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What is MyCare Ohio?

MyCare Ohio is a new demonstration program created by the State of Ohio and the federal government for many people who are “dually eligible,” which means they are on both Medicare and Medicaid. Generally, a person who participates in MyCare Ohio will have his or her Medicaid and Medicare benefits and services (including physical, behavioral and long-term care services) coordinated through a single health plan administered by a private insurance company (this is often referred to as “managed care”).
According to the State of Ohio, MyCare Ohio is intended to improve health outcomes while containing costs, but the new program is very complicated and has caused frustration for many new enrollees and others (for example, payments to many independent providers have been significantly delayed since the program’s launch, which also affects people with disabilities who depend on them for support).
This document is meant to be only guidance and is not a substitute for legal advice. Please contact Disability Rights Ohio if you have additional questions or if you have a specific problem with MyCare Ohio.

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Is MyCare Ohio a statewide program?

No. The MyCare Ohio program operates only in 7 regions across the state, a total of 29 counties. If you do not reside in one of these counties, this new program does not affect you. The regions and counties are:

Region Counties
Northwest Fulton, Lucas, Ottawa, Wood
Southwest Butler, Clermont, Clinton, Hamilton, Warren
West Central Clark, Greene, Montgomery
Central Delaware, Franklin, Madison, Pickaway, Union
East Central Portage, Stark, Summit, Wayne
Northeast Central Columbiana, Mahoning, Trumbull
Northeast Cuyahoga, Geauga, Lake, Lorain, Medina

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Who must enroll in MyCare Ohio?

In general, if you live in one of the 29 counties listed above, are 18 years of age or older, and are on both Medicare and Medicaid (“dually eligible”), you must enroll in a MyCare Ohio plan. There are exceptions, however, as explained below.
Who may not enroll in MyCare Ohio?
You are not eligible to enroll in MyCare Ohio if any of the following applies to you:

  • you are not eligible for full Medicaid benefits;
  • you are not eligible for Medicare Parts A, B, and D;
  • you are enrolled in the PACE Program;
  • you have a delayed Medicaid spend-down;
  • you have any private medical insurance, including retiree benefits, other than a Medicare Advantage Plan;
  • you receive services through a waiver program administered by the Ohio Department of Developmental Disabilities (Individual Options, Level One, SELF, and Transitions DD waiver programs); or
  • you are residing in an Intermediate Care Facility for individuals with intellectual disabilities (ICF/IID).
  • What if I only receive services from a county board of developmental disabilities, and do not receive waiver services and do not reside in an ICF/IID?

Then you are eligible to enroll in MyCare Ohio. However, this is not mandatory. You can talk to your service and support administrator for more information to see if this is the best decision for you.

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Must I enroll in a MyCare Ohio plan if I reside in a nursing facility?

Yes, if you also meet the other eligibility requirements: you are 18 years of age or older, you reside in one of the 29 demonstration counties, and you are on both Medicaid and Medicare.

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Are individuals who are being served by Medicaid waivers eligible to enroll in MyCare Ohio?

Yes, individuals who meet the other eligibility requirements and who are receiving services through any home and community-based services waiver programs administered by the Ohio Departments of Medicaid or Aging (such as the Ohio Home Care, PASSPORT, Transitions Carve Out, and the Assisted Living waivers) will be transitioned to MyCare Ohio. However, as noted above, individuals receiving services under any waiver administered by the Ohio Department of Developmental Disabilities are not eligible to enroll in MyCare Ohio.

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If I must enroll in MyCare Ohio, do I have to receive all of my benefits through MyCare Ohio?

No. You must receive your Medicaid benefits through MyCare Ohio. However, you have the option of receiving your Medicare benefits in the same way that you have in the past.

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What if I do not want to receive my Medicare benefits through MyCare Ohio?

You must contact the Ohio Medicaid Consumer Hotline at 1-800-324-8680. You must tell them that you do not want to receive your Medicare benefits through MyCare Ohio.
If you do not contact the Ohio Medicaid Consumer Hotline and let them know that you do not want to receive your Medicare benefits through MyCare Ohio, you will be automatically enrolled for both Medicare and Medicaid benefits. If you choose not to receive your Medicare benefits through MyCare Ohio, you will still be enrolled and receive your Medicaid benefits through MyCare Ohio.

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How do I enroll?

You should have received a letter in the mail letting you know that you are eligible for MyCare Ohio and explaining that you must enroll in a plan. In order to enroll in a plan, you can call the Medicaid Consumer Hotline at 1-800-324-8680.

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What options are available to me with MyCare Ohio?

MyCare Ohio allows you to enroll in your choice of health plans through a private insurance company. The letter from Medicaid will detail what those plans are and give you some basic information about them. When you enroll in MyCare Ohio, you will choose what plan you would want to enroll in.

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Which managed care companies have plans through MyCare Ohio?

Aetna, Buckeye, Molina, Caresource, and United Healthcare. However, the plans from which you may choose depends on the region in which you live, and each region has plans from two of these companies (although one, the Northeast region, has three).

Region Counties Companies
Northwest Fulton, Lucas, Ottawa, Wood Aetna, Buckeye
Southwest Butler, Clermont, Clinton, Hamilton, Warren Aetna, Molina
West Central Clark, Greene, Montgomery Buckeye, Molina
Central Delaware, Franklin, Madison, Pickaway, Union Aetna, Molina
East Central Portage, Stark, Summit, Wayne Caresource, United
Northeast Central Columbiana, Mahoning, Trumbull Caresource, United
Northeast Cuyahoga, Geauga, Lake, Lorain, Medina Buckeye, Caresource, United

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Does it matter which plan I choose?

Yes. Each plan is different. The plans offer different services and access to different doctors. It is important that you review plans carefully and make a decision. You should look at each plan and see which plan works with your current doctors, which plan works with the hospitals you use, what extra services are offered (such as transportation or dental services), how much your prescription co-pays will be and any other factors that are important to you.

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Where can I find help choosing a plan?

There are several places where you can speak to someone who has been trained to help you choose a plan.

  1. The state’s long-term care ombudsman program now acts as an ombudsman program for the MyCare Ohio program. For more information, you may call 1-800-282-1206 or visit its website at aging.ohio.gov/services/ombudsman.
  2. Medicaid Consumer Hotline at 1-800-324-8680.
  3. Your local independent living center.

If you are receiving services through a county board of developmental disabilities, you can talk to your service and support administrator.
You may also contact the plans directly and ask questions. The contact information for the plans is listed in the letter that you will receive from Medicaid.

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What happens if I do not choose a plan?

If you do not contact the Medicaid Consumer Hotline to tell them which plan you want, the Department of Medicaid will choose a plan for you.

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Can I change to a different plan after I have enrolled in MyCare Ohio?

If you decide to receive both your Medicare and Medicaid benefits and services through MyCare Ohio, you can change your plans monthly. However, if you choose not to receive your Medicare benefits and services through MyCare Ohio, then you can only change your plans during the first ninety (90) days of your initial enrollment or during the annual open enrollment period.

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Will I have to change my doctor or other health care provider?

Maybe. Generally, your current health care provider will be covered during the first year of the program. This is called the transition period. After the transition period, you can continue to use that health care provider if that provider works with your new MyCare Ohio plan. It is important that you find out from your plan which health care providers they work with, and make sure your provider is listed. If your health care provider is not listed, you can ask them to start working with your plan. If your health care provider does not work with your new MyCare Ohio plan, you may not be eligible to receive services from that health care provider under your plan after the end of the transition period.
If you have questions about which providers work with your MyCare Ohio plan, you can call the phone number that is on the back of your MyCare Ohio plan identification card.
If you are not eligible to receive services from your current health care provider and your provider will not work with your MyCare Ohio plan, your MyCare Ohio plan must help you find a new health care provider to help you meet your health care needs.

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What if I am scheduled to receive treatment prior to enrollment in MyCare Ohio?

If you were scheduled to receive treatment or a health care service prior to enrollment in MyCare Ohio, contact your MyCare Ohio plan right away, before you receive treatment.

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What if I never received a letter, or I lost my letter?

You should call the Medicaid Consumer Hotline at 1-800-324-8680.

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What if I have additional questions about this program or am experiencing problems with this program?

You can call the following agencies for help in answering your questions about this program:

  1. Medicaid Consumer Hotline at 1-800-324-8680.
  2. The state’s long-term care ombudsman program now acts as an ombudsman program for the MyCare Ohio program. For more information, you may call 1-800-282-1206 or visit its website at aging.ohio.gov/services/ombudsman.
  3. Ohio Consumer Voice for Integrated Care at 1-614-456-0060, ext. 237.
  4. Disability Rights Ohio at 1-800-282-9181 (TTY 1-800-858-3542) – Press 2 for intake
  5. Your local independent living center. 

If you receive services through a county board of developmental disabilities, you can talk to your services and support administrator (SSA).

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Can I still live at home after I am enrolled in MyCare Ohio?

Yes. Your MyCare Ohio plan should coordinate all of your care services, including services you receive under waiver programs that help you remain in the community. If you experience a change in your services that you do not like, or you think puts you at risk of having to move into a nursing home or assisted-living facility, or any other institutional setting, please call Disability Rights Ohio. We will provide you with information about your rights and information on how to appeal adverse actions made by MyCare Ohio plans. You can call us at 1-800-282-9181 (TTY 1-800-858-3542) and press 2 for intake.

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