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2021 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 at https://members.ohiomh.com/Login.aspx. 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 at www.ohiomh.com for information.
After you receive your renewal form from the Ohio Department of Medicaid (ODM) you will need to take a few steps to keep UnitedHealthcare as your health insurance company.
Click here to learn how to renew your Medicaid coverage.
UnitedHealthcare Community Plan
Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. Members can choose a primary care doctor from our network. Plus get access to a 24/7 nurse advice hotline, health education materials and extras that other plans don't offer. View the benefits below to see all that it offers.
This plan is available in the following counties:
Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, and Wyandot.
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Benefits & Features
Asthma and COPD Care
Individual care to help control asthma or COPD symptoms.
Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:
- Manage flare-ups.
- Reduce symptoms.
- Help you stay active.
Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:
- Work with you to develop a plan of care that meets your individual needs.
- Coordinate with family members, caregivers and health care providers.
- Help get additional services or support you may need.
Our plan includes visits for chiropractic care.
- Members of all ages can get up to 15 visits per year.
- Members under 21 may get additional visits with prior authorization.
Choice of Doctor
From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.
You get a primary care physician (PCP), who is your main doctor. If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Choice of Birth Center
Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds of hospitals across Ohio.
We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.
Checkups and cleanings are covered.
Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.
Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.
Equipment and Supplies
The health and safety of our members at home are important.
Our plan covers medical equipment ordered by a member's doctor or care manager. This can include supplies like:
- Hospital beds.
- Oxygen tanks.
- Wheelchairs or walkers.
For some of these services prior approval is required. Please check your member handbook for these details.
We provide the exams and treatments needed to help keep your feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.
Our podiatry coverage includes:
- Routine foot exams.
- Tips about foot care and choosing the right shoes.
- Information about nerve damage warning signs.
Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect your hearing.
- Exams, therapy and tests.
- With prior approval, hearing aids and batteries.
Healthy First Steps®
Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up.
We will help you:
- Choose a pregnancy provider and a pediatrician (child’s doctor).
- Schedule visits and exams and arrange rides to your visits.
- Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
- Get supplies, including breast pumps for nursing moms.
- Connect with community resources such as Women, Infants and Children (WIC) services.
An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.
Earn great gifts for you or your child by doing things like:
- Completing well-child exams.
- Getting lab tests.
- Recording the family's health activities.
Home Health Care
If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing.
With approval, our plan covers:
- An in-home medical visit.
- Medical equipment like hospital beds, walkers or wheelchairs.
- Disposable medical supplies.
- Help with personal care or housekeeping.
This plan pays for all medically necessary expenses related to a hospital stay. This way you can rest and heal.
Our plan covers:
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
And after leaving the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Kidney Disease Care
Kidney disease is a serious medical condition. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.
Our plan includes:
- Health education and support.
- Organ transplant if needed.
Lab and X-rays
Knowing what's wrong and finding it early can make all the difference. With prior approval, our plan covers:
- Labs and testing.
- X-rays, scans and other imaging.
We'll help you get the information needed to improve your health or be at your best.
You can receive information in your preferred language. Just ask. We also have people at our service centers who speak more than one language. Chances are, we have someone who speaks your language.
Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.
You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.
Member Services Representative
Meet your personal health plan assistant. Our job is to help you get the most of your benefits. We can help you:
- Schedule doctor, dental and vision appointments.
- Arrange for extra support services.
- Complete a health risk assessment.
- Stay in touch with you.
Mental Health and Substance Abuse Services
Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:
For some of these services prior approval is required. Please contact Member Services to learn more.
With our plan there are no copayments for covered services.
- Care from highly skilled and compassionate doctors.
- Treatments at respected hospitals and clinics.
- Home medical equipment and supplies to help them be their best.
Medical questions and situations come at inconvenient times. For questions about health, call a nurse 24/7. Call: 1-866-801-4407, TTY 711.
Our NurseLine nurses will:
- Listen to the symptoms.
- Provide guidance on self-care.
- Advise the member about getting care at a doctor visit or an urgent care center.
- Help know when to go to the emergency room.
Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan includes:
- Screening for obesity.
- Counseling for obesity.
A pregnancy is an incredible journey. It's a journey the new mother wants to make with the help of friends, family and a pregnancy doctor, or OB-GYN.
All recommended prenatal clinical visits and tests are covered by our plan.
At these visits, the clinic will:
- Make sure both mother and baby are healthy.
- Explain what to expect at each stage of the pregnancy.
- Answer any questions.
After a serious illness, surgery or injury, you may need extra nursing and therapy.
With prior approval, our plan covers short stays in a rehabilitation center where you can heal. Included are:
- Nursing home services.
- 24-hour nursing care.
- Help with activities of daily living.
- Physical, occupational and speech therapy.
Call Member Services for information on available providers.
Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.
Most people know the bad health effects of smoking. And they know they need to quit. We support our members with coaching while they quit. We support our members while they quit, with coaches and supplies. The only thing they won't get from us is a lecture.
Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.
With prior approvals, our plan covers visits for:
- Occupational therapy.
- Physical therapy.
- Speech therapy.
- In-home therapy.
Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Call 1-800-895-2017 (TTY 711) to schedule a ride. You must call at least 48 hours ahead of time..
Rides are available to:
- Dental and vision appointments.
- Women, infants and children (WIC) visits.
- Job and Family Services offices for benefits redetermination.
UnitedHealthcare On My Way™ is an engaging, interactive program that informs Ohio youth and helps prepare them for many real-world situations that lie ahead. UnitedHealthcare OMW™ teaches the practical skills of managing bank accounts, securing housing, creating a resume, finding job training and applying for college. It is a reliable, go-to resource they can use throughout their journey toward independent living.
You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:
- Urgent care centers.
- Federally qualified health centers.
- Other walk-in clinics.
You'll get the care, eyeglasses and treatment that let you see life more clearly.
- Annual eye exams.
- Glasses and $150 toward contact lenses.
You also can chose from an expanded selection of frames.
This benefit is offered by Block Vision.
Well visits with your doctor can help keep you and your family healthy. These visits can catch health problems early, so they can be treated.
Preventive services include:
- Checkups for adults and children.
- Well-baby care.
- Care for women expecting a baby.
- Routine shots and tests.
There are no copayments for preventive care.
Wellhop for Mom & Baby
Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.
Here’s how it works:
- Join video conversations every other week with women who have similar due dates and a group leader.
- Chat and share experiences with moms from your group on the Wellhop app or website.
- Visit the Wellhop library. You’ll find articles, videos and more.
Ohio Medicaid Handbook Insert
Use the documents below to learn more about each important health topic.
UnitedHealthcare On My Way
UnitedHealthcare OMWTM (UnitedHealthcare On My Way) is an interactive website that helps you get ready for real life. It's easy and fun, and has important information all on one secure site.
Download the brochure to find out more about
Money: Set up a budget and learn about taxes.
Housing: Understand and compare housing options.
Work: Create a resume and learn interview tips.
Fraud, Waste and Abuse
Fraud, Waste and Abuse
Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness.
Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits.
Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources.
Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.
What is provider fraud, waste and abuse?
- Billing for services not rendered
- Upcoding (billing for more expensive services or procedures than were actually provided or performed)
- Soliciting, offering or receiving kickbacks
- Improper or sloppy billing practices
- Failure to maintain adequate records
- Routine waiver of coinsurance and deductible
What is member fraud, waste and abuse?
- Loaning or using another person's insurance card
- Forging or selling prescription drugs
- Providing false information when applying for program benefits
UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:
- Anonymous fraud, waste and abuse hotline: 1-877-766-3844
Clinical Health Guidelines
Clinical Health Guidelines
American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care
Preventive Pediatric Health Care Screening
2021 Recommendations for Preventive Pediatric Health Care screening guidelines (periodicity schedule) from the American Academy of Pediatrics
Preventive Services Guideline
2021 Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)
For a description of the UnitedHealthcare practice guidelines, please write to:
UnitedHealthcare Community Plan Quality Improvement
5900 Parkwood Place
Dublin, Ohio 43016
Member Newsletters 2016 - Current
Member Newsletters Prior to 2016
Member Advisory Council and Connected Advisors
UnitedHealthcare Care Managers for Member's Unique Needs
Every UnitedHealthcare MyCare Ohio member receives a personal representative. These Care Managers are licensed professionals providing education and coordination of UnitedHealthcare Connected® for MyCare Ohio (Medicare Medicaid Plan) benefits, tailored for each member's unique needs.
Click here to watch a video on how these Care Managers are helping current members.
We recently mailed you a letter that included some information on benefit changes. Some of the information did not pertain to members that only have their Medicaid covered benefits through our plan. Please disregard that letter. The letter also had an incorrect number for the Ohio Medicaid Hotline. The correct number for the Hotline is 1-800-324-8680. We are sorry for any confusion this may have caused you. Please view the Member Clarification Letter for additional information.
Use the documents below to learn more about each important health topic.
UnitedHealthcare Member Advisory Council and "Connected Advisors"
UnitedHealthcare Member Advisory Council and "Connected Advisors" is an advisory council to ensure that UnitedHealthcare actively engages consumers, families, advocacy groups, and other key stakeholders as partners in the program design and delivery system.
Who is involved?
- Any members, or a member's representative, are eligible to participate.
- There are no term limits for participation.
- Representatives from member stakeholder or advocacy organizations.
- Representation reflects the diversity of the member population including: race, ethnicity, religion, sexual orientation, gender, disability (physical or mental), age, parental status, or genetic information.
They will advise and guide the UnitedHealthcare Community Plan of Ohio on:
- Clinical design and delivery
- Strategies to support members in the community
- Abuse and neglect initiatives
- Promote member-centric culture
- Provide input regarding research and best practices
How is it organized?
- Three local groups of "Connected Advisors" with representation in the Northeast (Cuyahoga, Geauga, Lake, Lorain, and Medina counties); Northeast Central (Columbiana, Mahoning, and Trumbull counties); and East Central (Portage, Stark, Summit, and Wayne counties) MyCare Ohio regions.
What will they do?
- Participate in quarterly conference calls or in-person meetings.
- There is no cost for participation.
- Decisions of the Member Council and Connected Advisors will be made by simple majority vote of members present.
- One member will be appointed/elected to participate in UnitedHealthcare's National Peer Ambassador program. The goal of a peer ambassador program is to elevate and empower members through meaningful dialogue, information exchange, and inclusion in the development of best practices, innovations, and delivery/design in promotion of a member-centered culture. The Community and National Peer Ambassadors connect virtually (via conference or web-based technology) to share experiences and insights regarding opportunities to better the quality of life and experience of the populations we serve. We leverage recommendations and insights shared by the Ambassadors to support improved outcomes and experiences in the promotion of a member-centered culture. The Ambassadors do not receive compensation for service in the ambassador role.
To learn more about UnitedHealthcare's Member Advisory Council and "Connected Advisors," or get involved, get information at www.myuhc.com/communityplan or call Member Services at 1-800-895-2017 (TTY 711).
Flu & Pneumonia Questions & Answers
Coronary Artery Disease
UnitedHealthcare Community Plan
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