About Your Care
We want to give you good care!
Molina MyCare Ohio Medicaid works with our providers to give you good health care. We look at your member benefits and make choices about care based on what you need. We want you to know:
- We do not reward staff or other people to deny care or give you less care
- We do not pay extra money to providers or our staff members to deny tests or treatments that you need to get better or stay healthy
If you have a concern about your health care, call Molina Member Services. If you call after our regular business hours, leave a message. We will return your call within the next business day.
- Our staff can accept collect calls.
- You can talk to our nurses about care choices and getting care through our 24-Hour Nurse Advice Line or 24-Hour Behavioral Health Crisis Line.
- A bilingual staff member or interpreter is available for members.
Primary Care
See your primary care provider (PCP) for a health checkup. Many people wait until they are very sick to see a provider. You do not need to wait. Make sure you schedule a checkup before you get sick. This will help keep you well.
Specialty Care
A primary care provider (PCP) can handle most health care needs. But sometimes there are special problems such as a broken bone or heart disease. A visit to a provider who has extra training may be needed. This provider is called a specialist. If you need to see a specialist, your PCP will make sure you see the right one and may be able to help you get an appointment faster.
Out of Area Care
Routine care is not covered outside the Molina MyCare Ohio Medicaid service area, unless you are seen by a Molina MyCare Ohio Medicaid participating provider. If you need special care by a provider who is not part of the Molina Healthcare network, your PCP will help to get the authorization (approval) that is needed.
If you travel outside the service area, Molina MyCare Ohio Medicaid pays for emergency care. You may go to a local emergency room (ER) or an urgent care clinic. You need to tell them you are a Molina Healthcare member and show them your Molina Healthcare ID card. Remember that routine care is not covered outside the Molina MyCare Ohio Medicaid service area.
Out-of-Network Services
If a Molina MyCare Ohio Medicaid provider is unable to provide you with necessary and covered services, Molina MyCare Ohio Medicaid must cover the needed services through an out-of-network provider. The cost to you should be no greater than it would be if the provider were in Molina MyCare Ohio Medicaid's network. This must be done in a timely manner for as long as Molina MyCare Ohio Medicaid is unable to provide the service.
After Hours Care
There may be times when you need care and your primary care provider (PCP) is closed. If it is after hours and the PCP’s office is closed, you can call our 24-Hour Nurse Advice Line/Behavioral Health Crisis Line. Nurses are available to help you 24 hours a day, 7 days a week.
Emergency Care
Emergency care is for sudden or severe problems that need care right away. It can also be care that is needed if your life or health is in danger. Emergency care is a covered benefit for members. If you need emergency care, call 911 or go to the nearest hospital. You do not need prior approval. If you have an urgent matter that does not threaten your life, you can also call our 24-Hour Nurse Advice Line/Behavioral Health Crisis Line, 24 hours a day, 7 days a week.
Second Opinions
Members who do not agree with a provider’s plan of care have the right to a second opinion from another Molina Healthcare provider or from an out-of-network provider. This service is at no cost to you.
Transition of Care
We care about your health. We want to ensure you get the care you need. If you have had health care services scheduled prior to joining Molina MyCare Ohio Medicaid, it is important that you call Member Services today, or as soon as possible, so we can help you get the care you need. For a time after you join Molina MyCare Ohio Medicaid, you may be able to continue to receive care from a provider that is not a network provider. 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: |
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365 days except if you are identified for high-risk care coordination. Then, your physician must be covered for 90 days. |
| Dialysis Treatment | 90 days (or more if authorized by plan) |
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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: |
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365 days except if you are identified for high risk care coordination. Then, your physician must be covered for 90 days. |
| Dialysis Treatment | 90 days (or more if authorized by plan) |
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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. |
Waiver Services - Direct Care including:
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365 days unless a change is required due to a health or other life event that changes your needs. |
| All other waiver services | 90 days and only after an in-home assessment is completed to transition your services to a new provider. (The services amount is maintained for 365 days) |
Language Assistance
You have the right to an interpreter. There is no cost. You should tell the office staff if you would prefer to talk in a different language. If you need help, call Member Services.