Medicaid Managed Care - Southwest Region
1-800-605-3040
(TTY) 1-800-292-3572
En Espanol 1-800-605-3040
Monday - Friday 8:00 a.m. - 8:00 p.m.
In Ohio, most individuals who receive Mediaid through the Covered Families and children (CFC) program must be enrolled in Managed Care Plan (MCP).
Southwest region includes Adams, Brown, Butler, Clermont, clinton, Hamilton, Highland and Warren counties. The MCP's that are available in these counties are: AMERIGROUP Ohio, Inc., Carsource and Molina Healthcare.
A Managed Care Plan or "MCP" is a private health insurance company that is licensed through the Ohio Department of Insurance and has a provider agreement with the Ohio Department of Job and Family Services (ODJFS) to provide health care to you, your family and others that are on Medicaid. They do this through contracts with doctors, specialists, hospitals, pharmacies and other health care providers in your region.
Does everyone have to join a MCP?
The only people excluded from MCP enrollment:
Consumers who are dually eligible under both Medicaid and Medicare, or
Consumers enrolled in a waiver program
How do I change my MCP?
If you already enrolled in an MCP, but you think you may want to change MCPs, you can change at certain times. Those times are:
If you have been an MCP member for less than three months
During you annual open enrollment month; and
Just cause (special reason)
Just call the ODJFS Manageed Care enrollment Center (MCEC) toll-free 1-800-605-3040. (TYY) 1-800-292-3572, En Espanol 1-800-605-3040 or on line at www.ohiomcec.com. An enrollment counselor will answer your questions and help you change from one MCP to another if you meet one of the reasons above.
What are my rights if I am unhappy about my health care services?
If you are unhappy with your MCP or its providers, you have the right to file anappeal, a grievance, and/or a state hearing. You can contact the MCP at their toll-free number and they can provide you with the following information;
The requirements and timeframes for filing an appeal, grievance, or state hearing;
The rules about state hearings and how to ask for a state hearing;
An explanation of how you may be able to have your services continue if you file an appeal or request a state hearing, and when you might have to pay for these services.
What can I expect once I choose an MCP?
Your MCP must provide you the following;
All the same medically necessary services that are covered by Medicaid fee-for-service
A member handbook that explains how to receive health care through the MCP, and the rules you must follow when getting health care services.
A member identification card. You must show this card every time you receive health care servcies.
A directory of all doctors, specialist, hospitals, pharmacies and other health care professionals who are with the MCP. This directory lists their addresses and telephone numbers. you can also see this information on your MCP's member website. All provides are listed at
www.ohiomcec.com Information on how to get benefits such as family planning services from out-of-panel providers.
Transitioning from Medicaid fee-for service to an MCP
What if I already have services scheduled?
If you are changing from Medicaid fee-for-service to an MCP, and have health care services already approved and/or scheduled, it is important that you call the memer services telephone number of the MCP that your chose as soon as possible. In certain situations, for a brief time after you enroll, your MCP may allow you to receive care from a provider that is not contracted with the MCP. However, you must call your MCP before you receive the care. It is especially important to call your MCP to let them know if you have the following services already approved and/or scheduled:
Organ, bone marrow, or hematapoietic stem cell transplant;
Inpatient/outpatient surgery;
Appointment with a specialty physician;
Chemotherapy or radiation treatments;
Third trimester prenatal (pregnancy care, including delivery;
Services you receive at home, including home health, therapies, and nursing;
Non-routine dental or vision services (for example braces or surgery); or
Medical equipment.