Health Care With Heart
There is a reason more Ohioans choose CareSource for their Medicaid plan than all other plans combined. Its because CareSource is more than just quality health care. We care about you and your familys health and wellbeing. CareSource members get access to a large provider network, reward programs like Kids First and Babies First®, free rides to health care appointments, pharmacies and more. Plus, we never charge a copay for any medical or behavioral health service!
Choose CareSource for your Ohio Medicaid health care plan and join over 1.2 million members who trust us with their health and well-being.
Fraud Accusations Appearance Of Conflict Not Considered
Its already known that the Medicaid department didnt consider whether the companies had been accused of fraud in the past, or even currently.
Paramount, the failed bidder, hasnt been.
But United Health subsidiary OptumRx is the subject of a lawsuit by Ohio Attorney General Dave Yost accusing the company of cheating the Ohio Bureau of Workers Compensation out of $16 million. OptumRx also handles Medicaid pharmacy benefits for United Healthcare Community Plan of Ohio.
Nor did the Medicaid department hold it against another successful bidder, Buckeye, that its parent, Centene, last June agreed to pay Ohio $88.3 million and set aside a total of $1.3 billion to settle claims that it ripped off Medicaid programs in 22 states.
Centene and United Health deny wrongdoing and United didnt respond to questions for this story.
An additional way the Medicaid department has been less than transparent: Director Corcoran filed ethics disclosures with the state saying that in each year of her service prior to negotiating the new contracts, she owned at least $1,000 worth of stock in UnitedHealth Group. However, she didnt file an affidavit disclosing her exact holdings at the time of negotiations that would have exempted her from a possible legal finding that she had a conflict of interest.
Lawless, the Medicaid spokeswoman, said the dismissal shows that the bidding process was proper.
This story was republished from the Ohio Capital Journal under a Creative Commons license.
Other Languages & Format Needs
Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.
If you need something translated into a language other than English, please call Buckeye Health Plan. We can also provide translations in other formats such as Braille, CD or large print.
If you need an interpreter for your medical appointment, contact Buckeye Health Plan before your appointment. We will arrange for one to be at your appointment.
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Centene Subsidiary Buckeye Health Plan Awarded Ohio Medicaid Contract
ST. LOUIS, Aug. 17, 2021 /PRNewswire/ — Centene Corporation announced today its Ohio subsidiary, Buckeye Health Plan, has been awarded a Medicaid contract by the Ohio Department of Medicaid to continue serving members with quality healthcare, coordinated services, and benefits. The contract will commence in early 2022.
“We have great respect for the critically important and long-standing partnership with the state of Ohio. We are humbled and honored to continue to offer high-quality healthcare services and programs for our members,” said Brent Layton, President of US Markets, Products and International, and Executive Vice President, for Centene. “We are committed to continuing our work with the Ohio Department of Medicaid, our providers, and community partners to remove barriers to care and improve health outcomes for Ohioans.”
Under the new contract, Buckeye will deploy new, innovative initiatives to meet members’ unique needs, including the launch of new technologies and local programs in partnership with providers and community partners.
“For more than 16 years, our local approach and member-focused programs have allowed Buckeye Health Plan to uniquely address the needs our members and their families face every day,” said Steve Province, President, and CEO of Buckeye Health Plan. “We look forward to working with the state and continuing our collective commitment to ensuring Ohio residents have access to comprehensive, quality healthcare.”
Ohio Medicaid Wont Say If It Considered Federal Oversight Reports In Massive Procurement
The Ohio Department of Medicaid not only is refusing to release key oversight reports from its contractors, its refusing to say whether it even considered them last year as it undertook the largest public procurement in Ohio history.
As a consequence of that procurement, the company with the highest score on the federally required oversight reports lost its business with the state. Meanwhile, another company got the second-lowest score, yet it retained state business worth billions.
Medicaid Director Maureen Corcoran apparently owned stock in that companys corporate parent, UnitedHealth Group, but she has steadfastly refused to say just how much she owned as she negotiated and signed a contract with United Healthcare Community Plan of Ohio.
How much the business will be worth to the company in the future is unknown. But it collected almost $1.8 billion from the state in 2019.
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Process For Referring Children/families For A Cans Assessment
Members that may benefit from OhioRISE enrollment may be identified through various means, including, but not limited to, health risk assessment information, provider referrals, member/ family referrals or following an emergency room/ inpatient hospitalization event due to a behavioral health diagnosis. Upon identification, Buckeyes Care Coordination team ensures the member and/ or family is connected with a local certified Child and Adolescent Needs and Strengths assessor to complete the assessment and determine program eligibility. The provider submits the CANS assessment into ODMs CANS IT system and determination is made through the OhioRISE Decision Support Model. In partnership with ODM, Buckeyes CC team monitors and accesses CANS IT system to determine RISE enrollment status.
Managing Care And Trying To Manage Profits
When the states and the federal government invited private corporations into Medicaid systems, they wanted to introduce private-sector efficiencies, but prevent undue profiteering.
The corporations, known as managed care organizations, play roles similar to those health insurers do for private businesses. They create provider networks, help determine what services are covered, and they pay claims.
In an attempt to ensure they arent overly profiting off of funds meant for the poor and disabled, the federal government requires the managed care organizations to file annual medical-loss ratio reports. The ratio referred to in the name is meant to determine how much taxpayer money the companies are spending on patient care, quality improvement and fraud prevention and how much theyre pocketing in the form of profits and administrative fees.
In Ohio, Medicaid managed-care organizations can at most keep 15% of the money theyre paid for profit and administration.
The Medicaid department regularly boasts of its commitment to transparency. But earlier this month it refused to release the care organizations medical-loss ratio, or MLR, reports. It said they contained trade secrets even though some other states Medicaid departments post the reports on their websites, and health care advocacy groups say the data they contain are essential for non-insiders to evaluate the efficiency of the huge programs.
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Ohio Department Of Medicaid Will Give Customers More Options In The Next Generation Managed Care Program
COLUMBUS, Ohio Ohio Department of Medicaid Director Maureen Corcoran today announced that Medicaid customers will have more options when choosing a managed care health plan in the departments new person-centered vision of care. Buckeye Health Plan will join six previously announced Next Generation managed care organizations :
|UnitedHealthcare Community Plan of Ohio, Inc.||AmeriHealth Caritas Ohio, Inc.|
|Humana Health Plan of Ohio, Inc.||Anthem Blue Cross and Blue Shield|
|Molina Healthcare of Ohio, Inc.||CareSource Ohio, Inc.|
Ohio Medicaid originally deferred its decision on Buckeyes application after the Ohio attorney general filed a lawsuit against Buckeye Health Plan and other entities related to Buckeyes pharmacy benefit management structure. That lawsuit has ended in a settlement. ODM notified Buckeye Health Plan of its decision to award a contract to the MCO upon completion of ODMs review.
Ohio Medicaids Next Generation managed care selection will begin covering members next year. Medicaid customers will continue to receive services through the transition and will have the opportunity to select among seven MCOs in the future program.
Medicaid Managed Care Annual Open Enrollment
Beginning September 17, 2021, Ohio Medicaid managed care members will be able to select their plan by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or utilizing the Ohio Medicaid Consumer Hotline Member Portal. You do not have to do anything if you want to keep your current Medicaid Managed Care Plan.
Visit the Ohio Medicaid Consumer Hotline website for information.
Questions about CareSource?
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Affordable Access To Valuable Dental Care
At Muskingum Valley Oral Surgery, we believe that everyone should have access to affordable dental care, and were doing our part to make sure that happens. As part of our commitment, we accept Buckeye Health Plan Insurance, and we encourage patients to be proactive about maintaining excellent oral health. If youre more cost-sensitive yet you still want to experience thebenefits of receiving consistent and exceptional dental care, then contact us today to schedule a visit with Dr. Lee!
Ohio Health Insurance Plans From Buckeye Health Plan
Buckeye Health Plan offers comprehensive Ohio health insurance plans that include coordinated healthcare, pharmacy, vision and transportation services.
Whether its getting insured for yourself and your loved ones or finding the right resources for your medical care, the Buckeye Health Plan team is here to help. Learn more and enroll today!
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Who Is Eligible For Buckeye Health Plan Insurance
So you can be sure that you qualify for Buckeye Health Plan Insurance, here are the minimum requirements that have to be met:
- United States citizenship or lawful presence in the United States
- Residency in the service area
- Residency and current enrollment in Medicare Parts A, B and D
- Residency and recipiency of full Ohio Medicaid coverage
- Residency and a minimum age of 18 years or older at the time of enrollment
Take Healthy Steps To Earn My Health Pays Rewards:
Take healthy steps to earn My Health Pays rewards.
$75 for an annual well care visit
$50 for an annual well care visit
$100 for annual comprehensive diabetes care – must complete all of the following once in the calendar year: HbA1c test, kidney screening and retinopathy screening
$25 for getting an annual flu vaccine
$75 for an annual breast cancer screening
$75 for an annual cervical cancer screening
Pregnancy and infant well-care:
$75 for completing a Notification of Pregnancy form within the first trimester.*
$25 for completing a Notification of Pregnancy form within the second trimester.*
*Log into the Secure Portal to access the NOP form.
$100 for completing 6 infant well care visits by 15 months old
$75 for a postpartum doctor visit between 21-56 days after delivery. Must notify Buckeye you are pregnant prior to having baby by calling or submitting a completed NOP.
Your My Health Pays reward dollars are added to your rewards card after we process the claim for each activity you complete. If you are earning your first reward, your My Health Pays Visa® Prepaid Card will be mailed to you.
This My Health Pays Rewards Visa Prepaid card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank Member FDIC. Card cannot be used everywhere Visa debit cards are accepted.
Log in to your member account to check your current My Health Pays rewards balance.
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Get To Know Your Otc Benefit
Your Wellcare By Allwell plan includes an over-the-counter benefit that gives you money to purchase everyday personal care and wellness products like vitamins, bandages, and toothpaste without having to leave your home.
This is one of the money-saving benefits of Medicare. Youll get the drugstore items you like to use, at no cost to you.
Enjoy this short video on how to use your OTC benefit allowance and get the most from your Wellcare By Allwell plan.
Ordering your OTC items is easy:
You may be able to pick up your OTC products from a CVS store near you. Please note: this does not include CVS locations inside of Target stores.
Connect to the CVS OTC website to view available products and store information.
If you have questions please, .
Wellcare By Allwell from Buckeye Health Plan4349 Easton Way, Suite 300Columbus, OH 43219
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Activate Onsite Health Center
Serves all plan members eligible for medical benefits by providing office visits, lab work and filling of many prescription drugs and provides access for employees needing drug screenings. Offers quality, convenient medical services including primary care, laboratory services, many prescriptions, and comprehensive wellness programs.
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Please Note: You Do Not Have To Do Anything If You Want To Keep Your Current Medicaid Managed Care Plan Or Mycare Plan
Visit the Ohio Medicaid Consumer Hotline website at Ohiomh.com for information.
Please reach out to for additional questions.
Buckeye Health Plan is a health plan provider offering Ohio Medicaid benefits for eligible members.
Our extensive network of local providers allows us to connect you with providers and services you need in your area. Our Ohio Medicaid plan members also have access to wellness resources and topics. Its time to take control of your health, and Buckeye Health Plan is here to help.
You Cannot Sign Up For A Mycare Ohio Plan If You:
- have other third party health care coverage except for Medicare.
- have intellectual or other developmental disabilities and receive services through a waiver or Intermediate Care Facility for Individuals with Intellectual Disabilities .
- are enrolled in PACE .
You may choose not to be a member of a MyCare Ohio plan if you are a member of a federally recognized Indian tribe.
If you think you meet any of the above rules and should not be a member, please call Member Services for help.
Buckeye is available only to people who live in our service area. Our service area includes Clark, Cuyahoga, Fulton, Geauga, Greene, Lake, Lorain, Lucas, Medina, Montgomery, Ottawa, and Wood.
If you move to an area outside of our service area, you cannot stay in this plan. If you move, please report the move to your County Department of Job and Family Services office, Social Security office, and to Buckeye.
Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 from 7 a.m. to 8 p.m., Monday through Friday, and 8 a.m. to 5 p.m. on Saturdays for assistance.
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Pregnancy & Newborn Services
Start Smart for Your Baby is our special program for women who are pregnant and for those moms who just had a baby. We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a . After completing this form, you will be enrolled in Start Smart. You will receive information in mail and over the phone. You can also get information in the .
Tips for PregnancyIf you are pregnant or want to become pregnant, keep these things in mind:
- Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
- Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
- Do not use tobacco, alcohol or drugs now or while youre pregnant.
Are You Pregnant? Tell Us Right Away!Call us. Or, you can to your Buckeye Health Plan account and fill out the Notification of Pregnancy form.
Text 4 BabyMembers can enroll in the text4baby program by texting “Baby” to 511411. For more information, call Member Services at 1-866-246-4358.
Buckeye Health Plan Launches New Program That Expands Pharmacists Role In Patient Care
“Pharmacists have the training and skills to do so much more than fill prescriptions, and this new initiative will allow pharmacists to demonstrate their value in todays evolving healthcare framework. This program will raise the bar for how pharmacy benefits and pharmacist-provided care are delivered in Ohio,” said Stuart Beatty, PharmD, Director of Strategy and Practice Transformation with the OPA and Associate Professor of Clinical Pharmacy at The Ohio State University. “The Ohio Pharmacists Association is proud to work with Buckeye Health Plan on this program to elevate the standard of care for their Ohio members.”By tapping the expertise of pharmacists, Buckeye Health Plans new program begins realigning pharmacy to increase the focus on the care and well-being of the patient.
The program is Buckeyes newest initiative in partnering with pharmacists to improve member health outcomes. Buckeye has several proven programs in place including a Pharmacy Coordinated Services Program to curb prescription drug abuse, Buckeye RxPlus to help members overcome the challenges of adherence and polypharmacy, and a Medication Therapy Management program to equip pharmacists with tools to educate members on how to use their medications properly through targeted interventions and comprehensive medication reviews.
For more information about pharmacist provider status in Ohio, .
Contact: Antonio Ciaccia, 389-3236
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How To Choose Caresource
Medicaid health care coverage is available for eligible Ohioans with low income, pregnant women, infants and children, older adults and individuals with disabilities.
|When you apply for Ohio Medicaid, you can choose CareSource as your managed care plan. Whether you apply online, by mail, over the phone or at your local Department of Job and Family Services , tell them you want to choose CareSource.|
|Switch to CareSource|
|If you were assigned to another managed care plan and want to switch to CareSource, call the Ohio Medicaid hotline, complete a change request within 90 days and tell them you want to switch to CareSource. If you have been on your plan more than 90 days, you can switch to CareSource during your next open enrollment period.|