To provide more integrated, coordinated care for its residents dually eligible for Medicare and Medicaid, Ohio is operating MyCare Ohio, a capitated model demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services. MyCare Ohio’s design has contributed to its high enrollment penetration rate, and its care management model has evolved over time to allow participating health plans more flexibility to meet the needs of their enrollees. While early evaluation results point to the strengths of this model, its long-term effectiveness will depend on continued stakeholder engagement and ongoing improvements to data sharing and quality measures.

This case study, developed for the Integrated Care Resource Center, describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders. State Medicaid agencies, particularly those looking to integrate care for dually eligible beneficiaries in capitated delivery systems, may find the information described in this brief useful.

This brief is a product of the Integrated Care Resource Center, a national initiative of the Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office, which is coordinated by Mathematica and the Center for Health Care Strategies.