Companionship is important. Adult day care provides care and companionship for members who qualify for extra help during the day. Caregivers also benefit, knowing their loved one is well cared for and safe during the day.
If your need for long‑term care has been determined by Ohio Medicaid, Adult Day Care can provide:
Social connections and friendship.
Bathing and personal care.
Asthma and COPD Care
Individual care to help control asthma and other lung diseases.
Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to help you:
Help you stay active.
Build a healthy future for you and your baby — and earn great rewards — through Baby Blocks. This program helps keep you and your baby healthy during your pregnancy and your baby’s first 15 months of life.
Baby Blocks includes:
Email appointment reminders.
Fun program to keep track of appointments.
Reward cards for clothing and more.
Once you sign up, you can choose either a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.
Members get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:
Work with you to develop a plan of care that meets your individual needs.
Coordinate with family members, caregivers and health care providers.
Help get additional services or support you may need.
Our plan includes visits for chiropractic care. Whether chiropractor services are your primary or alternative treatment method, you're covered.
Members of all ages can get up to 15 visits per year. Members under 21 may get additional visits with prior authorization.
Choice of Doctor
From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.
You get a primary care physician (PCP) who is your main doctor. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
Treatment if you are sick or injured.
Referrals to specialists for certain conditions.
Regular exams help keep teeth and gums strong and healthy. Beginning April 30, 2015, oral exams are covered once per year for members over age 21.
Equipment and Supplies
Our plan covers some medical equipment ordered by a member's doctor or case manager. This can include supplies like:
We provide the exams and treatments needed to help keep your feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.
Our podiatry coverage includes:
Routine foot exams.
Tips about foot care and choosing the right shoes.
Therapeutic shoes and inserts for members with diabetes.
Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect hearing.
Exams, therapy and tests.
Hearing aids, batteries, and accessories.
Healthy First Steps
When you're pregnant, you receive help and advice from your family and friends. Yet every pregnancy is different. This program will support you through your pregnancy.
We help you:
Find a doctor for both mother and baby.
Learn about nutrition, fitness and safety.
Get supplies, including breast pumps for nursing moms.
Home Health Care
If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing.
With approval, our plan may cover:
An in-home medical visit.
Medical equipment like hospital beds, walkers or wheelchairs.
A home health aide, nursing services or a private nurse.
Physical, occupational, and speech therapy.
Help with personal care or housekeeping.
Home infusion therapy.
This plan pays for most expenses related to a hospital stay. This way you can rest and heal.
Our plan covers these services and more:
Room and board.
Supplies and equipment.
Treatment and therapies.
Diagnostic tests and exams.
And after leaving the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Language and Interpretation
You and your doctor need to understand each other. We can explain information in English or in your primary language. If you are visually or hearing impaired, special help can be provided.
Kidney Disease Care
Kidney disease is a serious medical condition. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.
Our services may include:
Needed equipment and supplies.
Home support services.
Health education and training.
Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.
You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.
Member Matters Representative
Every member of the health plan gets a personal Members Matter representative. This person can help you get the most of your benefits. They can:
Welcome you to the plan and help you understand your benefits.
Arrange for extra support services.
Complete a health risk assessment.
Help you access community services.
Mental Health and Substance Abuse Services
Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:
Sometimes a person's health and safety needs require the assistance from community service programs. Here’s where the My Advocate™ program can really help.
My Advocate helps members learn about and sign up for money-saving programs like:
Food, housing and utility discounts.
Free wireless cell phone.
Community child care.
Members can get My Advocate™ by calling their Care Manager at 1-877-542-9236 (TTY: 711).
Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.
Our nurses will:
Listen to symptoms.
Help with self-care.
Advise you about getting care at a doctor visit or an urgent care center.
Help you know when to go to the emergency room.
Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan include weight counseling. The counseling takes place in your primary care setting, so that it can be managed along with your other needs.
Most people know the bad health effects of smoking. And they know they need to quit. We support our members with coaching while they quit.
Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.
Our plan covers visits for:
You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:
Urgent care centers.
Federally qualified health centers.
Other walk-in clinics.
Eye exams are covered once every two years.
Beginning April 30, 2015, eye exams are covered once every two years for members age 21-59. No extra allowance for contact lenses. Contact lenses are covered only if medically necessary.
Ready to get started?
Call Us: 1-877-542-9236
Monday–Friday 7:00 a.m. to 8:00 p.m. local time Voicemail available 24/7.