Ohio Medicaid’s Managed Care program is designed to offer a tailored approach to healthcare, ensuring that individuals receive the support and services best suited to their unique needs. Navigating the healthcare system can be complex, and Ohio Medicaid aims to simplify this process through its managed care plans. These plans emphasize personalized care, giving you more control and better access to the healthcare services you require.
Navigating Your Ohio Medicaid Managed Care Options
Choosing the right managed care plan is a crucial step in accessing your Medicaid benefits effectively. Ohio Medicaid understands that your healthcare needs and preferences are personal, and they provide options to help you select or change your plan to ensure it aligns with those needs. If you ever feel your current plan isn’t meeting your expectations, you have avenues to make a change.
Selecting Your Managed Care Plan
Making an informed decision about your managed care plan is essential. Ohio Medicaid offers resources and opportunities to choose a plan that works best for you.
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Annual Open Enrollment: Each year, Ohio Medicaid holds an open enrollment period in November. This is a dedicated time for all Medicaid members to review their current plan and make changes if desired. You can switch to a different managed care plan during this period, and your new selection will take effect on the first day of the following month, ensuring a smooth transition in your healthcare coverage.
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Just Cause Enrollment Changes: Recognizing that your needs might change outside of the annual enrollment period, Ohio Medicaid provides the option to request a plan change at any time for “Just Cause.” This provision is in place to address situations where you have significant concerns about your current plan, particularly regarding access to necessary healthcare services or benefits. If you believe you have valid reasons to change plans outside of open enrollment or the initial 90-day enrollment window, you can submit a Just Cause request. To initiate this request, reach out to the Ohio Department of Medicaid through the Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 711). You can also contact your managed care plan directly to discuss your concerns and explore the Just Cause option.
To make your plan selection or explore your options, you can conveniently visit the Ohio Medicaid Consumer Hotline Portal at https://members.ohiomh.com. Alternatively, you can speak with a representative directly by calling the Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 711). The hotline is staffed with representatives ready to assist you Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m. Eastern Time.
OhioRISE Program Integration with Managed Care
For individuals enrolled in the OhioRISE (Resilience through Integrated Systems and Excellence) program, the managed care structure is slightly different, tailored to address behavioral health needs specifically. OhioRISE enrollees receive their behavioral health services through Aetna, which is the designated OhioRISE plan. However, for medical, dental, vision, and other general health services, OhioRISE members can choose from one of the seven other managed care programs available under Ohio Medicaid, or they can opt for fee-for-service Medicaid. This integrated approach ensures that OhioRISE members receive specialized behavioral healthcare while still having comprehensive coverage for all their healthcare needs through the broader Ohio Medicaid system.
