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Medicaid Moving Majority of Clients to Managed Care

As part of the Budget Bill (HB 66), pharmacists will begin to see considerable changes to the Medicaid program in Ohio. The most significant will be the enrollment of more than 1.3 million Medicaid consumers in Medicaid Managed Care Plans (MCPs) by December 31, 2006. MCPs are said to offer Medicaid consumers additional services including a "medical home" setting for their healthcare needs, toll-free access to member service representatives for help in accessing health services, a network directory of healthcare professionals, and access to specialized services for special healthcare needs including care management services. For providers, MCPs offer assistance in the care management of patients with complex healthcare needs, assistance with patient healthcare issues and questions through a toll-free, 24/7 nurse hotline, prevention-focused health promotion and patient education programs and services.

Statewide expansion of the Medicaid managed care program will be conducted in two phases. In Phase I, Medicaid consumers participating in the Covered Families and Children (CFC) program will be enrolled first. To-date, 19 health plans have expressed interest in participating in the program. A listing of these plans is available at www.jfs.ohio.gov/ohp/bmhc/pro-man-care.stm. />
In Phase II, 125,000 Medicaid consumers who are Aged, Blind or Disabled (ABD) will be enrolled in a Medicaid MCP. Approximately 400,000 ABD Medicaid consumers will be exempt from enrollment in an MCP. These include, but are not limited to, ABD children, Medicaid/Medicare dual-eligibles, consumers with a spend-down, institutionalized consumers and consumers who are participating in a home and community-based waiver program. They will continue to received healthcare services through the traditional Medicaid fee-for-service program.

The Bureau of Managed Health Care (BMHC)is keeping stakeholders informed through meetings with various group, as well as through their website listed above.


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