The following are Managed Care Updates from ODM:
2021 Managed Care Annual Open Enrollment
Open enrollment runs from December 1 through December 31, 2021.
ODM began mailing open enrollment letters today and will continue through mid-November.
If a member doesn’t choose a new MCO, they will stay with their current MCO.
Member should direct all questions about their plan to:
Ohio Medicaid Consumer Hotline: 1-800-324-8680
Ohio Medicaid Consumer Hotline Website: www.ohiomh.com
ODM released a FAQ document which can be accessed here.
Unwinding of the Federally-Designated Public Health Emergency
The COVID-19 public health emergency (PHE) was most recently renewed effective July 20, 2021 and will likely continue for the entirety of CY2021.
HHS will provide states with 60 days’ notice prior to termination when a decision is made to terminate the PHE declaration or let it expire.
Under the Families First Coronavirus Response Act (FFCRA) continuous coverage requirement, ODM is unable to discontinue Medicaid coverage for members except when the individual voluntarily requests discontinuance of eligibility, is no longer a resident of the state, or is deceased.
State law enacted as part of the biennial budget gives ODM only 60 days after the PHE ends to complete and act on eligibility redeterminations for all members for whom a redetermination has not been conducted in the last 12 months and imposes other post-PHE eligibility actions.
Go-Live for the Next Generation Ohio Medicaid Program
Ohio Medicaid’s next generation program is projected to go-live on July 1, 2022.
This date encompasses all of Ohio Medicaid’s next-generation initiatives – Medicaid Managed Care, OhioRISE, Single Pharmacy Benefit Manager (SPBM), Provider Network Management (PNM) module and Centralized Credentialing, and Fiscal Intermediary (FI).
Members will be able to select from the next generation plans during Member Transition Enrollment in spring 2022. Additional information will be sent to members.
Please direct Medicaid managed care members with questions about the next generation program to the managedcare.medicaid.ohio.gov Resources for Individuals page or the Ohio Medicaid Consumer Hotline.
October CANS Training Dates Announced
The CANS is a functional assessment tool that will be used across systems to make determinations on OhioRISE (Resilience through Integrated Systems and Excellence) eligibility, care planning, Qualified Residential Treatment Program (QRTP) level of care, ongoing assessment, and monitoring of individual and population outcomes.