The document discusses changes to Ohio's Medicaid program including expanding care management programs statewide and applying care management to more populations. It notes that managed care can help control costs while maintaining access and quality. WellCare Health Plan was selected as one of the managed care organizations and they offer benefits like transportation, vision, over-the-counter items, and disease management programs to Medicaid recipients.

2. Why is Medicaid changing in OH?
 HB 66/Budget Mandate:
Transform Medicaid by
expanding care
management programs
and stabilizing costs
 Expanding the current full-
risk program to all CFC
consumers statewide
 Applying care management
to the ABD population
through the most effective
approach
ODJFS Average Medicaid Spending Per Person
Per Member Per Monthn
$-
$400
$800
$1,200
$1,600
$2,000
95 96 97 98 99 00 01 02 03
State Fiscal Year (SFY)
Averagepermember,
permonthcosts
= Aged, Blind and Disabled
= Covered Families and Children

3. Why Managed Care?
 Managed Care is Cost Effective
 Ensures Access to Providers
 Enhances Quality of Care
 Ensures Customer Satisfaction
 Plans offer Value Added Services
 Disease Management/Case Management
 A 24-hour Personal Health Advisor
 Expanded Benefits & Incentive Programs

4. Who’s affected?
 Covered Families and Children (CFC)
Also known as Healthy Families and Healthy Start
 Children (up to age 19)
 Pregnant Women
 Families (Parents and Children)
 About 261,000 people in NE region
 Aged, Blind and Disabled (ABD)
 Except for dual-eligibles, children under 20,
waiver, institutionalized and spend-down
 About 25,000 in NE Region

5. What’s happening in your county?
Northeast Region –
Managed Medicaid

6. Members
Government Partners
Premium to WellCare
AdministrationNetwork and Medical
Hospitals
Ancillary
Physicians
Specialists
Case Management
Customer Services
Claims Payment
Disease Management
How do we partner with the State?

7. Who is WellCare Health Plan?
IL IN
NY
CT
FL
GA
LA
Core Business Operational Strategy
 Largest provider of managed care
services exclusively focusing on
Medicaid & Medicare
 Over 2 Million Members
Nationally
National Prescription Drug Plan Opportunity
 One of the largest PDP plans in
the Country
New Medicaid Opportunity – Ohio
 Contract with ODJFS for
CFC and ABD
 Patient-focused with
preventive care emphasis
MO
OHIO

8. What does WellCare offer?
-
,
Benefit Design
Network Structure
Preventive Care
Primary Care
Model
Additional
Services
Case/
Disease
Mgmt
Mandatory Benefits
PCP, Specialists, Ancillary,
Facilities
HealthCheck, Prenatal
Coordination of Care, Referrals
Therapies, Home Care, Surgery
RN’s coordinate care for members
with chronic, high risk conditions

9. What are WellCare’s Extra Benefits?
 No copays for any service
 Transportation (30 one-way, 15 round trip)
 Medical appointment
 WIC
 Redetermination
 Vision
 Annual exam (Kids and Adults)
 Up to 2 pairs eyeglasses each year
 Frame upgrade

10. Extra Benefits (continued)
 Personal care items mailed to your home
each month (Up to $10)
 Pain relievers, vitamins, bandages,
toothbrushes, etc.
 No cost
 No prescription necessary
 You choose what you need

11. Extra Benefits (continued)
 Personal Health Advisor
 24-hour health advisor line
 Care Management
 Programs for chronic diseases
 Nurses work with members to help coordinate
healthcare needs
 Prenatal Rewards Program
 Prenatal Visits/Postpartum Visit
 Free Stroller

12. How Do Clients Enroll?
 Automated Health Systems (AHS)
 Enrollment Vendor for ODJFS
 Choice
 Eligible clients must call AHS to enroll
 FFS until member of WellCare
 If No Choice
 Auto-assigned
 Assignment Process
 History/Relationship with Provider (PCP/Hospital)
 Proximity to Provider
 AHS Contact Information
 (800) 605-3040
 TTY – (800) 292-3572

13. How Can WellCare Member Services
Help?
 Educator
 Educating members on benefits
 Educating on how to access services
 Researcher
 Finding providers that meet cultural, demographic,
health care needs
 Assisting with claim issues
 Facilitator
 Supporting transportation arrangements
 Capturing changes to demographic information
 Providing language services
 Capturing OTC orders
 Coordinator
 Identifying transition and/or coordination of care needs
 Identifying candidates for disease/case management
 Dedicated customer service team
 Multi-lingual capacity
 Superior responsiveness
Our Member Service Associates serve as advocates for our Members’ health care needs.
WellCare Member Benefits

14. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Susan Titterington
Office: (216) 378-7651
Cell: (216) 255-1806
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials

15. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Lynn Charles
Office: (216) 378-7820
Cell: (216) 357-8901
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials

16. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Christine Thwing
Office: (216) 378-7845
Cell: (216) 357-8902
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials

17. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Tiffanie Riggs
Office: (216) 378-7818
Cell: (216) 357-8904
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials

18. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Ivelisse Roig
Office: (216) 378-7522
Cell: (216) 357-8905
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials

19. How Do We Work Together?
 Opportunities for Education
 Health Fairs
 Community Events
Contact Us
Jacqueline Shorter
Office: (216) 378-7816
Cell: (216) 357-8903
Website address: www.wellcare.com
 Provider Look-up
 Rx Formulary
 Member Materials