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08/29/2022

Helpful Details for Ohio Medicaid Managed Care Patients

 

With Ohio Medicaid’s managed care program set to change for the better come Dec. 1, 2022, the Ohio Department of Medicaid (ODM) is detailing and answering FAQs about its Next Generation managed care plans—which are meant to focus on the individual, honor members’ choice, and provide continuity in the provision of members’ care. 



The Next Generation of Ohio Medicaid program will be implemented in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. After the implementation of OhioRISE on July 1 and Centralized Credentialing and the Single Pharmacy Benefit Manager on October 1, the Next Generation managed care plans will be implemented on December 1 to provide a more personalized approach to supporting Ohio Medicaid members’ healthcare needs.

The Next Generation managed care plan changes do not apply to MyCare Ohio plans, which will continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits, with enhanced coordination of medical, behavioral, and long-term care services.

Have questions about what actions Ohio Medicaid managed care members are encouraged to take? Read on for answers to some of the most common questions. You can also visit https://www.ohiomh.com/, review the Member Transition Infographic and visit https://ohiomh.com/resources/nextgenerationmedicaidfaq to access the Member Transition FAQs.


Will Ohio Medicaid managed care members lose coverage?

In the coming months, Ohio Medicaid members will receive many communications about their healthcare coverage. It is incredibly important for you to ensure your contact information is up to date. Additionally, please carefully review all communications shared by ODM and follow the instructions provided to ensure continuity of coverage. Learn more here.


What actions are Ohio Medicaid managed care members encouraged to take to select a plan?

Ohio Medicaid encourages all managed care members to review and select the Next Generation plan that best fits their healthcare needs.

Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending November 30, 2022.


What does this mean for current Ohio Medicaid managed care members who are also enrolled in the OhioRISE program?

OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through one of the seven Next Generation managed care programs or fee-for-service Medicaid.


What does this mean for current Ohio Medicaid managed care members currently with Paramount Advantage?

Current Ohio Medicaid managed care members who do not select a plan will stay with their current plan, with the exception of Paramount members. Paramount Advantage Medicaid has been acquired by Anthem Blue Cross and Blue Shield (Anthem). Anthem is working with Paramount Advantage to continue providing your healthcare coverage and you will continue receiving healthcare coverage through Paramount Advantage until the Next Generation managed care plans begin providing healthcare coverage. At that time Anthem will be your Next Generation managed care plan. You do not need to take any action to begin receiving healthcare benefits through Anthem and there will be no disruption in your care. All Ohio Medicaid managed care members can select a different plan at any time until the end of open enrollment through November 30.


What does this mean for Ohio Medicaid managed care members in a continuing plan?

Ohio Medicaid members do not need to do anything and will remain with their current managed care plan. Ohio Medicaid encourages all members to review the Next Generation plans available and select the plan that best meets their healthcare needs. Members can review and select any one of the seven Next Generation plans that best fit their healthcare needs at any time through November 30, 2022.


What does this mean for newly eligible Ohio Medicaid managed care members?

Individuals who are newly eligible for managed care, those who are currently in Medicaid fee-for-service but not enrolled with a managed care plan, and those with a gap in eligibility of 91+ days will receive care paid for through Medicaid fee-for-service until December 1, 2022 when they will be transitioned to an Ohio Medicaid Next Generation plan.

ODM will notify impacted members which plan they have been transitioned to. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment through November 30. Newborns and case additions will continue to be added to managed care plans as they become Medicaid eligible during this time.


How can an Ohio Medicaid managed care member select a Next Generation plan?

Managed care members can review their options using information in communications distributed by Ohio Medicaid and housed on the Medicaid Consumer website at https://www.ohiomh.com/.  Managed care members may select their plan at any time through November 30, by contacting the Ohio Medicaid Consumer Hotline at (800) 324-8680 or through the online portal at https://members.ohiomh.com.


What resources are available to Ohio Medicaid managed care members to help them identify which Next Generation plan best meets their healthcare needs?


When will Ohio Medicaid managed care members begin receiving services from their selected plan?

Ohio Medicaid managed care members will remain with their current managed care plan until Ohio Medicaid's Next Generation managed care plans begin providing healthcare coverage on December 1, 2022.

 

 


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