Frequently Asked Questions
- What is a Managed Care Plan (MCP)?
- How often will I get a new Medical card?
- What happens if I don’t choose a MCP?
- What happens when you join an MCP?
- What happens when you join an MCP but you are already approved or scheduled to get health care from a doctor or
hospital who does not work with your new MCP?
- How do you obtain health care through your MCP?
- What else should you know about getting our Medicaid health care through an MCP?
1. What is a Managed Care Plan (MCP)?
An MCP is a private health care insurance company that contracts with the state to provide all medically necessary health care you can
get with an Ohio Medicaid card. For example, an MCP must provide certain extra health care, such as:
- A toll-free medical advice phone line that is open 24 hours a day every day
- Help coordinating care for individuals with special health care needs
- Annual physical exams for adults
Some MCPs may also choose to provide other services and benefits, such as:
- Transportation to medical appointments and Medicaid redetermination appointments
No or lower co-payments (Individuals who use an Ohio Medicaid card may have co-payments for dental services, routine eye examinations,
eye glasses, and non-emergency services provided in a hospital emergency room.)
2. How often will I get a new Medical card?
MCPs send one card when you enroll in the plan. MCPs send only one permanent medical card,
which should be kept for the entire time you are on the MCP. The MCP card replaces the paper Medicaid medical card.
3. What happens if I don’t choose a MCP?
An MCP will be chosen for you if you do not make your selection by the date listed on your notice of mandatory enrollment.
4. What happens when you join an MCP?
Your MCP will send you their member identification card and member handbook. You will get health care from doctors and
hospitals who work with your MCP. You should choose an MCP that has most of the doctors and hospitals you want to use.
If the doctors or hospitals you have been using do not work with your MCP, you will have to change doctors or hospitals.
If you decide later you want to change MCPs, you can do so only:
- during the first 3 months you are enrolled in your MCP;
- if we decide you have a just cause;
- or during the next open enrollment month, which is November.
5. What happens when you join an MCP but you are already approved or scheduled to get health care from a doctor or
hospital who does not work with your new MCP?
You must phone the member services office of your new MCP before you receive the health care. You may be able to receive
the following health care from a doctor or hospital who does not work with your MCP:
- Organ, bone marrow, or hematopoietic stem cell transplant
- Inpatient/Outpatient surgery
- Appointment with a primary or sociality physician in the first three months of MCP membership
- Chemotherapy or radiation treatment
- Third trimester prenatal (pregnancy) care, including delivery
- Treatment plan related to a hospital discharge within the last 30 days
- Durable medical equipment
Your MCP must offer to pay them. If the doctor or hospital agrees to the payment, they can provide the above health care.
If they do not agree to the payment, your MCP will help you find another doctor or hospital that can provide the health care to you.
6. How do you obtain health care through your MCP?
Your MCP’s member handbook provides the information about how you get health care through your MCP.
7. What else should you know about getting our Medicaid health care through an MCP
Your MCP must:
- Provide you will all the same medically necessary health care that is 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. Read the handbook as soon as you get it.
- Give you a member identification card to use every time you get health care. You will not get an Ohio Medicaid card after you are an MCP member
- Give you a directory of all doctors, specialists, hospitals, and other health care professionals who are in the MCP, that lists their addresses and telephone numbers, and whether they will see you as a new patient. You can also see this information on your MCP’s member website.
- Have a toll-free member services line to help you and answer your questions
- Have a toll-free medical advice phone line that is open 24 hours a day every day
- Have translation services when needed if you do not speak English.
- Allow you to change your primary care provider (PCP) at least monthly by phoning the MCP
- Help you file a complaint or request a state hearing if you are unhappy with your health care services
- Help coordinate care for individuals with special health care needs.
- Provide annual physical exams for adults
- Provide medically necessary emergency or non-emergency ambulette transportation to Medicaid-covered services
- Provider non-emergency transportation if you must travel 30 miles or more to see MCP-authorized providers and you ask the MCP to provide transportation.