MyCare Ohio, a new managed care program for Ohioans who receive both Medicare and Medicaid benefits, will begin starting May 1. MyCare Ohio will be implemented in 29 participating counties (Area Agency on Aging). MyCare Ohio is a three-year demonstration project developed to determine the ability of the State to better manage the care and costs of Medicare/Medicaid recipients. Long term care (LTC) facilities should immediately begin to learn about the program details specific to LTC and to initiate dialogue with the insurance carriers for their region.
LTC facilities will need to contract with the Managed Care insurance plans to become a provider. Two of Ohio's trade associations for Long Term Care, the Ohio Health Care Association and LeadingAge Ohio, are helping to lead discussions with the five insurance plans involved to identify the billing and payment guidelines that will impact the LTC providers. Details will continue to evolve right up to the initial implementation date of May 1st.
If a beneficiary who lives within the May 1 implementation area (Cuyahoga, Lorain, Medina, Geauga and Lake Counties) did not choose a plan for Medicaid by Monday, March 17, a plan has been chosen for them by the Ohio Department of Medicaid (ODM). If recipients do not like the plan chosen for them by the state, they have up to 90 days to change their plan. Physicians have 365 days to contract with the plans; therefore recipients have the year to transition to a participating physician.
Skilled Nursing Facilities (SNFs) are encouraged to meet with insurance carriers and to review the profiles of their residents to determine if any may be excluded from the program.
Residents will receive notification of their Medicare enrollment into MyCare Ohio later this year and will be given a deadline date to opt-out of changing their Medicare plan. Recipients must choose a plan, or opt-out and retain traditional Medicare entitlement by the deadline or a plan will be chosen for them.
OHCA has released several documents to help explain MyCare Ohio and how it affects certain individuals and long term care facilities. These documents are available to download on our website.
