In my prior two posts, I’ve discussed the coming My Care Ohio pilot program for people on both Medicare and Medicaid (people called “dual eligibles.”) On February 21, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”.) On February 28, I 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 rather than maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.)
In the weeks before My Care Ohio is scheduled to start in a particular area, people in that area who are on both Medicare and Medicaid will receive a letter asking them to choose a Managed Care Organization. (The expected start dates are listed in the February 21 post.) This letter is called the “friendly letter. Dual eligibles in Cuyahoga, Geauga, Lake, Lorain, and Medina counties, My Care Ohio should already have received the “friendly letter” asking them to choose a Managed Care Organization by March 16. Unfortunately, because of the Medicare insurance rules, the MCOs can’t advertise their program and can’t disclose the providers on their approved lists, so the “friendly letter” asks people to make a blind choice. (Yes, that’s nuts, but it’s what is happening.)
During the first year, dual eligibles will be assumed to opt out of managed care for Medicare. They can’t opt out of Medicaid managed care. People who want managed care for both Medicare and Medicaid during the first year of My Care Ohio will need to actively opt into Medicare managed care. (In other words, in year one, silence equals opting out of Medicare managed care.)
For years two and three (Remember, it’s planned as a three-year program,) dual eligibles will be assumed to opt into managed care for both Medicare and Medicaid. They still won’t be able to opt out of Medicaid managed care. If they want to opt out of Medicare managed care, though, they will have to actively take steps to do so. (Silence equals opting in for year two and three.) It’s not yet determined what action will be necessary to opt out. (The Ohio Department of Medicaid has a year to figure that out.)
Opting into Medicare managed care will get a covered person a single Managed Care Organization that (supposedly) can coordinate their care as well as their Medicare and Medicaid benefits.
These Managed Care Organizations will be insurance companies. The companies will be paid a fixed amount of money for each covered person. The insurance companies will profit by holding expenditures below that amount. (In the insurance industry and in HMOs, this is called “capitation.”) The Managed Care Organizations that will be available in the various districts in the My Care Ohio program are listed in my February 21 post.)
The dual eligible people who opt into Medicare managed care will have the ability to change Managed Care Organizations each month if they wish.
In this first year of My Care Ohio, dual eligible people must choose:
(1) Whether to accept managed care for Medicare for this first year (when opting in requires positive action;)
(2) Which Managed Care Organization to join for Medicaid (and Medicare if opting in.)
In addition, for years two and three, dual eligible people will have to choose:
(3) Whether to accept managed care for Medicare for years two and three (when opting out requires positive action.)
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