My Care Ohio

“My Care Ohio” (People on both Medicare and Medicaid) Enrollment for 2017

Posted on November 3, 2016 by Jim Koewler — No Comments ↓

This week’s blog takes another break from the ongoing discussion of the 2016 changes to Ohio Medicaid’s rules. My Care Ohio enrollment for 2017 has started, so this installment will discuss strategies to reduce the adverse impacts that My Care Ohio could possibly cause to a person’s long term care.

Ohioans on both Medicare and Medicaid were first enrolled into My Care Ohio in May, June, and July 2014. These “dual eligible” (better described as “dual covered”) Ohioans were renewed around this time in 2015 and in 2016, and Ohioans who have become covered by both Medicare and Medicaid have been added to the program as they receive that dual coverage.

My Care Ohio is a system of “managed care” for people on both Medicare and Medicaid in Ohio. It is an attempt to control the state’s costs for long term care paid from the state budget.

When the implementation of My Care Ohio started in 2014, the February 22, 2014 installment tried to provide an overview on how the My Care Ohio program was supposed to work. The February 28, 2014 installment explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person The March 7, 2014 installment described the decisions that “dual eligibles” must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. The March 13, 2014 installment outlined what to choices to make when enrolling in My Care Ohio. When all of 2014’s enrollees were placed into the My Care Ohio program, the July 4, 2014 installment described how enrollees could minimize the likelihood that needed care services would be cut by opting out of Medicare participation in My Care Ohio. After a few months of experience with My Care Ohio, the December 5, 2014 installment described how the program was cutting off long term care benefits for some people.

Now that it’s time to make enrollment decisions for My Care Ohio for 2017, I want to revisit the strategies that dual-covered Ohioans should use.

My biggest fear for people in the My Care Ohio program is that their managed care organizations (i.e., the insurance companies to which they are assigned) will reduce services that the managed care organizations/insurance companies deem unnecessary as a way to cut costs. (We’ll call the managed care organizations/insurance companies the “MCOs.”) For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.) In fact, friends of mine who work in nursing homes have described a number of such discharges triggered by MCOs. Unfortunately, without the 24 hour care that a nursing home provides, these discharged seniors are at great risk to their health and well-being. Some of them will likely die.

The best protection against unwise cuts in services is the personal doctor. My fear is that a doctor could feel pressured by the MCO that pays the doctor’s fee to comply with an MCO decision. Because the doctor gets his or her payment from the MCO, the doctor may be hesitant to question or oppose the MCO’s decision to reduce services.

To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

– Opt out of the Medicare portion of My Care Ohio;
– Find out which MCO works best with the care providers (other than the doctor) that you would like to use and enroll with that MCO; and
-Choose a Medicare supplement (not an Advantage Plan) from an insurer that is not one of the MCOs in the My Care Ohio program.
– If you can’t get a supplement, then get the best Advantage Plan you can find.
– If the Advantage Plan is from an insurance company that serves as a My Care Ohio MCO in your area, choose a different insurance company as your MCO.

For example, a person in Summit County (where I live) can choose between United Health Care and CareSource as his/her MCO. Then the person would sign up for a Medicare supplement, preferably with a company other than United or CareSource. (Get the supplement enrollment done before December 7.) If the person can’t get a Medicare supplement (most likely because of health issues,) then the person should look for the Advantage Plan that fits best with his/her needs. (The person should look for coverage of the prescription drugs that the person uses and participation of the person’s doctor.)

If the person got a Medicare supplement or an Advantage Plan from a company other than United or CareSource, then the person should choose an MCO (United or CareSource) whose provider lists for the My Care Ohio program is best for the person’s situation. If the person DID get a Medicare supplement or Advantage Plan from United or CareSource, then the person should choose the other company as his/her MCO if at all possible.

Then, the person should tell Ohio Medicaid that he/she chooses to OPT OUT of Medicare’s participation in My Care Ohio.

After taking these steps, the person’s doctor is paid by someone other than the MCO and would be immune (as much as possible) to perceived pressure from the MCO to acquiesce to questionable care decisions.

Remember, in this fourth year of My Care Ohio, the program assumes that Medicare will be opted into My Care Ohio. You must take steps to notify the program that you choose to opt out for Medicare.

Ohio Medicaid changes “Aged Blind Disabled” Eligibility – Miller Trust can’t pay Health Insurance Premium

Posted on July 7, 2016 by Jim Koewler — No Comments ↓

This week’s blog continues the discussion of the changes to Ohio Medicaid’s Aged, Blind and Disabled (ABD) program coming in 2016-2017. The initial installment (April 28, 2016) provided an overview of the transition from the old system (following section 209(b) of the federal Medicaid law) to the new system (that will follow section 1634 of the federal Medicaid law.) The May 5, 2016 installment discussed the new income rules that will go into effect with the new eligibility system. The May 12, 2016 installment discussed setting up a Qualified Income Trust (aka Miller Trust) that will be necessary for people who need ABD Medicaid to help pay for long term care. The June 16, 2016 installment discussed the Ohio rules that describe how to use the Miller Trust each month. The June 23, 2016 installment discussed the difficulty in understanding the need for a Miller Trust. The July 1, 2016 installment, discussed the need to empty the Miller Trust account every month. Today’s installment will discuss the need to balance the Miller Trust with the desire to have health insurance.

The Ohio Department of Medicaid has finalized its new rule on Miller Trusts (aka Qualified Income Trusts or QITs.) A copy of the final rule is available here. The form Miller Trust from the Ohio Department of Medicaid can be found here. Because the rule calls them QITs and today’s installment makes a number of references to the new rule, for this installment, I’ll usually call them QITs.

As discussed in previous installments, the QIT is tricky to use each month. Many people are considering whether it would simplify managing the QIT to put all of the person’s income into the QIT each month. Section K of the QIT rule allows the Medicaid recipient “to have all,or only a portion, of his or her income placed into the QIT account” as long as at least the income over $2,199 is placed into the QIT account. No one can doubt that that it would be easier to deal with one bank account each month than it would be to deal with multiple bank accounts.

Once income is placed into the QIT account, it becomes subject to the limitations of the QIT rule and the QIT’s declaration of trust. Section E of the QIT rule and Article III of the QIT template limit payments from the QIT account to (1) the monthly income allowance of the Medicaid beneficiary for his or her personal spending, (2) the share of the Medicaid recipient’s income that must be shared with his or her spouse according to Medicaid’s rules , (3) incurred medical costs of the Medicaid recipient, and (4) a small amount for bank fees, legals fees, accounting fees, and other similar fees. (Note: There is also a reference in subsection 2 to an income share for family dependents, but there has never before been a sharing of income with anyone other than the spouse, and there does not seem to be any change to the income rules allowing income to be shared with dependents, so I am not sure that sharing of income with dependents is really going to be allowed.)

None of the allowed payments from the QIT account is available for the payment of medical insurance premiums.

Before this recent change in rules, Ohio Medicaid allowed a covered person to use part of his or her income each month to pay for health insurance premiums. (The payment of insurance premiums leaves less money to pay for care costs, but Medicaid would increase its payment to the care provider to make up for the revenue lost to the insurance premium.)

The new version of the income rules has not changed the requirements regarding insurance premiums. A Medicaid covered person still can purchase medical insurance without running afoul of the new rules. BUT, the insurance premiums can’t be paid out of the QIT. In short, medical insurance premiums are an allowed expense for the person, but not an allowed expense for the person’s QIT.

So, if the Medicaid recipient wants to have medical insurance, payment arrangements must be made outside of the QIT. The ease of using the QIT to manage all income is lost if the person wants to keep medical insurance. Likewise, if the person handling the income for the Medicaid recipient wants to ease his or her administrative burden by placing all income into the QIT, medical insurance won’t be available.

(As an additional result of having no medical insurance, the Medicaid recipient will have both Medicare and Medicaid controlled in the My Care Ohio program, which might result in a loss of some care through the program’s cost controls. For a review of the My Care Ohio program, read the blog posts available through the My Care Ohio category.)

“My Care Ohio” Enrollment for 2016

Posted on November 5, 2015 by Jim Koewler — No Comments ↓

My Care Ohio enrollment is back. Ohioans on both Medicare and Medicaid were first enrolled into My Care Ohio in May, June, and July 2014. These “dual eligible” (better described as “dual covered”) Ohioans were renewed around this time in 2015,and Ohioans who have become covered by both Medicare and Medicaid have been added to the program as they receive that dual coverage.

My Care Ohio is a system of “managed care” for people on both Medicare and Medicaid in the populous areas of Ohio. It is an attempt to control the state’s costs for long term care paid from the state budget.

When the implementation of My Care Ohio started in 2014, the February 22, 2014 blog post tried to provide an overview on how the My Care Ohio program was supposed to work. The February 28, 2014 blog post explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person The March 7, 2014 installment described the decisions that “dual eligibles” must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. The March 13, 2014 installment outlined what to choices to make when enrolling in My Care Ohio. When all of 2014’s enrollees were placed into the My Care Ohio program, the July 4, 2014 installment described how enrollees could minimize the likelihood that needed care services would be cut by opting out of Medicare participation in My Care Ohio.

Now that it’s time to make enrollment decisions for My Care Ohio for 2016, I want to revisit the strategies that dual-covered Ohioans should use.

My biggest fear for people in the My Care Ohio program is that their managed care organization (i.e., the insurance company to which they are assigned) will reduce services that the managed care organization/insurance company deems unnecessary as a way to cut costs. (We’ll call the managed care organization/insurance company the “MCO.”) For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.) In fact, friends of mine who work in nursing homes have described a number of such discharges triggered by MCOs. Unfortunately, without the 24 hour care that a nursing home provides, these discharged seniors are at great risk to their health and well-being. Some of them will likely die.

To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

– Opt out of the Medicare portion of My Care Ohio;
– Find out which MCO works best with the care providers (other than the doctor) that you would like to use and enroll with that MCO; and
-Choose a Medicare supplement (not an Advantage Plan) from an insurer that is not one of the MCOs in the My Care Ohio program.
– If you can’t get a supplement, then get the best Advantage Plan you can find, just make sure it’s not from a My Care Ohio MCO.

For example, a person who can choose between United Health Care and CareSource as their MCO (as in Summit County where I live) would look at these insurers’ provider lists for the care providers that they prefer. Then, the person would tell Ohio Medicaid that they choose to OPT OUT of Medicare’s participation in My Care Ohio. Then the person would sign up for a Medicare supplement with a company other than United or CareSource. (Get the supplement enrollment done before December 7.) After taking these steps, the person’s doctor is paid by someone other than the MCO and would be immune to perceived pressure from the MCO to acquiesce to questionable care decisions.

Remember, in this third year of My Care Ohio, the program assumes that Medicare will be opted into My Care Ohio. You must take steps to notify the program that you choose to opt out for Medicare.

“My Care Ohio” could cut off your Long Term Care Benefits

Posted on December 4, 2014 by Jim Koewler — No Comments ↓

My Care Ohio is cutting off Medicaid payments for some seniors who need long term care. Without payment, the providers can’t afford to provide long term care.

The insurance companies that “manage” care for Ohioans who are covered by both Medicare and Medicaid have started to identify people who, in the opinion of employees of the insurance company employees, are not eligible for Medicaid and then have cut off Medicaid payments for those people. To be blunt, this seems very much like the “death panels” that Republicans claimed would result from the never-adopted Clinton health plan.

For those who have not followed the My Care Ohio discussion from its start earlier this year, My Care Ohio is a system of “managed care” for people on both Medicare and Medicaid (called “dual eligible” but more accurately described as “dual covered”) in the populous areas of Ohio. It is an attempt to control the state’s costs for long term care paid from the state budget.

When the implementation of My Care Ohio started earlier this year, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”) on February 22, 2014. On February 28, 2014, I explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.) On March 7, 2014, I described the decisions that dual eligibles must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. (Your Options in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”) On March 13, 2014, I outlined what to choices to make when enrolling in My Care Ohio. (What to choose in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”.)

When all of 2014’s enrollees were placed into the My Care Ohio program, I described how enrollees could minimize the likelihood that needed care services would be cut by opting out of Medicare participation in My Care Ohio (Keep your doctor separate from your Managed Care Organization in the “My Care Ohio” program) in my July 4, 2014 post. On November 13, 2014, I reiterated my suggestions about My Care Ohio enrollment with the opening of the renewal period for next year. (“My Care Ohio” Enrollment for 2015)

As it happens, just as we muddle through the 2015 enrollment period, we also get feedback from long term care service providers about the treatment of their clients/patients at the hands of the My Care Ohio insurance companies. That feedback is not good news for Ohio’s dual-covered seniors. The insurers are looking for people whom they can cut off from coverage using the opinions of insurance company doctors to justify their decisions.

These people would not have been covered by Medicaid in the first place if their own doctor had not determined that long term care was necessary. So, for these people under insurance company scrutiny, we have a repeated difference of opinions between doctors. It seems, however, that only the opinion of the insurance company doctor matters.

My biggest fear for people in the My Care Ohio program is that their managed care organization (i.e., the insurance company to which they are assigned, whom we will call an “MCO”) will reduce services (in order to cut costs) that the managed care organization/insurance company deems unnecessary. For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.) Sadly, my biggest fear seems to have come to pass.

These MCOs are quick to tell the people whom they de-fund that the insurance company hasn’t cut off their long term care. If the long term care stops, that’s the decision of the care provider (nursing home, assisted living facility, or home-care provider, etc.) That, however, is a disingenuous story. The real story should be that the insurer is cutting off payments to the provider and the provider is not in a position to provide long term care for free.

Now, this process is not the insurers’/MCOs’ fault (not all their fault anyway.) This is a state of Ohio decision to cut costs by cutting off care. An MCO’s job is to be the actual “hatchet man.”

So, if you or a loved one is dual covered (both Medicaid and Medicare) in Ohio, protect against service cuts. The best protection against unwise cuts in services is keeping your personal doctor and keeping your doctor away from undue influence by the MCO. To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

Opt out of the Medicare portion of My Care Ohio;
Find out which MCO works best with the care providers (other than the doctor) that you would like to use and enroll with that MCO; and
Choose a Medicare supplement (not an Advantage Plan) from an insurer that is not one of the MCOs in the My Care Ohio program.
If you can’t get a supplement, then get the best Advantage Plan you can find, just make sure it’s not from a My Care Ohio MCO.

Remember, in this second year of My Care Ohio, the program assumes that Medicare will be opted into My Care Ohio. You must take steps to notify the program that you choose to opt out for Medicare.

For more information, visit Jim’s website.

Jim Koewler’s mission is
“Protecting Seniors and People with Special Needs.”

For help with long term care or with planning for someone with special needs,
call Jim, or contact him through his website.

“My Care Ohio” Enrollment for 2015

Posted on November 13, 2014 by Jim Koewler — No Comments ↓

My Care Ohio enrollment is back. Ohioans on both Medicare and Medicaid were first enrolled into My Care Ohio in May, June, and July 2014. Now, it’s time to enroll for 2015.

My Care Ohio is a system of “managed care” for people on both Medicare and Medicaid (called “dual eligible” but more accurately described as “dual covered”) in the populous areas of Ohio. It is an attempt to control the state’s costs for long term care paid from the state budget.

Now that it’s time to make enrollment decisions for My Care Ohio for 2015, I want to revisit the strategies that dual covered Ohioans should use.

As I’ve written before, my biggest fear for people in the My Care Ohio program is that their managed care organization (i.e., the insurance company to which they are assigned) will reduce services (in order to cut costs) that the managed care organization/insurance company deems unnecessary. (We’ll call the managed care organization/insurance company the “MCO.”) For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.) In fact, friends of mine who work in nursing homes have described a number of such discharges triggered by MCOs. Unfortunately, without the 24 hour care that a nursing home provides, these discharged seniors are at great risk to their health and well-being. Some of them will likely die.

To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

Opt out of the Medicare portion of My Care Ohio;
Find out which MCO works best with the care providers (other than the doctor) that you would like to use and enroll with that MCO; and
Choose a Medicare supplement (not an Advantage Plan) from an insurer that is not one of the MCOs in the My Care Ohio program.

Remember, in this second year of My Care Ohio, the program assumes that Medicare will be opted into My Care Ohio. You must take steps to notify the program that you choose to opt out for Medicare.

For more information, visit Jim’s website.

Jim Koewler’s mission is
“Protecting Seniors and People with Special Needs.”

For help with long term care or with planning for someone with special needs,
call Jim, or contact him through his website.

Keep your doctor separate from your Managed Care Organization in the “My Care Ohio” program

Posted on July 3, 2014 by Jim Koewler — No Comments ↓

In my prior four posts on My Care Ohio, I’ve described the new (in Ohio) program for people on both Medicare and Medicaid (people called “dual eligibles.”) On February 21, 2014, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”.) On February 28, 2014, I explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.) On March 7, 2014, I described the decisions that dual eligibles must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. (Your Options in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”) On March 13, 2014, I outlined what to choices to make when enrolling in My Care Ohio. (What to choose in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”) Now that My Care Ohio has actually started in all of the counties to be included (in the three-year pilot program, anyway,) I want to revisit these issues, revise one of my suggestions, and highlight what I consider to be the most important suggestion. (I plan to resume the series on how to buy long term care insurance wisely next week.)

My biggest fear for people in the My Care Ohio program is that their managed care organization (i.e., the insurance company to which they are assigned) will reduce services (in order to cut costs) that the managed care organization/insurance company deems unnecessary. (For the sake of brevity, let’s call the managed care organization/insurance company the “MCO.”) For example, if the person is in a nursing home and is doing well, the MCO might decide that the person can go home and receive home care (with a resulting big reduction in costs.) If the person did well in a nursing home because of the 24 hour supervision, sending them home would be a mistake. However, I fear the cost-cutting motive of the MCO’s management and fear that some people will be sent home that should not move home.

The best protection against unwise cuts in services is the person’s doctor. If, though, the person’s doctor gets his or her payment from the MCO, the doctor may be hesitant to question or oppose the MCO’s decision to reduce services. To avoid MCO influence over the doctor, I urge all people in the My Care Ohio program to:

Opt out of the Medicare portion of My Care Ohio; and
Choose an MCO different than the insurance company through which they have their Medicare supplement or advantage plan.

For example, a person who has United Health Care for a Medicare supplement should make sure NOT to include Medicare in their My Care Ohio program and also make sure NOT to choose United Health Care for their My Care Ohio MCO. That way, the doctor is paid by someone other than the MCO and would be immune to perceived pressure from the MCO to acquiesce to questionable care decisions.

It’s not too late to change MCOs. Every My Care Ohio participant has 90 after coverage starts to change MCOs and possibly to opt out of Medicare coverage. My Care Ohio started on May 1 for the first group (Cuyahoga, Geauga, Lake, Lorain, and Medina counties,) so people in those counties have until July 29 (assuming I counted 90 days correctly) to switch. (The other groups started in June and July, so their 90 day period to make changes still has lots of time.)

I also withdraw my earlier suggestion not to renew your Medicare supplement or advantage plan for next year. After watching the first weeks of My Care Ohio, I feel that the separation of the doctor from My Care Ohio in the way suggested above is sufficient. Withdrawing completely from supplements and advantage plans would accomplish no more toward this goal and would add more expenses to people’s annual health costs.

For more information, visit Jim’s website.

Jim Koewler’s mission is
“Protecting Seniors and People with Special Needs.”

For help with long term care or with planning for someone with special needs,
call Jim, or contact him through his website.

What to choose in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”

Posted on March 13, 2014 by Jim Koewler — No Comments ↓

In my prior three posts, I’ve discussed the coming My Care Ohio pilot program for people on both Medicare and Medicaid (people called “dual eligibles.”) On February 21, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”.) On February 28, I explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.) On March 7, I described the decisions that dual eligibles must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. (Your Options in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”)

When deciding which options to choose among those questions, dual eligibles should consider a number of factors:

My Care Ohio is a pilot program. The dual eligibles that participate are essentially “guinea pigs.” Sorry.

My Care Ohio gives control over treatment decisions to an insurance company as a managed care organization. The insurance companies will be paid a fixed amount per person under their supervision. Treatments approved cut into the insurance company’s profit.

Medicare is the “big dog.” No matter which service providers may be on (or, more importantly, off) a Medicaid MCO’s approved list, if a dual eligible can use the service provider with his or her Medicare coverage, Medicaid (even managed care Medicaid) has to go along. (Note: Many long term care services may not fall under Medicare at all (like in-home non-skilled care.) Medicaid will have full control over those services and providers.)

My Care Ohio will probably result in a smaller number of providers staying on any one insurer’s approved list. At the same time (and unrelated,) the Affordable Care Act will probably prompt insurers to reduce their approved list of providers. So, reliance on a particular insurer may allow the insureds fewer choices of medical service providers and possibly even fewer choices in the next year.

The marketing rules for Medicare “companion” insurance (i.e., supplements and Advantage plans,) could make information from the managed care organizations available only AFTER the deadline to choose a managed care organization.

If I were choosing for myself, with the factors described above in mind, I would try to position myself for maximum flexibility to keep (or find) providers that I like as much as I possibly could.

I suggest that dual eligibles should
(1) Let the Department of Medicaid make the initial choice of the Medicaid Managed Care Organization this year (to avoid wasting time looking for information on the MCOs when that information is limited or not even available;)
(2) After the Managed Care Organizations release their information and provider lists, use the 90-day window at the beginning of year one to determine which MCO is better and change MCOs if appropriate;
(3) Opt out of managed care for Medicare. (Remember, opting out of Medicare is the default choice for year one;)
(4) Drop (don’t renew) Medicare supplements and Advantage plans when the open enrollment period arrives later this year (Remember, for these “dual eligibles,” Medicaid can pay the co-pays and deductibles for Medicare-covered services;) and
(5) Make sure to opt out of managed care for Medicare when the annual renewal of My Care Ohio comes up. (Remember, in years two and three, opting out of Medicare requires notification to the appropriate authorities.)

Good luck!

For more information visit www.ProtectingSeniors.com

Jim Koewler’s mission is
Protecting a Senior’s Life Savings™
from the costs of long term care

For help with long term care costs, call Jim
or contact him through his website.

Your Options in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”

Posted on March 7, 2014 by Jim Koewler — No Comments ↓

In my prior two posts, I’ve discussed the coming My Care Ohio pilot program for people on both Medicare and Medicaid (people called “dual eligibles.”) On February 21, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”.) On February 28, I explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver rather than maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.)

In the weeks before My Care Ohio is scheduled to start in a particular area, people in that area who are on both Medicare and Medicaid will receive a letter asking them to choose a Managed Care Organization. (The expected start dates are listed in the February 21 post.) This letter is called the “friendly letter. Dual eligibles in Cuyahoga, Geauga, Lake, Lorain, and Medina counties, My Care Ohio should already have received the “friendly letter” asking them to choose a Managed Care Organization by March 16. Unfortunately, because of the Medicare insurance rules, the MCOs can’t advertise their program and can’t disclose the providers on their approved lists, so the “friendly letter” asks people to make a blind choice. (Yes, that’s nuts, but it’s what is happening.)

BACKGROUND

During the first year, dual eligibles will be assumed to opt out of managed care for Medicare. They can’t opt out of Medicaid managed care. People who want managed care for both Medicare and Medicaid during the first year of My Care Ohio will need to actively opt into Medicare managed care. (In other words, in year one, silence equals opting out of Medicare managed care.)

For years two and three (Remember, it’s planned as a three-year program,) dual eligibles will be assumed to opt into managed care for both Medicare and Medicaid. They still won’t be able to opt out of Medicaid managed care. If they want to opt out of Medicare managed care, though, they will have to actively take steps to do so. (Silence equals opting in for year two and three.) It’s not yet determined what action will be necessary to opt out. (The Ohio Department of Medicaid has a year to figure that out.)

Opting into Medicare managed care will get a covered person a single Managed Care Organization that (supposedly) can coordinate their care as well as their Medicare and Medicaid benefits.

These Managed Care Organizations will be insurance companies. The companies will be paid a fixed amount of money for each covered person. The insurance companies will profit by holding expenditures below that amount. (In the insurance industry and in HMOs, this is called “capitation.”) The Managed Care Organizations that will be available in the various districts in the My Care Ohio program are listed in my February 21 post.)

The dual eligible people who opt into Medicare managed care will have the ability to change Managed Care Organizations each month if they wish.

OPTIONS

In this first year of My Care Ohio, dual eligible people must choose:
(1) Whether to accept managed care for Medicare for this first year (when opting in requires positive action;)
(2) Which Managed Care Organization to join for Medicaid (and Medicare if opting in.)

In addition, for years two and three, dual eligible people will have to choose:
(3) Whether to accept managed care for Medicare for years two and three (when opting out requires positive action.)

For more information visit www.ProtectingSeniors.com

Jim Koewler’s mission is
Protecting a Senior’s Life Savings™
from the costs of long term care

For help with long term care costs, call Jim
or contact him through his website.

My Care Ohio: A Triumph of the Stick over the Carrot

Posted on February 28, 2014 by Jim Koewler — No Comments ↓

Warning: This week’s post is a rant about Ohio Medicaid policies and policymakers. (For my background description of the My Care Ohio program, see last week’s post “Managed care for Ohio Medicare/Medicaid ‘Dual Eligibles.’“) Feel free to tell me that I’m wrong or to ignore me until next week.

Gov. Kasich has, from the beginning, targeted the long term care Medicaid costs in the state budget. Any sane governor would look for ways to reduce that cost because it is often the largest single line item in the state budget.

When he first took office, Gov. Kasich proposed having more people receive their long term care at home (presumably through the PASSPORT program.) Now, however, his administration has launched My Care Ohio, a managed care program for the state’s “dual eligible” population (i.e., people on both Medicare and Medicaid.)

My Care Ohio will provide care coordinators to all covered people. The care coordinators’ job is to make sure that all involved caregivers and providers that stand under the managed care umbrella are on the same page. That’s great! Excuse me, though, if I have misgivings that the care coordinators unspoken instructions will conflict with this promising description.

The care coordinators work for the managed care organizations. The managed care organizations are insurance companies. These managed care companies will be paid a flat rate for each of their insureds in the program. Insurance companies make money by paying out less in claims than they receive in premiums. So, I cannot help but believe the care coordinators main job will be to cut costs. Now, I’m not necessarily against cutting costs, but the managed care model tends to cut costs by squeezing (or squeezing out) the care providers. This is the “stick,” and I fear a decline in the quality of care over time. I resent the use of this stick when the governor talked up the carrot in the past.

The carrot would have been (and maybe still can be, but only after the My Care Ohio 3-year pilot program runs its course) changing Medicaid rules a little bit to create a greater incentive for people to choose to stay in their homes on Passport rather than move into nursing homes.

Currently, it’s tricky and unpredictable when applying for Passport, especially when there’s a married couple. The standard on what the well spouse (the spouse not seeking Medicaid coverage) can keep while the spouse needing care can qualify for Passport should also be used for a spouse seeking nursing home Medicaid. (These standards set how poor a married couple must be to qualify for Medicaid.) Unfortunately, these standards are not the same between nursing home Medicaid and Passport (at least, they aren’t implemented in the same way during the application process.) It is financially more advantageous to go into a nursing home, the highest cost place to receive long term care.

If the “how poor is poor enough” question were answered the same way for Passport as for nursing home coverage, more people would choose to stay at home. The “carrot” would be the same financial eligibility standards.

Well, Gov. Kasich abandoned the carrot. He’s picked up the stick, and I expect him to use the stick to force provider payments lower.

My Care Ohio is being touted as giving “dual eligible” people more choice. Except for the choice between cost-cutting insurance company A and cost-cutting insurance company B, I don’t see many choices in the My Care Ohio program. A real and valuable choice could have been whether to get long term care at home, in an assisted living facility, or in a nursing home. That is a choice that would mean something to seniors and their families.

I wish the Ohio Department of Medicaid had chosen the carrot of evening the Medicaid eligibility playing field so that the choice to stay home (where Medicaid’s costs are much lower) would be as financially advantageous as moving into a nursing home.

For more information visit www.ProtectingSeniors.com

Jim Koewler’s mission is
Protecting a Senior’s Life Savings™
from the costs of long term care

For help with long term care costs, call Jim
or contact him through his website.

Managed care for Ohio Medicare/Medicaid “Dual Eligibles”

Posted on February 21, 2014 by Jim Koewler — No Comments ↓

Ohio will soon launch My Care Ohio, a 3-year pilot program instituting managed care for people who have health care coverage through both Medicare and Medicaid, the so-called “dual eligible” people. The pilot program focuses on the state’s population centers. (Several other states are implementing similar programs.)

Who’s in? People on both Medicare and Medicaid who are
in nursing homes;
on the Passport waiver;
on the Choices waiver;
on the Assisted Living waiver;
on the Ohio Home Care waiver; or
on the Transitions Carve Out waiver.

Who’s out?
People with ICF-MR level of care served in an ICF/IID facility;
People on a waiver from Department of Developmental Disabilities;
People on monthly spend-down that isn’t met every month; and
People on third-party health insurance (usually through a retirement plan.)

People on a Medicaid “Period of Restricted Coverage” (i.e., they gave away assets so Medicaid won’t cover all of their costs) will be IN the managed care program for the costs that Medicaid will cover during that restricted period. After the Period of Restricted Coverage ends (assuming that the managed care program is still going,) these people will be on the managed care program for their full Medicaid coverage. (This news arrived in an email from the Ohio Department of Medicaid the afternoon after the original version of this post was published.)

The following counties (sorted by district) are included:

Northeast district
Cuyahoga, Geauga, Lake, Lorain, and Medina counties
Buckeye, CareSource and United are available Managed Care Organizations (MCOs)
Enrollment starts May 2014

Northeast Central district
Columbiana, Mahoning, and Trumbull counties
CareSource and United are available MCOs
Enrollment starts June 2014

Northwest district
Fulton, Lucas, Ottowa, and Wood counties
Aetna and Buckeye are available MCOs
Enrollment starts June 2014

Southwest district
Butler, Clermont, Clinton, Hamilton, and Warren counties
Aetna and Molina are available MCOs
Enrollment starts June 2014

Central district
Delaware, Franklin, Madison, Pickaway and Union counties
Aetna and Molina are available MCOs
Enrollment starts July 2014

East Central district
Portage, Stark, Summit, and Wayne counties
CareSource and United are available MCOs
Enrollment starts July 2014

West Central district
Clark, Green, and Montgomery counties
Buckeye and Molina are available MCOs
Enrollment starts Juny 2014

The Ohio Department of Medicaid expects 100,000 people to be in the program, with 37,000 of them on one of the waivers.

People on both Medicare and Medicaid in the regions listed above will receive a “friendly letter” approximately 60 days before their district’s enrollment start. That first letter will allow them 30 days to choose an MCO. (Making a choice of plans is called “active enrollment.”) The person can actively enroll in an MCO for both Medicare and Medicaid or can enroll in an MCO for Medicaid only. (Those that enroll in both have the ability to switch plans monthly.)

For people who do not choose a plan in the 30 days after the friendly letter, a second letter will come explaining that the person has been assigned to one of the plans in his or her district. (This is called “passive enrollment.”) According to the Department of Medicaid, the assignment of an MCO via passive enrollment will be performed by a complicated algorithm that considers past usage of medical providers. Even after this passive enrollment, a person can change plans in the first 90 days after the start date. During 2014, passive enrollment will be used only for Medicaid. (During the enrollment period for 2015, passive enrollment will be used for both Medicare and Medicaid.)

For a limited period of time during the transition to managed care, people will keep their same services at the same rates. The period of time during which no change will occur varies among the different services, especially waiver services.

After this transition period, MCOs may drop providers. This is the big point that will impact the covered people. When a trusted provider is no longer available, people’s care and their confidence in their care will be impacted.

Editorial note: I realize this is about as readable as the stock listings. Sorry. My Care Ohio is a potential sea change in how long term care is administered, so I wanted to lay out my understanding of the program. I hope to offer more analysis in the future.

Second editorial note: I changed this post slightly a day after it was originally published. I wanted to get this information posted at my usual Friday morning time, but my midnight proofreading wasn’t very good. I did my proofreading when I had the chance. Sorry.

For more information visit www.ProtectingSeniors.com

Jim Koewler’s mission is
Protecting a Senior’s Life Savings™
from the costs of long term care

For help with long term care costs, call Jim
or contact him through his website.