Leaving the Plan (Disenrollment)

As a member of a managed care organization (MCO), you have the right to choose to end your membership at certain times during the year. You can choose to end your membership during the first three months of your membership or during the annual open enrollment month.

The Ohio Department of Medicaid will send you something in the mail to tell you when your annual open enrollment month will be. Call the Medicaid Hotline at 1-800-324-8680 (TTY 1-800-292-3572). You can also submit a request online to the Medicaid Hotline website at www.ohiomh.com.

If you live in a mandatory enrollment area, you will have to choose another managed care organization to cover your health care services.

When will my membership end?

If you call before the last 10 days of the month, your membership will end the first day of the next month. If you call after this time, your membership will not end until the first day of the following month.

If you chose another managed care organization, your new managed care organization will send you information in the mail before your membership start date.

Special reasons to leave the plan

Sometimes there may be a special reason that you need to end your membership with a plan. This is called a "just cause" membership termination. Before you can ask for a just cause membership termination, you must first call AmeriHealth Caritas Ohio and give us a chance to resolve the issue. If we cannot resolve the issue, you can ask for a just cause termination if you have one of the following reasons:

You move and our plan is not available where you now live, and you need non-emergency medical care in your new area before your membership ends.
We do not, for moral or religious objections, cover a medical service that you need.
Your doctor has said that some of the medical services you need must be received at the same time, and the services are not all in our network.
You have concerns that you are not receiving quality care and the services you need are not available from another provider in the AmeriHealth Caritas Ohio network.
You do not have access to medically necessary Medicaid-covered services, or do not have access to providers that are experienced in dealing with your special health care needs.
The PCP that you chose is no longer in our network, and that was the only in-network PCP who spoke your language and was located within a reasonable distance from you.
Another plan has a PCP in their network who speaks your language, is located within a reasonable distance from you, and will accept you as a patient.
If you think staying as a member in your current managed care plan is harmful to you and not in your best interest.

A member may request a different MCO at any time if they are a child receiving Title IV-E federal foster care maintenance, or are in foster care or other out-of-home placement. The change must be initiated by the local public children's services agency (PCSA) or the local Title IV-E juvenile court (Ohio Administrative Code: Rule 5160-26-02.1).

You also have the option not to be a member of any managed care organization (MCO) if:

You are a member of a federally recognized Indian tribe, regardless of your age.
You are an individual who receives home- and community-based waiver services through the Ohio Department of Developmental Disabilities.

You may ask to end your membership for just cause by calling the Medicaid Hotline at 1-800-324-8680 (TTY 1-800-292-3572). The Ohio Department of Medicaid will review your request and decide if you meet a just cause reason. You will receive a letter in the mail to tell you if the Ohio Department of Medicaid will end your membership and the date your membership ends.

If you live in a mandatory enrollment area, you will have to choose another plan unless the Ohio Department of Medicaid tells you differently. If your just cause request is denied, the Ohio Department of Medicaid will send you information that explains your right to a state fair hearing for appealing the decision.

If you lose Medicaid eligibility

It is important that you keep your appointments with the county department of job and family services. If you miss a visit or don’t give them the information they ask for, you can lose your Medicaid eligibility. If this happened, AmeriHealth Caritas Ohio would be told to stop your membership as a Medicaid member and you would no longer be covered by AmeriHealth Caritas Ohio.

If you lose your Medicaid eligibility but it is started again within 90 days, you will automatically become an AmeriHealth Caritas Ohio member again.

Can AmeriHealth Caritas Ohio end my membership?

AmeriHealth Caritas Ohio may ask the Ohio Department of Medicaid to end your membership for certain reasons. The Ohio Department of Medicaid must okay the request before your membership can be ended.

The reasons that AmeriHealth Caritas Ohio can ask to end your membership are:

For fraud or for misuse of your AmeriHealth Caritas Ohio ID card
For disruptive or uncooperative behavior to the extent that it affects our ability to provide services to you or other members

Things to keep in mind if you end your membership

If you have followed any of the above steps to end your membership, remember:

Continue to use AmeriHealth Caritas Ohio doctors and other providers until the day you are a member of your new health plan or back on regular Medicaid.
If you chose a new plan and have not received a member ID card before the first day of the month when you are a member of the new plan, call the AmeriHealth Caritas Ohio Member Services Department. If they are unable to help you, call the Medicaid Hotline at 1-800-324-8680 (TTY 1-800 292-3572).
If you were allowed to return to regular Medicaid and you have not received a new Medicaid card, call your county caseworker.
If you have chosen a new plan and have any medical visits scheduled, call your new plan to be sure that these providers are in the new plan’s provider network and that any needed paperwork is done.
If you were allowed to return to regular Medicaid and have any medical visits scheduled, please call the providers to be sure that they will take the regular Medicaid card.

Members