If you have questions regarding Medicaid HMO's, the MAC (Medical Assistance Coordinator) in your area can assist. To find your specific MAC, you can go to MAC.
6/26/08-ODJFS has recently learned that Anthem Blue Cross Blue Shiled Partnership Plan (Anthem) and Wellcare of Ohio(Wellcare) not renew their provider agreements with the Ohio Department and Family Services to serve Aged Blind, or Disable(ABD) Medicaid consumers in Ohio. All of the state's ABD consumers will continue to have other options. The Northeast region (Ashtabula, Cuyahoga, Erie, Geauga, Huron, Lake, Lorain, and Medina Counties)- Anthem and Wellcare's ABD members will be provided an opportunity to select from the remaining managed care plan (Buckeye Community Health Plan) or fee for service Medicaid. Notices to members will specify these options and provide an opportunity for choice. Notices to Anthem Members will be sent on approximatey July 8, 2008, and notices to Wellcare's members will be sent on approximately July 9,2008. Notice to Buckeye's members will be sent on approximately July 23, 2008.
The notices will instruct ABD Managed Care members in the above counties to make their choice by calling the ODJFS manged care enrollment center(MCEC) AT 1-800-605-3040 or by accessing the MCEC website at MCEC. Copies of these notices and detailed information about this process will be mailed to the CDJFS Directors and county managed care coordinators.
All enrollment changes will take place by September 1, 2008.
As of January 2007, Ohio Health Plans' Bureau of Managed Health Care (BMHC) is responsible for the oversight of Medicaid services for over one million Covered Families and Children (CFC) enrolled in manage plans (MCP). By June 2007, approximately 125,00 Aged, Blind and Disabled (ABD) will be enrolled in MCP's.
ABD individual's excluded from the HMO' include;
1. Children under 21 years of age.
2. Consumer's who are eligible for Medicare and Medicaid.
3. Consumer's with a spend down liability.
4. Consumers enrolled in home and community-based programs such as PASSPORT, Ohio Home Care, Assisted Living Waiver, etc.
5. Those individual's whose permanent residence is a nursing facility or ICF/MR.
For the above mentioned individual's or a resident of a NF who is just making an application for Medicaid, the usual level-of-Care (LOC) process still applies. However, for individuals who are under Managed Care Plan, the usual level of care process will not authorize Managed Care Plan payment.
Enrollees in MCP plans can change their plan to a different plan within the first 3 months enrollment and then annually, thereafter. Also, in other circumstances, with approval of the Bureau of Managed Care plans, the plan can be changed.
Nursing Facility services provided to Medicaid Managed Care Plans enrollees must be authorized by the Managed Care Plan. Some Managed Care Plans prefer to work only with the NF's with which they have a contract. NF providers may contact MCP's directly to discuss contracts for service provision to the managed care population. Rates for NF services are negotiated between the MCP and the NF provider.
Prior authorization for any NF services is required by most, if not all, MCP's. NF's must obtain authorization before accepting a new admission for any Medicaid managed care enrollee. An MCP can deny payment to the NF if prior authorization is not received. Aged, Blind, and Disabled individual's on MCP's are eligible for NF care not to extend beyond the last day of the calender month following admission,not exceeding 62 days. For example, an ABD enrollee admitted on February 21 would be eligible for MCP payment for NF services only through March 31.
The Ohio Administrative Code Rule of 5101:3-3-26-02 directs the termination of managed care enrollment and the transfer to fee-for-service Medicaid for MCP enrollees requiring a long term placement in a NF. In all cases, the MCP submits a request to the Bureau of Managed Health Care and not to the County Department of Job and Family Service (CDJFS). NF's should initiate the level of care determination process for fee-for-service Medicaid eligibility prior to the end of managed care coverage for a member requiring a longer stay.
To find out more go to Managed Care Plans
