A Managed Care Plan or “MCP” is a private health insurance company that is licensed through the Ohio Department of Insurance and has a provider agreement with the Ohio Department of Job and Family Services to provide health care to your family and others that are on Medicaid.

An MCP must provide and arrange for all of the medically necessary services you get with the monthly Medicaid card. They do this through contracts with doctors, specialists, hospitals, pharmacies and other health care professionals in your area. You will work with a primary care provider or “PCP” that will provide health care or refer you to specialists in your MCP.

Your MCP will also provide special services and extras such as:

• A toll-free member services telephone number with staff that will help you get the care and services you need;
• A 24-hour (every day of the year) toll-free hotline with staff who can provide medical advice or directions on how to access health services;
• Help coordinating care for children with special health care needs; and
• Annual physical exams for adults.

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:

• Eligible for Supplemental Security Income (SSI) under Title XVI,
• Receiving foster care or adoption assistance under Title IV-E,
• In foster care or out-of-home placement, or
• Receiving services through the Ohio Department of Health’s Bureau for Children with Medical Handicaps (BCMH),

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:

• Which MCP offers all or most of the doctors I go to, or may want to go to?
• Which MCP offers the hospitals I like to use?
• Which MCP offers extra services that I want or like? (such as gift certificates for members who get prenatal care and immunizations on time, or who keep Healthchek appointments).

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.

If you are already enrolled in an MCP but you think you may want to change MCPs, you can change at certain times. Those times are:

• If you have been an MCP member for less than three months;
• Change during your Open enrollment month; and
• Just Cause (special reasons refer to your member handbook).

Just call the ODJFS Managed Care Enrollment Center (MCEC) toll-free at 1-800-605-3040, (TTY) 1-800-292-3572, En Espanol 1-800-605-3040 or on line at www.ohiomcec.com. An Enrollment Counselor will answer your questions and help you change from one MCP to another if you meet one of the reasons above.

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

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:

• The requirements and timeframes for filing an appeal, grievance, or state hearing,
• The rules about state hearings and how to ask for a state hearing,
• An explanation of how you may be able to have your services continue if you file an appeal or request a state hearing, and when you might have to pay for these services.

Your MCP must:

• Provide you with all the same medically necessary services that are covered by Medicaid.
• Give you a member handbook that explains how to get health care through the MCP, and the rules you must follow when getting health care services.
• Give you a member identification card. You must show this card every time you receive health care services.
• Give you a directory of all doctors, specialists, hospitals, pharmacies and other health care professionals who are in the MCP. This directory lists their addresses and telephone numbers. You can also see this information on your MCP’s member website.

• Choose one of your MCP’s doctors as your primary care physician (PCP) and agree to see your PCP or the providers to whom your PCP refers you.
• Follow all the rules in your MCP member handbook.
• Get your health care through the doctors, specialists, hospitals, pharmacies, and other health care professionals that are in your MCP’s provider directory, except under the special circumstances listed in your member handbook.
• Tell your MCP and your county caseworker right away if your address changes, so they can send you important information about your health care benefits.

After you choose an MCP, you will choose a provider for each family member. This provider is called a Primary Care Provider or “PCP”. Your PCP will work with you to coordinate your health care, such as giving you check ups and shots, treating you for most of you health care needs, sending you to a specialist if needed, or admitting you to the hospital.

When choosing a PCP keep the following in mind:

• Each MCP works with specific provider. Make sure the PCP you want is on the MCP’s panel (list of MCP’s health care providers).
• You can find out which providers you can choose from in your area by calling:
  • The MCP’s toll-free member services telephone number or looking on the MCP’s website (refer to page 11 for toll-free phone numbers and website); and
  • The ODJFS Managed Care Enrollment Center (MCEC) 1-800-605-3040, (TTY) 1-800-292-3572, En Espnol 1-800-605-3040, or looking at the MCEC website at www.ohiomcec.com.
• You can choose a different PCP each month for each member of your family that enrolls in the MCP.

MCP members get special additional services through their MCP in addition to all medically-necessary Medicaid covered services, such as:

• Each MCP member has a primary care physician or “PCP”. You will work with your PCP who will provide health care or refer you to a specialist in your MCP.
• A toll-free member services telephone center, with staff to help you get the care and service you need (a TTY line for those with hearing difficulties),
• A 24 hour (every day of the year) toll-free medical advice line with staff that can provide medical advice or direction on how to access health services,
• Information for members with special needs, such as those who speak a language other than English,
• Interpreter services for any language including assistance with written materials,
• Annual physical exams for adults,

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:

• What services are available.
• How to obtain services, including prior authorization requirements.
• How after-hours and emergency coverage are provided.
• Information on how to get benefits such as family planning services from out-of-panel providers;
• The MCP’s policy on referrals for specialty care and for other services not provided by your PCP.
• Information on post-stabilization care services.
• Information on advance directives.
• Information about your rights and protections.

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. In certain situations, for a brief time after you enroll, your MCP may allow you to receive care from a provider that is not contracted with the MCP. However, you must call your MCP before you receive the care. It is especially important to call your MCP to let them know if you have the following services already approved and/or scheduled:

• Organ, bone marrow, or hematapoietic stem cell transplant,
• Inpatient/outpatient surgery,
• Appointment with a specialty physician in the initial month of MCP membership,
• Chemotherapy or radiation treatments,
• Third trimester prenatal (pregnancy) care, including delivery.
• Services you receive at home, including home health, therapies, and nursing;
• Non-routine dental or vision services (for example braces or surgery); or
• Medical equipment.

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:

CARESOURCE	Unison Health Plan
1-800-488-0134	1-800-895-2017
(TTY) 1-800-750-0750	(TTY) 1-888-616-0021
www.caresourceohio.com	www.unisonhealthplan.com
Monday - Friday 7:00 am - 7:00 pm	Monday - Friday 7:00 am - 7:00 pm

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

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:

MCP	Annual Eye Exams for Adults*	Gift Certificates for Obtaining Prenatal Care	Gifts/Gift Certificates for Getting Immunizations and/or Keeping Healthchek Appointments
CareSource	YES	YES	YES
Unison Health Plan	YES	YES	YES

*All MCPs provide annual eye exams for children

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:

1. It is medically necessary for a member to use an ambulance or ambulette for transportation to an MCP covered service; and/or
2. A member must travel 30 miles or more from their home to reach an MCP-authorized provider.

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.

Health Care Plan	Cab Fare/ Shuttle Service	Must Call MCP in Advances
CareSource	30 round-trips per member per 12-month period to any covered medical care, WIC or CDJFS re-determination appointments when each one-way trip is less than 50 miles	48 hours (2 business days) or up to 30 days in advance notice
Unison Health Plan	30 one-way trips per member per 12-month period to any covered medical care, WIC, participation pharmacy or CDJFS re-determination appointments	48 hours (2 business days)

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.

MCP's Name	Member Services Telephone Number
24/7 Medical Advice Line
	Name	Phone Number
Family Doctors
Pediatricians
Dentists
Pharmacies
Hospitals

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. An Enrollment Counselor 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
Monday - Friday
8:00 a.m. to 8:00 p.m.
(800) 605-3040