A Provider’s Guide to Ohio Medicaid Managed Care
If you’re an Ohio homecare provider, you may have some questions about Medicaid Managed Care and how it works. HHAeXchange is the premiere Homecare Management Software company for the Medicaid LTSS population, and we’re the leader in connecting payers and providers to enable more collaboration, communication, and workflow efficiencies. Through the use of the HHAeXchange Portal, our goal is to make working with Ohio’s Medicaid Managed Care plans easy and efficient.
We put together a quick guide with key background info and other important details providers should know about Medicaid in Ohio. Check it out below!
The information presented in this blog post was extracted from the Ohio Medicaid Managed Care website.
What is Medicaid Managed Care?
Medicaid Managed Care acts just like regular private health insurance for individuals enrolled in the Ohio Medicaid program.
In Ohio, most people approved for Medicaid are automatically enrolled for Medicaid Managed Care coverage. Shortly after enrolling in Medicaid, individuals get a letter asking them to choose a Medicaid Managed Care Plan (MCP). Once enrolled with an MCP, the plan sends a permanent card for use when seeking services from providers as well as information about the scope of coverage of the plan.
What are the Medicaid Managed Care plans in Ohio?
There are five Medicaid Managed Care plans in Ohio:
What are some of the more recent major changes made to the Medicaid Managed Care program?
In January 2012, Ohio embarked on a redesign of the Medicaid Managed Care program. Changes to the program reduced the state’s administrative service regions to three; combined coverage for the Covered Families and Children (CFC) with Aged, Blind, and Disabled (ABD) populations; covered a portion of children with special needs; and implemented several other changes aimed at improving quality of care and health outcomes for individuals.
What does the Ohio Department of Medicaid (ODM) do?
Launched in July 2013, the Ohio Department of Medicaid (ODM) is Ohio’s first Executive-level Medicaid agency. With a network of approximately 130,000 active providers, ODM delivers health care coverage to more than 2.9 million residents of Ohio on a daily basis. Working closely with stakeholders, advocates, medical professionals, and fellow state agencies, ODM continues to find new ways to modernize Medicaid in Ohio. Five managed care plans (MCPs) were selected and began providing services in all three regions in July of 2013.
Who is covered under ODM?
Ohio expanded Medicaid coverage in January 2014 to individuals making up to 138% of the federal poverty level (Group VIII). In any given month during state fiscal year 2018, Ohio’s five MCPs provided services to an average of 2.4 million Ohioans, nearly 88% of all individuals enrolled in Medicaid.
How can I confirm if a patient is eligible for coverage?
Providers are responsible for confirming Medicaid eligibility and the MCP enrollment for their patients. The ODM has two sources for eligibility and enrollment:
Information online through the Ohio Medicaid Information Technology System (MITS)
Information through Interactive Voice Response lines at (800) 686-1516. – The first response states patient eligibility. – The second prompt provides the patient’s managed care plan enrollment, if any.
Where can I find more information?
For more information on the Ohio Medicaid Managed Care program, visit medicaid.ohio.gov/provider/ManagedCare. For additional Medicaid resources, check out medicaid.ohio.gov/RESOURCES/Resources-for-Providers.
HHAeXchange is the nation’s leading EVV solution with over 214 million visits confirmed annually through our platform. As an alternate EVV solution provider certified by the Ohio Department of Medicaid (ODM), we’re actively providing solutions to meet EVV requirements for Ohio agencies. If you still need to find an EVV solution before the January 2021 deadline, contact us to learn more.