The MyCare Ohio Plan (MCOP), also known as the Integrated Care Delivery System (ICDS) Medicaid Waiver, 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 services, adult day care, home care, and assistance for home modifications for disabilities under this program’s home and community based services waiver group.
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 Medicare and Medicaid and includes health, behavioral, and long-term care services in the home, assisted living, and nursing homes. These services might include doctor visits, meal delivery, medical transportation, personal care assistance, and much more. Please make note, individuals may opt out of receiving their Medicare benefits via MyCare Ohio and instead receive them via traditional Medicare or a Medicare Advantage plan. However, opting out is not an option for their Medicaid benefits.
As of 2020, 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, Montgomery, 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 Aetna Better Health of Ohio, Molina Healthcare of Ohio, Buckeye Health Plan, CareSource, and UnitedHealthcare Community Plan of Ohio. 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 and enrolled in both Medicare (Parts A, B, and D) and Medicaid. Ohio Medicaid has different eligibility requirements depending on the age of the applicant. Medicare is offered to all Americans 65 years of age 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, as of 2020, one must have monthly income no greater than $783. Married applicants can have monthly income up to $1,175. However, there is one exception, individuals who are in the Home and Community Based Services (HCBS) waiver group may be entitled to a higher monthly income limit of 300% of the Federal Benefit Rate (FBR). This figure is currently $2,349 / month.
Assets – the combined value of a single applicant’s countable financial assets cannot exceed $2,000. However, there are many exceptions to what is countable, such as one’s home (up to an equity value of $595,000), a vehicle, and personal items. Married applicants are permitted slightly more money in the bank: $3,000.
Individuals or married couples that 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 specialize 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 Integrated Care Delivery System (ICDS) Medicaid Waiver’s (MyCare Ohio) home and community based services group. These services include respite services, adult day care, emergency response systems, home modifications, personal care assistance, home delivered meals, home maintenance and chore services, social work counseling, nutritional consultation, nursing services, home care attendant services, durable medical equipment, transportation (medical and non-medical), and homemaker services. One may also receive transitional services to assist with relocating from a nursing home to living back at home.
MyCare Ohio also permits participants to consumer-direct or self-direct their care (in a limited capacity) of certain HCBS services. 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 except for extraordinary circumstances. 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. To see which plans are available in your area, click here. (Look for the drop down menu in the answer of question #2). For additional information about this program, click here.