News About a CareSource Network Change

By now, you may be aware that CareSource will be ending its contract with Cleveland Clinic effective Friday, September 1, 2017. 

This change to your Medicaid Managed Care plan will not affect the care and coverage provided to you by Neighborhood Family Practice. You can continue to come to any of our five community health center locations for the same high quality care and coverage you’ve always received from NFP. However, the change will impact where you will be hospitalized or receive specialty care when needed.   

Except for emergencies and active treatment that is specifically approved to ensure continuity of care, the last day you will be able to receive services from Cleveland Clinic facilities including Lutheran and Fairview Hospitals is Thursday, August 31, 2017. If you wish to continue receiving care through Cleveland Clinic, please call the Ohio Medicaid Consumer Hotline at 800.324.8680 or go to www.ohiomh.com/EnrollOptions.aspx to change your Medicaid Managed Care plan to Buckeye Health Plan, Molina Healthcare, Paramount Advantage or UnitedHealthcare Community Plan.

If you prefer to remain with CareSource, your specialty care and hospital coverage will be directed to The MetroHealth System and there is no need for you to do anything at this time.

We understand the changes to your CareSource coverage may be confusing, and NFP is committed to helping you understand and make decisions about your future coverage that are best for you.  If you have any questions or need help selecting another Medicaid Managed Care plan, please call us at 216.281.8945.

Updated 8.3.17
                                                                                           

FAQs

CareSource recently announce that Cleveland Clinic will no longer be a participating health partner with CareSource.  Please review the commonly asked questions below for more information about how this change my impact your care.

Q:    What is changing with my coverage and when will it start?
A:    Beginning September 1, 2017, CareSource will no longer cover care at Cleveland Clinic.  The last day CareSource members can receive services from Cleveland Clinic will be August 31, 2017 except for emergencies and certain covered services for continuity of care. 

Q:    What care will be covered after August 31, 2017?
A:    Any care by a Cleveland Clinic doctor after August 31, 2017 will need to be pre-authorized by CareSource.  CareSource will only pay for the following:

  •        If you are undergoing an active course of treatment
  •        If you are in the second or third trimester of pregnancy
  •        If you are being treated for a terminal illness.

Q:    Does this change affect my care at Neighborhood Family Practice?
A:    No.  You can continue to come to any of our five community health center locations for the same high quality care and coverage you’ve always received from NFP. 

Q:    Does this change affect me if I have CareSource MyCare?
A:    Yes, beginning September 1, 2017, CareSource MyCare will no longer cover care at Cleveland Clinic unless you are in an active course of treatment that has been approved by CareSource.

Q:    Can I still go to Cleveland Clinic?
A:    You may continue going to Cleveland Clinic until August 31, 2017.  After August 31, 2017, your care at the Cleveland Clinic will no longer be covered as an in-network benefit from CareSource. 

Q:    What if I have an appointment scheduled at Cleveland Clinic after August 31, 2017?
A:    After August 31, 2017, most services are no longer covered.  Any care by a Cleveland Clinic doctor after August 31, 2017 will need to be pre-authorized by CareSource.  To obtain a prior-authorization to continue your care, ask the doctor who ordered your care to call CareSource at 800.488.0134 (TTY for the hearing impaired: 800.750.0750 or 711).  

Q:    What if I wish to continue going to Cleveland Clinic after August 31, 2017?
A:    If you want to keep going to Cleveland Clinic for your care, you will need to choose another Medicaid plan to have these services covered by your insurance.  These plans include:

  •         Buckeye Health Plan
  •         Molina HealthCare
  •         Paramount Advantage
  •         UnitedHealthcare Community Plan

Q:    How do I change my Medicaid Managed Care Plan? 
A:     There are a number of options available to help you change your Medicaid Managed Care Plan:

  • The Ohio Medicaid Consumer Hotline can help you if you choose to change to another Medicaid Managed Care plan.  They can be reached at:
  •  Cleveland Clinic has resources available to help you understand your Medicaid coverage:
    •  If your last name starts with A-G, please call Human Arc 833.324.7750
    • If your last name starts with H-O, please call MedAssist at 866.686.0887
    •  If your last name starts with P-Z, please call RevCare at 800.848.6303
       
  • Neighborhood Family Practice has patient benefit specialists available to answer your questions and help you select another plan.  They can be reached at 216.281.8945.

Q:    When/how soon do I need to make this change to continue to have coverage at Cleveland Clinic?
A:    You may change your plan anytime between now and the end of November.  Keep in mind that to have coverage from your new Medicaid Managed Care Plan by September 1, 2017, you will need to change your plan by August 22, 2017.

  • Changes made between now and August 22, 2017 (effective September 1, 2017)
  • Changes made between August 23 – September 20, 2017  (effective October 1, 2017)
  • Changes made between September 21 – October 20, 2017 (effective November 1, 2017)
  • Changes made between October 21 – November 20, 2017 (effective December 1, 2017)
  • Changes made between November 20 – November 30, 2017 (effective January 1, 2018)

Q:    What are my options if I choose to stay with CareSource?
A:    If you prefer to remain with CareSource, your specialty care and hospital coverage will be directed to The MetroHealth System and other participating hospitals in the area.  For a complete list, please contact member services at CareSource: 800.488.0134 or visit the website at CareSource.com and use the “Find a Doctor/Provider” online tool located under “member Resources” on the right-hand side of the web page.

We will update this page with information about upcoming Medicaid information sessions hosted by Cleveland Clinic. You may also visit www.clevelandclinic.org/acceptedinsurance.