers and providers include links to the two health plans serving our region, helpful documents, FAQs and plan contact information for providers, and resources for help with questions and concerns about MyCare Ohio enrollment and coverage.