Medicaid Mangaged Care 101

Medicaid Managed Care provides for the delivery of Medicaid health services and additional services through contracted arrangements between state Medicaid agencies and Managed Care Organizations (MCO’s) in Ohio in most counties. MCO’S that accept a set per member per month payment (capitation) for these services.

If you have Medicaid, you must pick an MCO or they will pick one for you. You can choose to have them manage your Medicare as well, but that is a choice. With Medicaid you must pick an MCO.

 As of 2019, MCOP is available in 29 of the 88 counties throughout the state of Ohio. These counties are:

Butler, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Delaware, Franklin, Fulton, Geauga, Greene, Hamilton, Lake, Lorain, Lucas, Madison, Mahoning, Medina, Montgomery, Ottawa, Pickaway, Portage, Stark, Summit, Trumbull, Union, Warren, Wayne, and Wood.

 There are five different Managed Care Organizations (MCOs) providing service. Not all five MCOs are available in every county. The MCOs are Aetna Better Health of Ohio, Molina Healthcare of Ohio, Buckeye Health Plan, CareSource, and UnitedHealthcare Community Plan of Ohio. The program’s overall administrator is the Ohio Department of Medicaid (ODM)

 If you live in one of these counties, you should have a managed plan and a case manager assigned. They should be coming out to see the resident every so often, you can ask when those times are. The case manager helps with care concerns and many things to assist the families.

There is more information on our resource page.