To: Governor Mike DeWine

Failure of MyCare Ohio

It is unfair for Ohio Medicaid Providers and it’s Senior citizens to be left in the dark looking for answers since MyCare Ohio took place on July 1st, 2014. Providers are facing a lot of challenge with Aetna and Molina. The Managed Care organizations are violating the rules and regulations under Mycare Ohio.
Direct Care Waiver Services: Personal care, Waiver Nursing, Home Care Attendant, Choices Home Care Attendant, Out- of-Home Respite, Enhanced Community Living, Adult Day Health Services, Social Work Counseling, Independent Living Assistance.
• Services will be maintained at current level and with current providers at the current Medicaid reimbursement rates for 365 days (the rule)

All other Waiver Services: Home Medical Equip & Adaptive and Assistive Devise, Non-Emergent Transportation, Chore, Emergency Response System, Home Modification, Homemaker, Meals, Alternative Meals, Pest Control, Nutrition Consultation, and Community Transition.
• Services will be maintained at current level for 365 days, and existing provider at existing rate for 90 days.

Other Issues providers face are as following:
• Claims being rejected even with the correct billing information entered
• Delay in payments for months without being able to track them on their portal
• Partial checks received even after waiting for months
• Lack of Portal Accessibility and limiting access to provider so provider’s won’t be able to track payment status and see what is submitted.
• Providers are forced to drop client’s due to lack of payments and insurance failure.
• HMO Case managers are lacking experience with consumer’s current services and needs
• Providers rate reductions by Molina and telling providers it’s a system issues.
• Consumer’s are confused with what will happen to them under MyCare Ohio
• No customer support to solve provider issues and questions except calling Aetna or Molina office that are often lack of experience themselves.
After carefully reviewing the disaster caused by MyCare Ohio; it is affecting everyone with our Senior citizens and the Disabled being abandoned by this new system. Providers are trying to do their best to provider the much-needed services to our senior citizens but It’s very difficult with expenses going and no money coming in from those managed care organizations and holding provider checks. It is time to take action, to stand up for our Senior Citizens, providers and tell the senators why they supporting this MyCare Ohio and hold them countable for this mess. The news groups are involved, but Are you? Watch this videos and news.
Dispatch: http://www.dispatch.com/content/stories/local/2014/08/25/workers-go-unpaid-under-new-state-program.html
http://www.10tv.com/content/stories/2014/08/15/columbus-ohio-10-investigates-medicaid-mess-up-leaves-nurses-broke.html

Why is this important?

The Managed Care organizations are violating the rules and regulations under Mycare Ohio.