“My Care Ohio” Enrollment for 2016

My Care Ohio enrollment is back.  Ohioans on both Medicare and Medicaid were first enrolled into My Care Ohio in May, June, and July 2014.  These “dual eligible” (better described as “dual covered”) Ohioans were renewed around this time in 2015,and Ohioans who have become covered by both Medicare and Medicaid have been added to the program as they receive that dual coverage.

My Care Ohio is a system of “managed care” for people on both Medicare and Medicaid in the populous areas of Ohio.  It is an attempt to control the state’s costs for long term care paid from the state budget.

When the implementation of My Care Ohio started in 2014, the February 22, 2014 blog post tried to provide an overview on how the My Care Ohio program was supposed to work.  The February 28, 2014 blog post explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person  The March 7, 2014 installment described the decisions that “dual eligibles” must make when My Care Ohio comes to their county:  (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three.  The March 13, 2014 installment outlined what to choices to make when enrolling in My Care Ohio.  When all of 2014’s enrollees were placed into the My Care Ohio program, the July 4, 2014 installment described how enrollees could minimize the likelihood that needed care services would be cut by opting out of Medicare participation in My Care Ohio.

Now that it’s time to make enrollment decisions for My Care Ohio for 2016, I want to revisit the strategies that dual-covered Ohioans should use.

My biggest fear for people in the My Care Ohio program is that their managed care organization (i.e., the insurance company to which they are assigned) will reduce services that the managed care organization/insurance company deems unnecessary as a way to cut costs.  (We’ll call the managed care organization/insurance company the “MCO.”)  For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.)  In fact, friends of mine who work in nursing homes have described a number of such discharges triggered by MCOs.  Unfortunately, without the 24 hour care that a nursing home provides, these discharged seniors are at great risk to their health and well-being.  Some of them will likely die.

The best protection against unwise cuts in services is the personal doctor.  My fear is that a doctor could feel pressured by the MCO that pays the doctor’s fee to comply with an MCO decision.  Because the doctor gets his or her payment from the MCO, the doctor may be hesitant to question or oppose the MCO’s decision to reduce services.

To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

– Opt out of the Medicare portion of My Care Ohio;
– Find out which MCO works best with the care providers (other than the doctor) that you would like to use and enroll with that MCO; and
-Choose a Medicare supplement (not an Advantage Plan) from an insurer that is not one of the MCOs in the My Care Ohio program.
– If you can’t get a supplement, then get the best Advantage Plan you can find, just make sure it’s not from a My Care Ohio MCO.

For example, a person who can choose between United Health Care  and CareSource as their MCO (as in Summit County where I live) would look at these insurers’ provider lists for the care providers that they prefer.  Then, the person would tell Ohio Medicaid that they choose to OPT OUT of Medicare’s participation in My Care Ohio.   Then the person would sign up for a Medicare supplement with a company other than United or CareSource.  (Get the supplement enrollment done before December 7.)  After taking these steps, the person’s doctor is paid by someone other than the MCO and would be immune to perceived pressure from the MCO to acquiesce to questionable care decisions.

Remember, in this third year of My Care Ohio, the program assumes that Medicare will be opted into My Care Ohio.  You must take steps to notify the program that you choose to opt out for Medicare.

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