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Big Changes Coming for Those Who Receive Both Medicare and Medicaid

Posted November 19, 2013 in LEAP in the News

Big Changes Coming for Those Who Receive Both Medicare and Medicaid

Northeast Ohio residents who receive both Medicare and Medicaid are facing some big changes early next year. If you haven’t heard the terms dual eligible, ICDS, or MyCare Ohio, you soon will. But don’t worry! LEAP is ready to help you understand the jargon and assist you in making informed choices about your health care and long-term services and support needs.

To begin alerting consumers and stakeholders about these changes, the Office of Congresswoman Marcia L. Fudge recently held a public meeting at Cuyahoga Community College’s Jerry Sue Thornton Center. Coordinated by LEAP and supported by the Northeast Ohio MyCare Ohio Coalition and the Northeast Ohio Consumer Voice for Integrated Care coalition, the event was attended by about 75 people.

Presenters included Deborah Nebel, director of public policy at LEAP; Semanthie Brooks, director of community advocacy at the Benjamin Rose Institute on Aging; and Dorothie Haygood, senior manager at the Western Reserve Area Agency on Aging.

Here are the key facts you need to know:

  • If you receive full Medicare and Medicaid benefits, the system refers to you as someone who is “dual eligible
  • Starting in 2014, your health care services will be delivered in a new way. Ohio will be implementing an integrated care delivery system (ICDS) called MyCare Ohio.
  • If you are 18 years of age or older, you will be required to enroll in a managed care plan to continue to receive your Medicaid coverage, including waiver services, assisted living, and nursing facility care. Exception: Adults who are on a DD waiver or who live in an ICF/IID residential facility are not eligible. Other adults with developmental disabilities may enroll if it makes sense to them to do so.
  • You can choose to receive Medicare coverage in the same manner you have accessed it in the past.

The purpose of these changes is to coordinate care more effectively, eliminate duplication of services, and save money, Nebel said. The changes are part of a three-year demonstration project that is taking place in seven regions in the state.

In Northeast Ohio (Cuyahoga, Lorain, Medina, Geauga and Lake counties), about 33,000 individuals will be part of MyCare Ohio, according to Brooks. Of these, about 15,000 are under the age of 65, do not receive waiver services, and live in the community. Many of these 15,000 people also have disabilities.

Brooks outlined the timetable for implementing MyCare Ohio. Here are the key dates you need to know.

  • Dec. 12, 2013: A letter will be sent to all dual eligible individuals informing them about the new program.
  • Jan. 29, 2014: An enrollment letter will be sent explaining the voluntary and mandatory enrollment periods.
  • Feb. 1, 2014: The participating managed care plans can send marketing materials about MyCare Ohio to prospective enrollees. The participating plans in Northeast Ohio are Buckeye, CareSource, and United Health Care.
  • Feb. 1 to Feb. 27, 2014: During this voluntary enrollment period, dual eligible individuals may choose a plan. Those who do not select a plan will receive a letter at the end of the month (Feb. 27) informing them that a plan has been chosen for them. If they prefer one of the other available plans, they must contact the enrollment broker directly to change plans.
  • March 1, 2014: Coverage will begin for those who enrolled voluntarily.
  • April 1, 2014: Coverage will begin for those who were assigned a plan and for those who chose another plan during the month of March. Mandatory participation in the demonstration for all dual eligible individuals.

Each of the three participating managed care plans will have its own provider network, including providers of long-term services and supports and a medication formulary. Brooks explained that it is very important for consumers to choose the plan that best fits their needs for health care and long-term services and supports, and that also includes their medications in the formulary.

Two opportunities exist for getting involved and ensuring that MyCare Ohio truly works to the benefit of dual eligibles, said Nebel.

  • Northeast Ohio Consumer Voice for Integrated Care: This group is part of a statewide coalition that is monitoring the planning and implementation of MyCare Ohio. LEAP and Benjamin Rose are facilitating this local coalition, which is focused on getting consumers involved in the three managed care plans serving Northeast Ohio. Each plan is required to have a group that monitors the plan's effectiveness, and 20 percent of the members of these groups, known as local governance bodies, must be plan members of family members of plan members. Consumers are needed to participate in these local governance bodies.
  • Northeast Ohio MyCare Coalition: This group includes 12 partners working together to educate consumers and the people who serve them about the new system. Additional community partners are needed to help in this education and targeted outreach.

For information about these groups, contact LEAP.