Medicaid Managed Care FAQ

Medicaid Managed Care Frequently Asked Questions

1. What is a Medicaid Managed Care Plan (MCP)?

In Ohio, most individuals who have Medicaid must join a managed care plan (MCP) to receive their health care. An MCP is a private health-care insurance company that provides medically necessary health care. The Ohio Department of Medicaid contracts with plans that provide medically necessary services as determined by the Ohio benefit package. Additionally, plans provide:
Some MCPs may also choose to provide other services and benefits, such as:

2. How do I enroll in a managed care plan?

Shortly after you are approved for Medicaid you will get a letter asking you to pick a plan. Individuals who do not choose a managed care plan will be automatically enrolled in one to receive coverage. The individual will be notified of their assigned plan and how they can choose and enroll in a different plan.

3. How do I change my managed care plan?

Once an individual has been assigned to a managed care plan they will have 90 days to choose a new plan. After that, individuals may change their plan every year during the open enrollment period or if they can show just cause for the change.

4. What Should I expect as a member of a MCP?

Managed care acts just like regular private health insurance. Once you are enrolled in a managed care plan, you will get a new card in the mail. Keep this card for as long as you are on the plan. Your plan will also send information about the doctors, providers, health services and benefits that are available to you. The member handbook will explain covered services, grievance and appeal processes, your rights as a member of the plan, and much more. You will receive reminders from your managed care plan about preventative medical services, such as screenings, tests, and immunizations to keep you healthy. Each plan also has an online member portal. You can create an account to access additional information and reprint your identification card. You may request the services of a care manager from the managed care plan to help you coordinate your medical care, help you navigate the managed care system, and help you with accessing community resources, as needed.

5. How often will I get a new Medicaid Managed Care Plan card?

MCPs send one permanent card when an individual enrolls with the plan.

6. Can my parent/spouse or anyone else speak to the managed care plan on my behalf?

The Health Information Portability and Accountability Act of 1996 (HIPAA) protects confidential health information. If you are 18 years or older, HIPAA prohibits the plans from discussing your information with anyone. You may grant permission to the plan to speak to another person. There are two different types of designations:
If you would like to appoint a personal or authorized representative, complete this form and send it to your managed care plan.

7. What happens when I enroll with a managed care plan but I am already approved or scheduled to get health care from a doctor or hospital that does not work with my new MCP?

Managed care plans are required to work with you during your transition of care. Call the MCP’s member services team before you receive any services and they can provide you with information on what steps you must take for the care to be covered by your new plan.

8. How do I obtain health care through my MCP?

Your MCP’s member handbook provides information about how you get health care through your MCP. 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.

9. Managed care plan responsibilities

Your MCP must: