Ohio Unveils “Aggressive New Approach” for Dual Eligibles’ LTC

Ohio is looking to make huge changes to the way it provides long-term care to its 190,000 “dual eligibles”—those who qualify for both the Medicare and Medicaid programs—with an aggressive new approach, reports the Columbus Dispatch.

“Dual eligibles” are among the sickest and most expensive to care for. In Ohio, they make up 10 percent of the 2.1 million on Medicaid, yet they account for 46 percent of long-term-care costs.

The goal is to make sure dual eligibles get the most-appropriate care in the right setting, avoid duplication of tests and other services, and save tax dollars.


Greg Moody, director of the health office, said managed-care plans will oversee an “Integrated Care Delivery System” with a single point of contact for beneficiaries, regardless of the care or service they need.

Neither benefits nor eligibility guidelines will change. Recipients can continue to use their same health aides, doctors and other care providers. Services also will include 24-hour access and in-home visits by trained health professionals.

Part of the proposed model includes requiring the development of “innovative rate-setting methods including outcome based performance incentives and focused care coordination to achieve more efficient use of limited health care resources in the Medicare and Medicaid programs,” says Ohio’s initial demonstration model report, released last February.


Ohio will also seek to create more flexibility in its Medicaid program through meeting each individual’s needs in the setting of their choice, and identified accessible housing as a primary barrier to transition from institutional settings to community settings through initiatives like “Money Follows the Person” and other transition efforts.

Check out the summary of the Integrated Care Delivery System, “Improving Care Coordination for Medicare-Medicaid Enrollees,” and find out more here.

Written by Alyssa Gerace