Program Improvements: The Next Generation MyCare program strives to deliver a person-centered experience for Ohioans across the state. Improvements to the current MyCare Ohio program include:

• Shorter turnround for prior authorizations
• Availability of independent External medical review that is binding on the Next Generation MyCare plan
• ODM-approved clinical coverage policies
• Stronger network adequacy for waiver providers
• Streamlined contracting process
• Improved transportation requirements for medical visits

ODM will share more information on these improvements prior to January 1, 2026.

New Next Generation MyCare plans: ODM awarded four managed care organizations as ODM’s Next Generation MyCare plans. The selected plans include a continued partnership with some of the plans who serve members in the current program, as well as a new plan. Prior to the Next Generation MyCare beginning in January 2026, MyCare Ohio members in the 29 counties where the program is currently available will have the opportunity to select from the available plans:

• Anthem Blue Cross and Blue Shield
• Buckeye Health Plan
• CareSource
• Molina HealthCare of Ohio

Age of eligibility increase: The age to be eligible for MyCare is increasing from 18 years or older to 21 years or older. This change removes overlap of members who are eligible for both Next Generation MyCare and OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multisystem needs.

Where do I go to learn more about MyCare Ohio or ask questions?

ODM has a hotline to help individuals choose the MyCare Ohio plan that best meets their needs. You can reach the Ohio Medicaid Consumer Hotline at 800-324-8680 Monday through Friday 7 a.m. – 8 a.m. and Saturdays 8 a.m. – 5 p.m. Eastern time or by visiting www.ohiomh.com.

To find additional information, including frequently asked questions about the MyCare Ohio program, visit the MyCare Ohio program member frequently asked questions document on the Families & Individuals MyCare Ohio webpage on medicaid.ohio.gov.