Ohio has constructed a Medicaid managed care system that allows flexibility for counties to participate at a variety of levels, depending in part on the availability of Medicaid MCPs. Each county in the Medicaid managed care program may participate in only one of the program's components:
- Voluntary - Medicaid consumers may select an MCP or remain in traditional fee-for-service to receive their health care. If they do not choose an MCP, consumers remain in fee-for-service.
- Preferred Option - Medicaid consumers may select an MCP or remain in traditional fee-for-service to receive their health care. Consumers not making a choice are automatically assigned to an MCP.
- Mandatory - Medicaid consumers must select an MCP (from among two or more MCPs available in their county) through which they will receive all of their health care. Consumers not making a selection are automatically assigned to an MCP based on prior medical usage when this information is available.
For all of these components, the target audience is eligible Medicaid consumers - predominantly those in Ohio Works First (formerly Aid to Families with Dependent Children, AFDC) and Healthy Start and Healthy Families. For more information on the type of county in which you live, open selection periods, or how and when you can change your MCP, please call the Selection Services Center toll-free at 1-800-605-3040.
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Overview of AHS' Role. The Medicaid Managed Health Care Selection Services Project is the vehicle used to achieve the goals of Ohio's managed care initiative. The Project's objectives include:
- educating Medicaid consumers about managed care choices and the enrollment process,
- educating Medicaid consumers about their rights and responsibilities,
- linking Medicaid consumers with the MCP of their choice,
- assigning Medicaid consumers to MCPs,
- processing MCP selections and assignments,
- processing selection changes and membership closures,
- identifying those eligible for Just Cause closures and Continuity of Care deferments and assisting them in completing appropriate applications,
- filing formal complaints and grievances, and
- reporting information requested by the State.
AHS provides culturally and linguistically competent information, education, and selection services in Ohio via our state-wide toll-free Helpline as well as through interaction with our staff in the field; as such, we have developed a reputation for providing outstanding customer service. AHS is committed to going the extra mile for consumers (whether a Medicaid consumer or a representative of the provider community participating in one of our train-the-trainer sessions) and providing solid, professional service.Furthermore the Ohio Project exemplifies our corporate philosophy of offering "high touch" customer service techniques along with state-of-the-art telecommunications and information systems solutions. We have developed specific selection services software that can perform a variety of functions so that timely, accurate plan selection occurs for the consumers and the Plans while all necessary reports are generated for the State. This software has been designed with a great deal of flexibility, which allows for easy modification and expansion.
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