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On November 1, the Ohio Department of Medicaid (ODM) announced four managed care organizations to serve as the Next Generation MyCare plans. MyCare Ohio is a managed care program designed for Ohioans who receive both Medicaid and Medicare benefits. The MyCare Ohio program combines Medicaid and Medicare benefits into one program, coordinated by a managed care plan. This approach to coordinating care keeps the member at the center of focus.
For more than a year, ODM has met with providers across the state to understand your experience with the MyCare Ohio program. This feedback helped mold the Next Generation program, which is a giant step toward delivering a better provider and person-centered experience for Ohioans across the state. ODM’s announcement and additional information can be found in the press release.
ODM awarded four managed care organizations as ODM’s Next Generation MyCare plans. The selected plans include a continued partnership of some of the MyCare Ohio plans who have served MyCare Ohio members in the current demonstration as well as the addition of new plans that have served in the Next Generation managed care program to allow members to have more choices to meet their healthcare needs. The four Next Generation MyCare plans are:
Friday's announcement does not immediately impact current members and providers of the MyCare Ohio program. Current MyCare Ohio members will continue to receive services with their current MyCare Ohio plan until the Next Generation MyCare plans begin serving members in January 2026 and will not lose coverage.
Starting in January 2026, the selected plans will support Ohioans who are dually eligible for both Medicare and Medicaid healthcare coverage in the 29 counties where MyCare Ohio is currently available, with statewide expansion following as quickly as possible. Before January 2026, ODM will support providers by providing details about expected changes and where to receive help in navigating those changes. ODM, the selected plans, and partner organizations will complete an extensive readiness review process to support a seamless transition to the Next Generation MyCare program.
Ohio Medicaid providers interested in contracting with the Next Generation MyCare plans can do so by contacting the plan(s) they wish to contract with.
ODM strives to meet the healthcare needs of Ohioans who are dually eligible for Medicare Medicaid. To accomplish this, we have continued our partnership with all the MyCare Ohio plans that have previously served MyCare Ohio members as well as plans that currently serve as Next Generation managed care plans to create a better member and provider experience and achieve the following goals:
- Focusing on the individual.
- Improving individual and population wellness and health outcomes.
- Creating a personalized care experience.
- Supporting providers in continuously improving care.
- Improving care for individuals with complex needs to promote independence in the community.
- Increasing program transparency and accountability.
This is a new vision for Ohio's MyCare program - one that focuses on the healthcare needs of Ohioans who are dually eligible. We look forward to continuing to work with you and hearing from you as we work together to better serve dually eligible Ohioans.
To learn more about the Next Generation MyCare program refer to the resources below:
- MyCare Ohio provider resources
- MyCare Ohio member resources
If you have questions or feedback about the Next Generation MyCare, please contact MyCareConversionQuestions@medicaid.ohio.gov.
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Ohio Medicaid’s annual open enrollment is underway. We know that members' needs are ever changing, that’s why we encourage members to review the managed care plans available and select the one that best fits their healthcare needs. If a member has not selected a plan, they still have time! Members can make their plan selection through November 30.
Members who wish to keep their current managed care plan do not have to do anything.
If they decide to switch, their new plan will begin covering them on the first day of the month following their selection. For example, if a member chooses a new plan in October, coverage begins November 1.
Medicaid plans cover medical, vision, dental, and behavioral health services as required by law. However, each offers value-added extras to keep members healthy and earn their business.
Taking part in open enrollment lets members learn the differences among the plans. Providers can help by encouraging members to take time to understand their options and review each plan with following in mind:
- Which plan communicates the way that is best for them and their family?
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What plan makes it easy for them and their family to make and keep appointments?
- Which plan supports them, and their family’s health conditions or health goals?
To help members select a plan, there are several resources available. Share these resources freely and use them when assisting members during open enrollment.
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Managed Care Health Plan Comparison Guides offers insight into required managed care plan services for each plan year, as well as the unique value-added benefits each plan offers. Guides for 2024 and 2025 are available:
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The Find a Managed Care Provider search tool can help identify the managed care plans contracting with (“in network”) your trusted providers.
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The Open Enrollment Frequently Asked Questions answers questions related to annual managed care open enrollment.
Additionally, each managed care plan has a member website that enrollees can visit to learn more about each plan’s approach to serving Ohio Medicaid managed care members:
Members can explore the managed care plans available and enroll by visiting www.ohiomh.com or by contacting the Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 711). Representatives are available 7 a.m.-8 p.m. Monday through Friday and 8 a.m.-5 p.m. Saturday, Eastern time. They can provide interpreters and answer member questions about open enrollment.
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Over the past few months, the Ohio Department of Medicaid held MyCare Ohio community input sessions throughout the state with providers to hear about your experiences as you help the members you serve navigate the current MyCare Ohio program and other Fully Integrated Dual-Eligible Special Needs plan (FIDE-SNP) models. Thank you for coming to these sessions and sharing your thoughts with us. This feedback about how we can improve the program is helping shape the Next Generation MyCare program, coming in January 2026.
The areas of feedback and suggestions we heard through our community input sessions included:
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Claims, billing, and prior authorizations:
- Review the current claims process to help decrease the time it takes for providers to receive payments.
- Strengthen prompt pay requirements to help providers get timelier reimbursement.
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Member experience:
- Integrate care coordination and caregiver identification policies into the Next Generation program to help members receive care needed.
- Improve timelines for members receiving their waiver services.
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Provider processes and network:
- Clarify and streamline the process to become a certified provider.
- Improve provider network auditing processes to help address gaps in member care.
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Transportation:
- Improve requirements around member wait times.
- Increase member choice in their preferred provider.
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Review the MyCare Ohio community input session presentation to learn more about the program and changes coming. If you were unable to come to a MyCare Ohio program community session and would like to share feedback, please email us at MyCareConversionQuestions@medicaid.ohio.gov.
The Ohio Department of Medicaid, in partnership with Maximus, the Provider Network Management (PNM) module vendor, is excited to share that we are continuing our provider awareness and training efforts. Training is scheduled for November 12-22, and the training schedule is available on the PNM and Centralized Credentialing page. Below, you will find instructions on how to register and a list of topics covered in each session.
Registration steps for enrolling through the learning management system
Access the Absorb learning management system to register for the training. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view various PNM module resources. For help, please see our job aid and follow the steps to create your account and/or register for training.
Training topics
- Provider Administrator Role (including change of Provider Administrator process)
- Provider Agent Role
- New Medicaid Enrollments (First-time applications entered by the Administrator)
- Updating/Changing to Medicaid Enrollment Information
- Medicaid Enrollment Revalidations
- Entering and Searching for Dental Claims
- Entering and Searching for Institutional Claims
- Entering and Searching for Professional Claims
Note: Additional session details are available within the Absorb course listing.
For more information
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. The ODM Integrated Helpdesk is open 8:00 a.m.-4:30 p.m. Monday-Friday, Eastern time.
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