In addition to an educational speech by Lisa Mastriano, Resource Development Director of Pregnancy Care of Summit County, members enjoyed several activities, including bingo. Prizes included MP3 players, Build-A-Bear ® toys, and giveaway bags which included educational material, baby booties, key rattles, and bibs. A grand prize of a car seat was given out to one lucky member, too.

Buckeye Member Connections representatives  Maria Clark, Danielle Dublkar and Valorie Rose as well as Start Smart Nurse Lori Edmondson spent the day with 11 young moms-to-be at this fun-filled event.

Buckeye’s mascot, Buckley the Squirrel, surprised Oakdale Elementary School fifth-grader Alexia Aranda with the game system as the grand prize for her winning entry in the recipe contest. The presentation was made at an assembly at the school January 27.

Alexia, the daughter of Bobby Jo Aranda, submitted a recipe for a frozen banana with yogurt.  Another fifth-grader at the school, Jacob Lowry, was a regional winner in the recipe contest. Jacob, who submitted a recipe for fruit/yogurt snack mix, received a $50 Subway gift card. Jacob, 11, is the son of Jennifer Lowry. 

Kids’ Club

Centene Corporation sponsored the recipe contest as part of its Kids’ Club program, which Centene kicked off last year to help educate its child members on a variety of health topics. As part of the Kids’ Club initiative, Centene’s health plans across the country, including Buckeye, reach out directly to children with newsletters, health education, and other innovative events such as the recipe contest.

Through its Kids’ Club efforts, Buckeye has an adopt-a-school partnership with Oakdale Elementary. Buckeye and Oakdale staff regularly partner to help students at the school learn more about healthy lifestyles through various exciting activities that teach healthy habits and improve the lives of students and their families.

In The News!

Check out these links from the Toledo Blade and WTVG-TV ABC Channel 13 to see media coverage of the recipe contest winners at the January 27 assembly.

http://abclocal.go.com/wtvg/video?id=7243145

http://toledoblade.com/apps/pbcs.dll/article?AID=/20100128/NEWS04/100129706

Winning Recipes

Alexia’s Frozen Banana and Yogurt

Ingredients:

• 1 Banana
• 1/8 cup Low Fat Granola
• ¼ cup Low Fat Vanilla Yogurt
• Stick

Instructions:

1. Put banana on a stick
2. Dip banana in yogurt (covering banana)
3. Roll banana covered in yogurt in granola
4. Freeze for one hour

Jacob’s Fruit and Yogurt (apple, grape, strawberry, raspberry) 

Ingredients:

• 50g Grapes, raw (about ½ cup)
• 150g Strawberries, raw (about 1 cup, halved)
• 1 cup Low-Fat Yogurt
• 1/2 Cup Raspberries
• 1/2 cup apples, sliced

 Instructions:

1. Cut fruit into pieces
2. Put yogurt into bowl
3. Place fruit into bowl with yogurt and mix together

Previously, Ohio’s MCPs, including Buckeye Community Health Plan, were responsible for providing all pharmacy benefits to their members. The ODJFS paid MCPs a capitation payment that included a fixed amount of funds to provide the pharmacy benefit, and MCPs were at full risk for the drug costs of their members. Now that the pharmacy is carved out of the benefit provided by MCPs, ODJFS has assumed responsibility for medications administered in the home. Capitation payments to MCPs have been adjusted accordingly to reflect the change in policy.

Currently, each of the seven Medicaid MCPs are responsible for pharmacy claims processing and prior authorization activities related to drugs dispensed by pharmacy providers to their members. Under the carve-out, managed care members will use the Ohio Medicaid fee-for-service (FFS) pharmacy benefit. All drug coverage policies will be the same for members enrolled in each of the seven MCPs as well as the FFS program.

What drugs are part of the carve-out? Will any drugs be covered by the MCPs?

The carve-out is limited to “take-home” drugs, meaning those drugs that are prescribed by a physician to be self-administered by the patient in their residence. Drugs administered by the physician or another professional in the course of an office or hospital visit are under the medical benefit and will still be part of the managed care benefit. Drugs administered via home health services or in a long-term care facility are carved out and under the FFS program.

Are any medical supplies part of the carve-out?

Some medical supplies that are usually obtained at the pharmacy, such as diabetic testing supplies, supplies for injection of insulin and other drugs, inhaler spacers, and peak flow meters, will only be able to be billed by pharmacies (including hospital pharmacies) and will no longer be covered when billed by any other provider type, including durable medical equipment (DME) dealers, clinics, or individual physician offices.

How will ODJFS ensure MCP members can continue to fill their prescriptions?

Prescription drug coverage for Medicaid MCP members will be the same as coverage for Medicaid FFS consumers. A transition period for MCP members will be in effect from February 1 through April 30, 2010. For claims within these dates of service, MCP members will be able to continue to receive medications that were filled under the MCP within the previous six months. If the drug claim for a MCP member requires prior authorization (PA) through FFS, the claim will be authorized during February, March, and April 2010 if the MCP member had a claim for the same drug during the previous six months that was covered by the MCP. The MCP member will be notified that the drug that was filled requires PA, but that they may continue to receive that drug through April 30, 2010. Beginning May 1, 2010, claims will deny at the pharmacy and the prescriber should either change to a drug that does not require PA or request PA.

Will MCP members have a different ID card for prescriptions?

No, MCP members will continue to use their MCP ID card to receive prescriptions. The MCPs have changed the ID card to include information about billing prescriptions through FFS.

Ohio Medicaid now covers these items that Buckeye members get from the pharmacy. Ohio Medicaid prior authorization and co-pay requirements apply.

• Prescription drugs
• Diabetic supplies
• Inhaler spacers
• Peak flow meters
• Condoms

Buckeye’s member identification (ID) card lets the pharmacy know that Ohio Medicaid will cover your prescription drugs. All Buckeye members have been issued new ID cards with that information on them.

If you have questions or problems with your prescription drug coverage, the supplies listed above, or the pharmacy, please contact:

• Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 800-292-3572). The Hotline is open Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 5 p.m.
• You can also use the Internet at http://jfs.ohio.gov/ohp/bhpp/meddrug.stm for lists of prescriptions that are available at no cost to you, have co-payments, or require prior authorization.

Pregnant?
If you are pregnant, after your baby is born your Medicaid caseworker must add your baby to your Medicaid case before Ohio Medicaid will pay for prescriptions for your baby.

• Ask your caseworker for instructions about how to report when your baby is born.
• When your baby is born, report to your caseworker as instructed so your caseworker can add your baby to your case.
• Ask your caseworker to add your baby to your Medicaid case quickly.

Pharmacy Providers

You can use any pharmacy that accepts Ohio Medicaid to get your prescription drugs, diabetic supplies, inhaler spacers, peak flow meters, and condoms.

Learning to fight flu and teaching healthy habits are a part of this unique partnership designed to improve the lives of students and their families. Buckeye and Oakdale are addressing a variety of health issues that affect students. Topics include:

• Flu and germ prevention
• Healthy eating/food choices
• Childhood obesity
• Literacy/book giveaways
• Preventive care/annual well care exam

As part of the collaboration, Buckeye and Oakdale produce health-related newsletters, conduct career days, and sponsor health-related contests, such as as a health snack recipe contest and a health rap contest.

The Buckeye/Oakdale partnership is part of an overall Kids’ Club initiative that has been put in place by Buckeye’s parent company, Centene Corporation (www.centene.com). As part of Kids’ Club, Centene’s health plans across the country reach out to child members about a variety of health topics through contests and events.