According to the Centers for Medicare and Medicaid Services “dual eligible” beneficiaries include individuals who receive full Medicaid benefits as well as those who only receive assistance with Medicare premiums or cost sharing.
A “dual eligible” demonstration program is also called an Integrated Care Delivery System (ICDS), which is a system of managed care plans selected to coordinate physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. “Demonstration” simply means that the program is in its pilot testing phase. MNS currently handles dual eligible demonstration programs for Texas (StarPlus MMP) and Ohio (MyCare), with more programs coming in the future.
MyCare Ohio is a managed care program designed for Ohioans over the age of 18 who are eligible to receive both Medicaid and Medicare benefits. This is called an Integrated Care Delivery System (ICDS) because it is a system of managed care plans selected to coordinate the physical health, behavioral health, and long-term care services of these beneficiaries.
While both Medicaid and Medicare programs provide individuals with access to critical services and care, there has always been a lack of coordination between these programs. MyCare Ohio Provides this coordination. Plus, MyCare Ohio plans may include additional services to their members. There is no additional cost to participate in this program.
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Please note that Medicare and Medicaid insurance plans do not electronically cross over. Therefore, in the case of patient having Medicare as the primary payor, and MyCare Medicaid as the secondary insurance payor, the MNS MyCare will take care of billing any claims to the secondary payor—at no charge to the patient.
Additionally, MNS does not charge the skilled nursing facility a fee to process MyCare retro claims.
The second phase of the MyCare Ohio demonstration will be effective January 1, 2015.
What does this mean?
Right now, people who live in the demonstration counties―and are eligible for Medicare and Medicaid―receive their Medicaid benefits through a MyCare Ohio managed care plan. On January 1, 2015, their Medicare coverage will change to the same managed care plan that provides their Medicaid benefits. This plan will also cover prescription drugs. Members will have the option to opt-out of the Medicare portion of the plan.
What do these members have to do?
If members want to receive their Medicare benefits and their Medicaid coverage through the same plan, you don’t have to do anything.
If members want to change how they receive their Medicare benefits, you must call the Ohio Medicaid Consumer Hotline at 800-324-8680 and tell them you do not want to change your Medicare plan.