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The MyCare Ohio Plan (MCOP) is a mandatory managed care program for Ohio residents that are enrolled both in Medicaid and Medicare. Persons who are “dual eligible” or “dual covered” (for both Medicaid and Medicare) and reside in one of the programs’ 29 participating counties (listed below) receive all their health and care services through this program. In addition to healthcare, program participants can receive assisted living, adult day care, home care and assistance for home modifications for disabilities under this program.
Ohio’s Medicaid managed care program is different from the state’s other Medicaid programs, such as the PASSPORT Waiver and the Assisted Living Waiver in that 1) participation is required and 2) enrollment is not limited. The voluntary Medicaid Waivers have enrollment caps and, therefore, waiting lists can exist.
The MyCare Ohio Plan (MCOP) allows individuals to have a single point of contact for both programs and includes health, behavioral, and long-term care services in the home, assisted living, and nursing home. These services might include doctor visits, meal delivery, medical transportation, personal care assistance, and much more.
As of 2016, MCOP is available in 29 of the 88 counties throughout the state of Ohio. These counties are:
Butler, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Delaware, Franklin, Fulton, Geauga, Greene, Hamilton, Lake, Lorain, Lucas, Madison, Mahoning, Medina, Montgovery, Ottawa, Pickaway, Portage, Stark, Summit, Trumbull, Union, Warren, Wayne, and Wood
There are five different Managed Care Organizations (MCOs) providing service. Not all five MCOs are available in every county. The MCOs are Paramount Advantage, Molina Healthcare, Buckeye Community Health Plan, CareSource, and UnitedHealthcare Community Plan. The program’s overall administrator is the Ohio Department of Medicaid (ODM).
In addition to residing in one of the 29 counties listed above, to be eligible for the MyCare Ohio program, one must be eligible for both Medicare and for Medicaid. Ohio Medicaid has different eligibility requirements depending on the age of the applicant. Medicare is offered to all Americans 65 and over. Therefore, this program is only open to Ohio residents, 65 years of age (unless disabled) who meet the following financial eligibility criteria.
Income – for a single (unmarried, widowed or divorced) applicant, they must have monthly income not exceeding $643 after deducting any regular medical expenses. Married applicants are permitted up to $1100 per month, after subtracting regular medical costs.
Assets – the combined value of a single applicant’s countable financial assets cannot exceed $1,500. However, there are many exceptions to what is countable such as one’s home, vehicle and personal items. Married applicants are permitted slightly more money in the bank: $2250.
Individuals or married couples who exceed the limits but still cannot afford their cost of care, should not be discouraged. There are many paths to Medicaid eligibility and there are persons who specialized in helping families to gain Medicaid eligibility. To read more about these options, click here.
Many benefits are available via this program, including case management, doctor and hospital visits, prescription medication, dental and vision visits, rehabilitation, and nursing home care. Those who are enrolled in the Assisted Living Wavier or PASSPORT Waiver can continue to receive the services that are available via these waivers via the new MyCare Ohio HCBS Waiver Program. These include respite services, adult day care, emergency response systems, home modifications, personal care assistance, home delivered meals, durable medical equipment, and homemaker services.
MyCare Ohio also permits participants to consumer-direct or self-direct their care (in a limited capacity). Participants can hire, train and terminate their Personal Care providers and Home Care Attendants. Participants are given the flexibility to hire friends or family members, but not spouses or legal guardians. To be clear, this means the adult children caring for their aging parents can be compensated for their caregiving efforts.
For more information about the MyCare Ohio Plan or to enroll in this program, call the Ohio Medicaid Consumer Hotline at 1-800-324-8680. One can also enroll online here. To see what plans are available in your area, click here. For additional information about this program, click here.