Today, Ohio Medicaid delivers healthcare coverage to more than 3 million Ohio residents. Of those, more than 90% receive coverage through our current managed care organizations (MCOs). While Ohio’s managed care structure has served Medicaid members well over the years, it has not kept up with changing needs. For that reason, Ohio Medicaid has embarked on a next generation managed care approach that focuses on the individual rather than the business of managed care. We want to do better for the people we serve.
Choosing Your Managed Care Organization (MCO)
Most people are automatically selected for Medicaid managed care coverage. Shortly after you enroll in Medicaid, you will get a letter asking you to choose a Medicaid MCO. Visit the websites below for each to learn more and find one that is right for you. If you don’t choose a plan, we will choose one for you. You can change plans up to 90 days from your date of initial enrollment, or during our annual open enrollment period.
A helpful way to enroll in managed care is online through the Medicaid MCO Member Service Website. With help from the MCO Member Service, you can compare plans additional benefits and view plans’ provider networks. You may want to consider: what services you might need, which health plan is accepted by the doctors you use, which plan was found to meet the highest quality for your health care needs, and which extra benefits are most beneficial to you.
Once you are enrolled with an MCO, you will get a new card in the mail. MCOs send one permanent card when you enroll. Keep this card for as long as you are on the plan. If you need to replace your managed care ID card, please contact your MCO, or use their online member portal. The plan will also send you information on your doctors, health services, and the scope of coverage from your plan.
Managed care works like regular private health insurance. Some services may require prior approval before you can receive them, or there may be limits on the number of services you can receive. Your MCO is available to answer your questions about coverage and help you find providers.
You can file a grievance with your MCO if you are dissatisfied with the MCOs services. You can also request an appeal from your MCO in the event your pre-services request is denied. Contact your MCO Member Services Department for assistance.
Introducing the Next Generation of Managed Care
Throughout 2021, Ohio Medicaid is working to unveil a new approach to managed care that puts you and your family first. In early 2022, you and your family will experience a new type of support through our managed care program, one that:
- Improves wellness and health outcomes. The 2022 managed care structure adopts a unified approach to population health management and engages you in decisions about your health and wellbeing. The framework leverages member health data to identify services and supports unique to your situation. And, it elevates the role managed care organizations play in coordinating care across your medical providers.
- Emphasizes a personalized care experience. The days of feeling like a number are decreasing as next generation MCOs commit resources and training to address hidden biases and impersonal practices that turn too many Ohioans away from seeking the care needed. The future program will strive to engage you on care options, and respect choices you make about your care.
- Supports providers in better patient care. We’re reducing several administrative burdens for your health care providers so they have more time to spend with you. From a unified prescription drug list to fiscal intermediary to centralizing provider credentialing, we’re eliminating redundancies and streamlining operations to eliminate time-consuming paperwork and processes.
- Improves care for children and adults with complex mental health needs, including establishing OhioRISE, a specialized managed care program for youth with complex behavioral health and multi-system needs.
- Increases program transparency and accountability through the systematic and systemic use of information and tailored approaches to meeting member health care needs.
- Additionally, the next generation structure replaces today’s opaque pharmacy benefit system with an agency-managed statewide program. Medicaid’s Single Pharmacy Benefit Manager will be responsible for providing and managing pharmacy benefits for all individuals enrolled in Ohio Medicaid managed care.
We know you’re going to have questions
Ohio Medicaid’s new approach to managed care is based on extensive feedback we received from providers, patients, and other key stakeholders about the way the system was working for them.
It is designed to make access to care simpler, more personal, and more effective. But, we know you’ll still have questions. Feel free to contact us at mcprocurement@medicaid.ohio.gov with suggestions, questions and guidance on the changes ahead.
For information related to the next generation of managed care, please visit managedcare.medicaid.ohio.gov.