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Medicare/Medicaid (duals) or consumers enrolled in waiver programs are excluded from MCP enrollment. Children under nineteen (19) years of age within the CFC and Healthy Start, Healthy Families programs have the option of being an MCP member if they are:
If you believe that your child meets any of the above criteria and you do not want your child to be a member of an MCP, you must call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040, or if you are hearing impaired (TTY) 1-800-292-3572 Monday-Friday 8:00 am to 8:00 pm. If we determine that your child meets the above criteria, your child will not have to join an MCP.
Because health care for you and your family is so important, choosing the best MCP is also important. If you are already enrolled you should also consider the same information before you decide to change plans. Here are some questions to ask yourself before choosing or changing your MCP:
You may have other concerns or questions that are important to you. You can call the MCPs in your region to ask your questions. The MCPs’ toll-free telephone numbers are in this guide.
MCP members get special additional services through their MCP in addition to all medically-necessary Medicaid covered services, such as:
Often, MCPs provide more services and benefits than the regular Medicaid fee-for-service (FFS) program offers. For a complete list of additional services and benefits offered by an MCP, please call the MCP’s toll-free number. The following are examples of additional services that the MCPs in your region provide:
You may have questions about certain doctors or other questions about an MCP before you choose or change plans. Here are important toll-free member services telephone numbers and websites for the MCPs in your region:
You also can call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040, if you are hearing impaired (TTY 1-800-292-3572) Monday-Friday, 8 am to 8 pm. A customer service representative can answer your questions and discuss your options. You can even make your choice right over the phone or through the website at https://www.ohiomcec.com/enroll. En Espanol 1-800-605-3040
Your MCP must:
When you are an MCP member you still have access to transportation for medical Appointments. You will be able to receive certain transportation help though your MCP, and you will be able to receive certain transportation services through your local county department of job and family services. Note: Emergency Ambulance Services are always covered by calling 911. MCPs must provide non-emergency transportation for their members if:
MCPs may provide additional transportation services as an extra benefit to members. The extra transportation assistance listed below is in addition to the transportation MCPs must provide to their members listed above. For more information on how to arrange non-emergency transportation, contact the MCP’s member services line. The county department of job and family services will provide transportation through the Non-Emergency Transportation (NET) program whenever the transportation shown below is not provided by the MCP. Note: Additional transportation benefits offered by your MCP do not have to be used prior to getting NET services.
Your MCP member handbook has information about getting health care. You can also call your MCP to ask questions. Make sure you know the following:
If you are unhappy with your MCP or its providers, you have the right to file an appeal, a grievance, and/or a state hearing. You can contact the MCP at their toll-free number and they can provide you with the following information:
If you are not already enrolled in an MCP, you will receive a notice that tells you when it is time for you to choose an MCP. The notice tells you about managed health care and how you can enroll. Choosing a Managed Care Plan (MCP) is Easy! To choose your MCP, you can call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040, Monday through Friday, 8:00 a.m. to 8:00 p.m. If you are hearing impaired you may call TTY 1-800-292-3572. A customer service representative will tell you about managed care, answer your questions, and help you choose an MCP. If you use the web you can look at information on line at www.ohiomcec.com and you can even enroll right over the internet. If you do not choose an MCP by the deadline, one will be chosen for you! The notice you receive will contain a date by which you have to choose an MCP. If you do not choose by this date, you will receive a letter telling you which MCP has been chosen for you. The letter will tell you how to make sure this is the MCP you want by calling the toll-free number above. If, for whatever reason, you do not get the MCP you want you can change your MCP under certain circumstances. Want more information? Go to Ohio’s Managed Care website for consumers: www.jfs.ohio.gov/ohp/bmhc/con-man-care.stm
What if I already have services scheduled? If you are changing from Medicaid fee-for-service to an MCP, and have health care services already approved and/or scheduled, it is important that you call the member services telephone number of the MCP that you choose as soon as possible. For the following services only, if your provider is not contracted with the MCP that you select, and you call before the date of the service, you may be able to receive the care through your current provider.
If you are already enrolled in an MCP but you think you may want a different MCP, you can change at certain times. If you have been an MCP member for less than three months and decide your MCP isn’t right for you, you can ask to change your MCP. Call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040 or if you are hearing impaired (TTY) 1-800-292-3572 or online at www.ohiomcec.com . They will tell you when your new plan starts. You can change during your Open Enrollment month. You will receive a notice that tells you JUNE is the open enrollment month for your region. Call the Managed Care Enrollment Center toll-free at 1-800-605-3040 or if you are hearing impaired (TTY) 1-800-292-3572 or online at www.ohiomcec.com. They will tell you when your new plan starts. You can change at other times for special reasons. In Ohio this is called Just Cause. If you have a problem with your MCP that makes you want to change to a new MCP, first you must call your MCP to see if they can help you. There is also information in your member handbook about the reasons for Just Cause. If you still want to change, call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040 or if you are hearing impaired (TTY) 1-800-292-3572 and explain your reason(s). Your reason(s) will be reviewed by the ODJFS. You may be contacted by a worker to discuss your issues or to ask for information. The state will also contact your MCP, and in some cases the doctors or other medical providers you use will also be contacted. Once all the information is reviewed, you will receive a letter that tells you if your request has been approved. If it is denied you may have the right to a state hearing.
Please use the chart below to keep the names and telephone numbers of your MCP and the doctors and other providers you and your family members use.
This Consumer Guide contains important information about how to get health care through an MCP, but it does not contain all the information you need to know about your MCP. Please be sure to keep this Consumer Guide along with your MCP Member Handbook and provider directory in a safe place. Keep your MCP identification card in a safe place. An MCP identification card is a permanent card. Do not throw it away. It is not like the monthly medical card that comes every month from the Medicaid program. Make sure you have your identification card with you when you need health care. Remember, as an MCP member, answers to your questions or help in getting health care are a phone call away. Call your MCP member service toll-free number; they are there to help you. You can also call the ODJFS Managed Care Enrollment Center toll-free at 1-800-605-3040, Monday through Friday, 8:00 a.m. to 8:00 p.m. If you are hearing impaired you may call TTY 1-800-292-3572. A customer service representative will tell you about managed care, answer your questions and help you choose an MCP. If you use the web you can look at information online at www.ohiomcec.com. You can even enroll right on the internet. En Espanol 1-800-605-3040
Call to speak with an Enrollment Counselor
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