According to the Centers for Medicare and Medicaid Services, "dual eligible" beneficiaries refers to those qualifying for both Medicaid and Medicare.
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 Ohio (MyCare) and Texas (StarPlus MMP). MNS is contracted with Molina, CareSource, and Buckeye for the MyCare Ohio program and Amerigroup Texas MMP for the Texas duals demonstration. We are looking to expand our network with other states in the future.
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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The second phase of the MyCare Ohio demonstration was 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 changed to the same managed care plan that provides their Medicaid benefits. This plan also covers prescription drugs. Members 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.
If you are a contracted payor using our management portal, click the button below to enter the gateway.