What to know about Medicaid open enrollment as it begins today

Nov. 01--Medicaid open enrollment, an important period for millions of Ohio residents who want to switch their plans in the health insurance program, begins today.

About 26 percent of Dayton-area hospital patients pay with Medicaid, the program that covers those with low incomes or disabilities. Three million Ohioans are covered by Medicaid.

The insurance plans in the state are managed by five private sector companies, and beneficiaries can choose to shop for another plan from today to Nov. 30.

Liz Williams, one of the outreach and enrollment workers at Dayton-based Fiver Rivers Health Centers, said all plans cover the essential benefits, including checkups, sick visits, labor and delivery and other essential care.

But those who need a specific medication or specialized type of care should make sure they are enrolled in a plan that provides the needed treatment, she said.

"Not every managed care plan covers everything," Williams said.

Also, not every hospital has a contract with every Medicaid plan, so it is important those enrolling check what insurance plans their doctor and preferred hospital take, she said.

In one example, when UnitedHealthcare and Premier Health struck an in-network deal earlier this year after a seven-month deadlock, the deal did not include UHC's Medicaid plan, which remains out of network.

The Medicaid plans can also have extra services, including cash health incentive programs and benefits for vision, transportation to appointments and pharmacy can vary between the plans.

"You want to look at your options at what best fits your family and not just the first one that they give you," Williams said.

Williams is part of the team at Five Rivers Health Centers trained to help people enroll in Medicaid or assist patients ineligible for Medicaid enroll in plans sold on the Affordable Care Act marketplace, which also started open enrollment today. She recommends patients call before coming in for assistance enrolling in Medicaid, but the group also helps walk-ins.

If Medicaid beneficiaries want to switch plans during open enrollment, they can call the consumer hotline at 1-800-324-8680 or register an account and change the information online.

Consumers can evaluate their options using a state report card that rates the Medicaid plans with one to three stars in five key areas of service: getting care, doctors communication and service, keeping kids healthy, living with illness and women's health.

More than half of Ohioans covered by Medicaid have a plan managed by Dayton-based CareSource, which has about 2,800 local employees and is one of the city's largest employers.

While CareSource has other lines of business, the nonprofit insurer's primary focus is Medicaid, and it manages about 1.2 million plans in Ohio alone, mostly for families and children. About 21 percent of those covered by CareSource are covered by Medicaid expansion.

CareSource made a $25 million net underwriting profit on its Medicaid plan in 2017, according to filings with the Ohio Department of Insurance.

Steve Ringel, president of Ohio Market for CareSource, said Medicaid is important to CareSource, which for more than 30 years "has been mission-focused in meeting the health care and social needs of the underserved."

CareSource said some of its extra benefits are vision, dental, transportation help, health incentive programs, one-on-one care management, disease management programs, and consumer councils to share thoughts in person.

"By focusing on social determinants of health, which in many cases prevents healthy outcomes, we are helping to treat the whole person," Ringel said.

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