Member Alert: MyCare Ohio Enrollment

OHCA learned that this past Saturday, the Department of Medicaid began sending the so-called "friendly letters" to all Medicare and Medicaid dual eligible Ohioans (duals) the department identified as being eligible qualifying for MyCare Ohio. MyCare Ohio is the name of the Integrated Care Delivery System (ICDS) dual eligible demonstration that is slated to begin March 1, 2014.

Medicaid is sending the friendly letters only to duals living in MyCare Ohio regions (see map of MyCare Ohio regions), including duals in skilled nursing facilities and assisted living communities in those regions. Duals living in ICFs/IID are not eligible for MyCare Ohio.

Between 50% and 60% of the average skilled nursing center's patients are dual eligibles beneficiaries. Most Assisted Living Waiver beneficiaries are duals. Duals include anyone who is currently enrolled in both Medicare and Medicaid.

An individual enrolled in one program who could be eligible for the other program but is not actually enrolled is not a dual beneficiary, and therefore not currently eligible for this demonstration.

On the other hand, a SNF patient who is on both Medicaid and Medicare but who currently is not in a Part A stay is eligible for MyCare Ohio. The same is true of a person on the Assisted Living Waiver who also has Medicare, even though Medicare does not cover their assisted living services.

Duals in each MyCare Ohio region will be invited to enrolled in one of two or three managed care plans (see breakdown of plans by region), starting March 1, 2014. Enrollment initially will be voluntary. Duals in the MyCare Ohio regions will be able to select a plan but will not be required to do so.

After a one to three month voluntary enrollment period, depending on the region (see MyCare Ohio enrollment timeline), duals who have not selected a plan will be auto-enrolled (mandatorily enrolled) in a plan.

Mandatory enrollment only applies to the person's Medicaid benefits. A dual eligible individual may opt out of MyCare Ohio and keep Original Medicare for their Medicare benefits, but they have to tell the state's enrollment center that they wish to opt out. If the person does nothing, they will be auto-enrolled in MyCare Ohio for both Medicare and Medicaid. OHCA will send further details on opting out will be sent to members as they become available.

What is the friendly letter? The friendly letter is an introductory message informing the beneficiary in general terms about MyCare Ohio, explaining its benefits, and giving a phone number and website for additional information. The letter tells the beneficiary that they will receive a subsequent notice about how to choose their plan.

What can you do now, as the friendly letter is going out?

1. Identify which patients/residents in your facility are dual eligibles. Remember that the person must be enrolled currently in both Medicare and Medicaid.
2. Let the dual eligibles know they can expect to receive the friendly letter and check whether they in fact receive them. Letters may take some time to reach the beneficiaries, if they get there at all.
3. Provide general assistance and information in response to questions about MyCare Ohio to the extent you feel comfortable doing so. The Department of Medicaid has provided fact sheets tailored to specific populations such as SNF and Assisted Living Waiver that may be helpful in educating patients/residents/families. Ombudsmen, AAA personnel, or others also may reach out to beneficiaries and families about MyCare Ohio. The managed care plans, however, are not permitted to market directly to them.
4. The state's MyCare Ohio resources are the Ohio Medicaid Consumer Hotline at (800) 324-8680 Monday – Friday, 7 a.m. to 8 p.m., Saturday 8 a.m. to 5 p.m.) and http://www.ohiomh.com/.

Advice to beneficiaries. The friendly letter is a prelude to the actual MyCare Ohio enrollment notice, which will come next month and will tell dual eligibles how and when to sign up for the program. Nonetheless, the friendly letter may prompt beneficiaries or families to ask for advice or recommendations about whether they should sign up, which plan they should choose, or whether they should opt out and stay with Original Medicare.

Medicare/Medicaid providers are not permitted to select plans for beneficiaries, direct or suggest that they choose a specific plan, encourage them to opt out, or otherwise steer their decisions.

Providers may furnish factual information such as, for example, supplying the state's fact sheets, describing the basic structure of MyCare Ohio, or informing the beneficiary that the provider does or does not have a contract with a specific MyCare Ohio plan.

If you have questions about anything in this bulletin or about other aspects of MyCare Ohio, please contact Pete Van Runkle or Diane Dietz at OHCA.

If you are a dual eligible beneficiary's authorized representative for Medicaid purposes, you are permitted to make MyCare Ohio-related choices on their behalf. Authorized representative is a very specific status for Medicaid and is not the same as authorization to handle patient funds, authorization to receive information about Medicaid eligibility, or any other less extensive authorization.