Today, Ohio Medicaid delivers healthcare coverage to more than 3 million Ohio residents. Of those residents, more than 90% receive coverage through our Next Generation managed care program. The program is focused on individuals rather than the business of managed care. Ultimately striving to serve Ohioans better, five visionary goals of the Next Generation program are to:
- Improve health and wellness outcomes. The Next Generation 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.
- Emphasize a personalized care experience. Next Generation managed care organizations (MCO) commit resources and trainings to address implicit biases and impersonal practices that turn too many Ohioans away from seeking the care needed. The program strives to engage you on care options and respects choices you make about your care.
- Support providers in better patient care. We’re reducing administrative burdens for your healthcare providers so they have more time to spend with you. From a unified prescription drug list to the Fiscal Intermediary to centralizing provider credentialing, we’re streamlining operations to eliminate unnecessary, time-consuming processes.
- Improve 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 multisystem needs.
- Increase program transparency and accountability through the systematic and systemic use of information and tailored approaches to meeting member healthcare needs.
Choosing your managed care plan
Most members are automatically selected for Medicaid managed care coverage. Shortly after you enroll in Medicaid, you will get a letter asking you to choose a Next Generation MCO. 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 Consumer Hotline website, where you can compare plans' additional benefits and provider networks. You should consider the services you might need, which plan is accepted by any doctors you currently use, and what extra benefits are most important to you.
Once you are enrolled with an MCO, you will get a new Medicaid member ID 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 directly or use their online member portal. Your MCO will also send you information on your doctors, health services, and the scope of your plan's coverage.
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 their services. You can also request an appeal from your MCO in the event your pre-services request is denied. Contact your MCO's Member Services Department for assistance.