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Transition of Care

If you had health care services scheduled before joining Molina Dual Options, it is important that you call Member Services today or as soon as possible. We will help you get the care you need with your new plan. For a time after you join Molina Dual Options, you may be able to continue to receive care from a provider that is not in our provider network. This is called transition of care. Transition of care is important to ensure a smooth transition to our health plan and the benefits, services and prescriptions you need.

Transition of Care Time Period for Non-Waiver Members

Service Services you were receiving from a non-network provider at the time of your enrollment in the MyCare Ohio program will be covered from the first date of enrollment for:
  • Physician
  • Community Mental Health
  • Addiction Treatment Centers

365 days except if you are identified for high risk care management then your physician must be covered for 90 days.

Dialysis Treatment

90 days (or more if authorized by plan)

  • Ohio Medicaid Prior Authorized Durable Medical Equipment, Vision and Dental
  • Scheduled Surgery
  • Chemotherapy/Radiation
  • Organ/Bone Marrow/Hematopoietic Stem Cell Transplant

Until the planned or authorized services are received.

Medicaid Home Health and Private Duty Nursing

90 days

Assisted Living or Medicaid Nursing Facility

Unlimited period if lived in the facility on the day you enrolled in the MyCare Ohio program and the service continues to be medically necessary.

 

Transition of Care Time Period for Waiver Members

Service Services you were receiving from a non-network provider at the time of your enrollment in the MyCare Ohio program will be covered from the first date of enrollment for:
  • Physician
  • Community Mental Health
  • Addiction Treatment Centers

365 days except if you are identified for high risk care management then your physician must be covered for 90 days.

Dialysis Treatment

90 days (or more if authorized by plan)

  • Ohio Medicaid Prior Authorized Durable Medical Equipment, Vision and Dental
  • Scheduled Surgery
  • Chemotherapy/Radiation
  • Organ/Bone Marrow/Hematopoietic Stem Cell Transplant

Until the planned or authorized services are received.

Medicaid Home Health and Private Duty Nursing

365 days unless a change is required due to a health or other life event that changes your needs.

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