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Medicare / Medicaid – MyCare Ohio

The Ohio Consumer Voice for Integrated Care (OCVIC) is a coalition led by UHCAN Ohio to assure that the managed care plans meets the needs of the adults on the MyCare Ohio Plan.  MyCare Ohio is a demonstration program that coordinates physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. In late 2012, Ohio became the third state in the nation to receive federal approval for its plan to coordinate benefits for residents covered by Medicare and Medicaid.   

MyCare Ohio began in May 2014 and is being implemented in 28 counties Ohio counties.  There are over 100,000 individuals enrolled in the MyCare Ohio program who either chose or were assigned to one of five health plans.  MyCare Ohio is a 3 year demonstration and will be evaluated by Ohio Department of Medicaid and the Centers for Medicare and Medicaid Services at the end of the demonstration.

The goal of MyCare Ohio is to encourage choice and self-direction, provide support for individuals to remain independent and in the community, and provide care management that includes face-to-face visits in the home and community.  Adults who are dual eligible often face a number of challenges:

  • Limited care coordination (communication and services are not well coordinated between Medicare and Medicaid
  • Medicaid and Medicare coverage is inconsistent, confusing and difficult to navigate
  • Multiple health care needs

OCVIC has worked with the plans and the Ohio Department of Medicaid to navigate this significant change.  UHCAN Ohio and its OCVIC partners have done this by bringing together the voice of consumers and by advocating for effective inclusion of those voices in the quality improvement of the system.  OCVIC listens to consumers and brings issues and solutions to the plans and the Ohio Department of Medicaid.

As the program matures, OCVIC continues to carry a range of issues for consumers but is focusing on the consumer advisory committees and access to care.  OCVIC urges the plans to make the required consumer advisory committees an integrated part of their quality improvement process.  Consumers can provide meaningful and valuable input into the problems they face and potential solutions.  UHCAN Ohio encourages the plans to ensure that the advisory committees represent the diversity of the population served so that progress can be made towards health equity.  

Objectives:

  • Ohio Department of Medicaid convenes a MyCare Ohio health equity workgroup.
  • The workload for care managers mirrors Passport and is stratified by complexity.
  • Consumer advisory committee (CAC) for three MyCare Ohio plans are trained and function to provide meaningful quality improvement feedback to the plans.
  • Systemic improvements are made to improve access to care
  • A mechanism is created to enable two way communication with members of CAC to contribute to advocacy that improves access, affordability and quality of healthcare

Accomplishments:

  • UHCAN Ohio has trained consumer advisory committees for two of the MyCare plans to help the participants provide meaningful input on systems changes that will lead to quality improvement.
  • OCVIC Coalition leadership meets regularly with the leadership of Medicaid, the managed care plans and consumers to communicate common concerns that are being experienced by those with MyCare.
  • UHCAN conducted a survey of over 3,000 MyCare members to identify the challenges they are having in getting quality healthcare under the plans.  The two major findings were problems with care coordination and durable medical equipment.

Leadership Team:

  • Ability Center of Greater Toledo
  • Benjamin Rose Institute on Aging
  • Center for Disability Empowerment
  • Center for Independent Living Options
  • Contact Center
  • Disability Rights Ohio
  • Easter Seals of Ohio
  • Legal Aid Society of Columbus
  • Linking Employment Abilities and Potential
  • Ohio Association of Area Agencies on Aging
  • Ohio Olmstead Task Force
  • Ohio Poverty Law Center
  • Ohio Association of Retired Americans
  • Ohio State Independent Living Council
  • Pro Seniors

Staff Contact: Steve Wagner swagner@uhcanohio.org 614-456-0060 x222

Action:

  • Partner
  • Consumer
  • Activist
  • Reporter
  • Funder