MyCare Ohio

MyCare Ohio is a new managed care program for Ohioans who receive BOTH Medicare and Medicaid benefits. The program is administered by the Ohio Department of Medicaid (ODM).

According to ODM, approximately 182,000 Ohioans are covered by both Medicare and Medicaid. Medicare and Medicaid are currently managed with almost no connection to each other, and no one entity is accountable for the care of the whole person. The current system is confusing and difficult for individuals to navigate. Benefits for individuals eligible for both programs, such as long-term care services and supports, behavioral health services and physical health services, are fragmented and poorly coordinated. MyCare Ohio is a system of managed care plans selected to coordinate the physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicare and Medicaid. This includes people with disabilities, older adults and individuals who receive behavioral health services. The MyCare Ohio program aims to improve the overall health and well-being of the individual while also improving health care quality and outcomes, as well as containing costs.

Enrollment into MyCare Ohio is mandatory for individuals receiving BOTH Medicare and Medicaid and will begin, in the Northeast Ohio region, March 2014. At this time, mandatory enrollment will be for Medicaid services only. In late February you will receive information from ODM about how to sign up for a MyCare Ohio plan. You may begin to sign up for a MyCare Ohio plan beginning March 1, 2014 and your plan coverage will be effective May 1, 2014. If you do not choose a plan in March, ODM will automatically enroll individuals into a MyCare Ohio plan. From there, you will have up to eight months to decide which Medicare plan best fits your health care needs. Beginning January 2015, if you have not selected a plan, a plan will be selected for you

The Lake County Council on Aging will be available to help you understand your MyCare Ohio options. Contact Yolanda Lowe at (440) 205-8111 x233 to learn more about MyCare Ohio and the available managed care plans.

Key aspects of this new system include:

A Team Approach to Care Coordination: MyCare Ohio focuses on the individual to effectively coordinate his or her care based on specific needs. An individual’s care team may include: the individual, family/caregiver, the MyCare Ohio plan care manager, the waiver service coordinator (if appropriate), the primary care provider, specialists, and other providers as applicable.
MyCare Ohio Plans: Ohio selected five managed care plans to manage Medicare and Medicaid benefits for people enrolled in MyCare Ohio. Three plans will serve Lake, Cuyahoga, Geauga, Medina and Lorain counties:UnitedHealthcare, Buckeye and CareSource.
Combined Benefit Package: MyCare Ohio participants will have access to all standard Medicare and Medicaid benefits, including doctor and hospital visits, mental health services, and long-term care services provided in nursing facilities, assisted living facilities or in the home (via services such as home-delivered meals, medical transportation, help with personal care), if applicable. In addition, MyCare Ohio plans may include additional services as part of their benefit packages. People who receive Hospice benefits will continue to receive those services separately from their MyCare Ohio plan.