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Managed Care
Common Questions about Managed Care
Managed Care

A managed care benefit package includes preventive care, hospital, emergency, prescription and may cover additional benefits such as vision, dental, and transportation.

A health insurance company that ODM has contracted with to pay for medical services provided.  Medicaid providers bill the managed care organization (MCO) and the MCO pays the provider.  Ohio Medicaid pays the MCO a set monthly rate per member for all services provided.

There are many benefits to a managed care plan like, one point of accountability for members, access to care and providers, 24-hour nurse line, care management, improved health outcomes, long-term efficiencies, health and wellness programs, member interaction/call center, nurse lines, and advisory groups.

Once you have been assigned to a managed care plan you  have 90 days to choose a different plan if you would like.  After initial enrollment, changes can be made during the open enrollment period each November or if just cause can be shown for a change.   

It is important to select a plan that best fits your health care needs and works with all or most of your doctors, specialists, preferred hospitals, etc. You may also want to see which plans offer extra services you need such as additional transportation, vision or dental services prior to selecting a managed care plan.  The Ohio Medicaid Consumer Hotline is available to assist.  

You can contact the Ohio Medicaid Consumer Hotline at (800) 324-8680.

There are easy ways to find out which plan works with your doctor or specialist:

  • Visit the Medicaid Consumer Hotline’s website https://www.ohiomh.com/ to search each MCP’s directory.
  • Call the Medicaid Consumer Hotline toll free 1-800-324-8680.
  • Visit each plan’s website for its provider directory.

Each managed care plan has a toll-free member service line that is printed on your MCP Member ID card for your convenience.  Each plan also has a toll-free 24-hour nurse line.

A Member ID card will be mailed to your residence.  Please be sure your address information is accurate.  

If you need to replace your ID card, you can get a new card by either calling your MCP Member Services Department or by signing up with your MCP in their Member Services Portal. You can print a copy of your ID card immediately from the MCP portal. If you order a card via telephone, it should arrive in the mail in 7-10 business days from the date of your request.

If your plan is unable to approve a request for services, your MCP will issue you a written Notice of Action which details your rights to request an appeal or a State Fair Hearing.  Appeals must be initiated within 90 calendar days from the day following the mailing date of the notice. You can request an appeal  by calling your MCP, in writing, completing the form on-line, in person or by fax. Standard appeals must be resolved within 10 calendar days. Expedited appeals must be resolved no later than 48 hours after appeal request.

If you move to another county please notify the County JFS office.  If you are enrolled with a statewide plan you will remain enrolled with your plan.  If you are enrolled with a regional plan and you move outside of their coverage area you will need to select a new plan.  
 

The Ohio Medicaid Consumer Hotline is available to help at toll free 1-800-324-8680.

Managed care plans are required to work with you during your transition of care. The plan will allow you to continue to work with the out-of-network for the first three months of enrollment.  Call your plan's member services team for information on what steps you can take for the care to be covered by your new plan.

Contact the Medicaid Consumer Hotline at 800-324-8680 Monday through Friday 7:00 a.m. – 8:00 p.m. and Saturday 8:00 – 5:00. Or online at www.ohiomh.com . Understand that you can only change plans during the first three months of enrollment or during the annual open enrollment.  If you need to change managed care plans at some other time call the Hotline and request a Just Cause exemption.