The Ohio Department of Medicaid (ODM) has been conducting MyCare Ohio program community input sessions across the state. During these sessions, we have been meeting with members, providers, and others to hear their experiences with healthcare and the providers who serve them and share the exciting changes coming to the program. From these sessions, we learned that there is confusion about the transition to the Next Generation MyCare program. The MyCare Ohio program is not going away, only improving.
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MyCare Ohio is a managed care program designed for Ohioans who receive BOTH Medicaid and Medicare benefits. This program has a team approach to coordinating your care based on your needs – a team with you at the center.
The MyCare Ohio plan that you choose provides all the same benefits that Medicare and Medicaid offer, including long-term care services and behavioral health services. Plus, your MyCare Ohio plan may include additional services to you.
You have two choices for receiving your MyCare Ohio benefits:
- Dual benefits: A MyCare Ohio plan provides both your Medicare and Medicaid benefits. You are eligible to receive added benefits the plan might offer, like $0 copayments for prescription drugs covered by Medicare and additional transportation services.
- Medicaid-only benefits: A MyCare Ohio plan only covers Medicaid-covered services. You will continue to receive prescription drugs through your “Part D” plan and any associated co-payments. Your Medicare benefits would be provided through traditional Medicare or through a private insurance company, commonly referred to as a “Part C” plan.
Is the MyCare Ohio program going away?
No, MyCare Ohio is not going away.
To better serve Ohioans who are dually eligible and the providers who serve them, ODM will be launching its Next Generation MyCare program in January 2026 for the 29 counties where MyCare Ohio is currently available. Statewide expansion will follow as expeditiously as possible.
The Next Generation MyCare program aims to improve member and provider experience by:
- Focus on the individual.
- Improve individual and population wellness and health outcomes.
- Create a personalized care experience.
- Support providers in continuously improving care.
- Improve care for individuals with complex needs to promote independence in the community.
- Increase program transparency and accountability.
What is the current status of the Next Generation MyCare procurement?
Earlier this year, ODM conducted a Request for Applications (RFA) that was intended for managed care organizations interested in becoming Next Generation MyCare plans for Ohioans who are dually eligible for Medicaid and Medicare.
As a next step in this process, ODM is reviewing the responses to the RFA we received and plans to award new MyCare contracts in the fall. The selected plans will be an essential piece in improving the health and lives of Ohioans.
Where do I go to learn more about MyCare Ohio or ask questions?
For questions related to Ohio Medicaid Enterprise System submitted claims (fee or service or managed care), prior authorizations, and billing, contact the Ohio Medicaid Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov.
For questions related to pharmacy claims and prior authorizations, contact the Gainwell Single Pharmacy Benefit Manager at 833-491-0344 or OH_MCD_PDM@GainwellTechnologies.com.
For questions related to PASSPORT or Assisted Living claims or service authorizations, contact the local Area Agency on Aging at 866-243-5678.
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