MyCare Ohio
MyCare Ohio, a program for "duals" covered under both Medicare and Medicaid, has two components: (1) a capitated duals demonstration project that integrates Medicare and Medicaid benefits and (2) a Medicaid-only managed care component for people who choose to continue their Medicare coverage on a fee-for-service basis. The program was launched in 2014 and operates in 29 Ohio counties. The Medicaid-only component operates under authority of an 1915(b) Waiver. People receiving LTSS related to intellectual or developmental disabilities are excluded from the program.
Capitation rates depend on age group (18-44, 45-64, and 65+), region of the state, whether Medicare benefits are included in the rate (duals demo versus Medicaid-only plan), and the level-of-care need and setting. The Waiver/NFLOC rate is for people meeting the nursing home level of care criteria who are either eligible for or receiving HCBS Waiver services or have resided in a nursing home for longer than 100 days. The Community Well rate is for others. For people getting the Community Well rate prior to placement in a nursing home, the (lower) Community Well rate remains in effect for the first 100 days in the nursing home. For people on the NFLOC rate who transition to Community Well, the NFLOC rate remains in effect for three months.
More information
Ohio Medicaid monthly
caseload reports (includes MyCare LTSS participants by setting)
Program documents
Contract with managed care organizations (see also Provider agreement, below):
Annual CMS Evaluation Report:
Supplemental quality reporting requirements:
Memorandum of Understanding with CMS:
Demonstration proposal to CMS:
Approved 1915(b) Waiver proposal for the Medicaid-only component:
Provider agreement:
For capitation rate information, see Appendix E of the MyCare Ohio Provider Agreement, above.
