Program benefits and 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

These improvements benefit providers by creating a more standardized, accountable, and transparent program.  ​Further information on these improvements will be shared 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. Starting in January 2026, the selected plans will support Ohioans who are 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:

• 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 or ask questions?

You can contact the Ohio Medicaid Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov for questions or issues about claims, prior authorizations, or other administrative tasks. Representatives are available 8 a.m.- 4:30 p.m. Monday through Friday.

The MyCare Ohio provider webpage on medicaid.ohio.gov shares more resources for providers including updates about the program, actions required, and the conversion charter. ODM regularly updates this page.  

To be Next Generation MyCare provider, you must be enrolled with ODM as a Medicaid provider. From there, you may contract with any of the Next Generation MyCare plans.