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MyCare Ohio Update from Ohio Department of Medicaid

The following is information from the Ohio Department of Medicaid regarding Ohio's Integrated Care Delivery System.

• Ohio Medicaid has been transitioning its government-run fee-for-service (FFS) program to private-sector insurance plans. Enrollment in private health plans increased from 36 percent of the Ohio Medicaid population in 2006 to a projected 75 percent in 2015.

• In 2013, Ohio competitively selected five private sector health plans to serve Medicaid beneficiaries statewide. Every month, these plans arrange care for 1.9 million Ohioans, process 4.9 million claims, pay provider bills totaling $384 million, and pay 98.5 percent of all properly submitted claims within 30 days (federal law requires 90 percent in 30 days). This is based on average monthly July 1, 2013 to June 30, 2014.

• In 2012, Ohio selected four of the five current plans (Buckeye, CareSource, Molina, United) and one new plan (Aetna) to coordinate services in 29 pilot counties for Ohioans receiving both Medicare and Medicaid. Previously there was little, if any, coordination of care between these programs. Now the five MyCare Ohio plans are required to integrate physical, behavioral, and long-term care into one coordinated benefit package for individuals enrolled in both Medicare and Medicaid.

• As of August 7, 2014, MyCare Ohio plans have enrolled 103,349 Ohioans, processed 358,857 claims, and paid provider bills totaling $103 million (more detail below). As with any major program conversion, there have been some issues, but the health plans are working directly with provider associations to identify and resolve issues as they arise, and make it as easy as possible for providers to convert from government-run FFS to private health plans.


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