Last month, the Ohio Department of Medicaid (ODM) implemented the Next Generation MyCare program in 29 counties to provide enhanced healthcare benefits to Ohioans who have both Medicaid and Medicare. Starting on April 1, 2026, ODM is rolling out the program to the rest of Ohio.
You must enroll with ODM and contract with the Next Generation MyCare plans.
- If you are already enrolled as an Ohio Medicaid provider and contracted with plans, no additional action is required.
- If you are a new provider to the program, you must:
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Enroll with ODM by visiting the Medicaid Provider Portal and completing the online application (credentialing, if required, will occur automatically during application processing).
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Contract with the Next Generation MyCare plans. You can contact each plan you wish to contract with directly.
- Ohio Department of Aging (AGE) enrolled providers can continue to provide services to members and submit claims in the program but should contract with the Next Generation MyCare plans if you have not already.
Once you begin serving members, you will need to submit Medicaid primary payer Electronic Data Interchange (EDI) claims through the Ohio Medicaid Enterprise System (OMES) one front door. If you’re using Direct Data Entry (DDE), submit claims through the plan’s portal following their existing process. For EDI claims where Medicare is the primary payer, you will submit those crossover claims to the primary payer.
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Eligible individuals living in one of the 29 counties now get care through a Next Generation MyCare plan. Members who were in the Ohio Home Care, Assisted Living, or PASSPORT waivers when they were enrolled in the program are now enrolled in the MyCare Ohio Waiver.
As the program becomes available across the state, eligible individuals will get a letter from ODM that gives them information about their plan, when their plan begins, and options for changing their plan or coordinating their Medicare and Medicaid coverage.
For questions or to learn more:
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The Ohio Department of Medicaid (ODM), 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. Provider Refresher Training is scheduled for February 17 - 27. The training schedule is available on the PNM and Centralized Credentialing page.
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 and NEW Power Agent Role
- Provider Agent Role
- Updating/Changing Medicaid Enrollment Information
- Prior Authorizations
- 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 ODM 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 8 a.m. - 4:30 p.m. Monday through Friday, Eastern Time. You can also email your questions to IHD@medicaid.ohio.gov.
ODM is revamping the ways we connect with providers and all our members. Follow us for updates on healthcare coverage, wellness tips, and important information for Ohioans. Stay connected and informed about the latest initiatives and resources available.
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