Senior Citizen's Guide digital books
Senior Citizen's Guide to Southwest Ohio

Health Care Home
Is It Right For Me?

The cost of health care continues to rise, with escalating costs straining budgets. However, there is an approach that increases the quality of care for thousands of Medicaid enrollees while decreasing the cost to Ohio taxpayers.

Two Systems under Medicaid

In Ohio today there are two systems operating under Medicaid – the state-federal program providing health care services to those most in need. The first is fee-for-service, where doctors and health care providers are reimbursed per services rendered. Fee-for-service Medicaid can get very costly for the state because services are fragmented and not part of a coordinated care model.

The second system is Care Coordination. Care Coordination is built on the idea that prevention, healthy living and responsible use of the health care system help keep costs in line. In Ohio, there are 1.5 million people who are part of a Medicaid Care Coordination plan. This model has been successful in Ohio and has provided a $1 billion fiscal benefit to the state.

The Health Care Home Model

As part of Medicaid Care Coordination, every enrollee is also part of a Health Care Home. That means that they get extra benefits including transportation to medical appointments, a 24-hour nurse hotline, and other important services to help them stay well. These are benefits that the fee-for-service program does not provide. In addition, the Health Care Home philosophy of care has helped keep people out of emergency rooms when that care is not appropriate, and connected to their primary care doctors for essential health needs.

Ohio Needs to Make a Change

Seniors in Ohio who are on both Medicare and Medicaid are not permitted to be part of a Health Care Home. In today’s health care environment, doctors who treat seniors who are on both Medicare and Medicaid are paid through these two programs – Medicare takes on the majority of the medical costs, acting as the primary payer of a dual eligible’s medical services. Medicaid is paid last, and these dollars are funded through the fee-for-service system, which is more costly for the state.

A better way to serve these seniors in need who are eligible for both Medicare and Medicaid is to have them be included in the Health Care Home, where their health care and other service needs are coordinated. Because Medicaid Care Coordination Plans proactively engage with their members, they can help facilitate care, making sure these seniors get the right care at the right time and in the right place. In addition to coordinating health care, these seniors would also get connected to the extra services to help them stay well.

Everyone deserves a Health Care Home. But especially for seniors with complex medical needs, it just makes sense. By coordinating care for seniors on Medicare and Medicaid, seniors in need will get more comprehensive care while at the same time providing the best value to Ohio taxpayers.

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