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Managed Care for Medicare/Medicaid Dual-Eligibles, Explained

MyCare Ohio coordinates Medicare and Medicaid for dual-eligible seniors -- here is what it does.

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Short answer

MyCare Ohio (sometimes referenced as Next Generation MyCare in current program materials) is Ohio's managed care program for people who qualify for both Medicare and Medicaid. It coordinates medical care, behavioral health, and long-term services and supports through a single managed care plan rather than separate systems.

What it coordinates

Medical care, prescription coverage, behavioral health, and home- and community-based long-term services and supports, all under one plan -- intended to reduce the coordination burden on a family managing a parent's care across separate Medicare and Medicaid systems.

Locally

The Council on Aging of Southwestern Ohio provides care management support for MyCare Ohio enrollees in our four-county coverage area.

Ohio's managed care programs are periodically restructured. Confirm current plan options and enrollment details directly with the Council on Aging or Ohio Department of Medicaid rather than relying on a program name alone.

Questions families ask

Which office is the Long-Term Care Ombudsman for the Cincinnati area?

Pro Seniors, Inc., based at 7162 Reading Road, Suite 1150, Cincinnati, OH 45237, is the Southwest Ohio regional ombudsman office, reachable at 1-800-488-6070.

What is the difference between the ombudsman and a facility licensing complaint?

The ombudsman advocates for an individual resident's care, rights and discharge concerns and cannot license, inspect or fine a facility. The Ohio Department of Health investigates regulatory complaints and can take licensing enforcement action, but is not an advocate for a specific resident's preferences.

Can the ombudsman act on my behalf if my parent doesn't want a complaint pursued?

No. The ombudsman acts only with the consent of the resident or their legal representative. If a parent with capacity does not want a complaint pursued, that decision stands even when family members disagree.

Is there a fee to use the Long-Term Care Ombudsman program?

No. The ombudsman program is a free, independent advocacy service, funded through the federal Older Americans Act, the state of Ohio, grants and local funding sources like United Way.

Does the ombudsman handle in-home care complaints, or only facility residents?

The Long-Term Care Ombudsman program's core mandate covers residents of licensed nursing homes and residential care facilities. For an in-home care agency concern, contact the agency directly first, and consider Ohio Department of Health or your county's consumer protection resources for unresolved regulatory issues.

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