The Ohio Department of Medicaid (ODM) has completed its rollout of the Next Generation MyCare program across the state. As members continue transitioning into the program, there are a few important things you should know to provide services and support their care.
If you serve members who are changing plans or newly enrolled in the program, you can continue to provide services for a certain amount of time without having a contract with the MyCare plans.
If you want to continue to serve members past their transition period, you must enroll with ODM and contract the MyCare plans directly. Ohio Department of Aging (AGE) enrolled providers can continue to provide services and submit claims but must contract with the plans if you have not already.
Verifying Member Eligibility
Helping members receive care is ODM’s priority. When you provide services to members, you can take the following actions to verify if an individual is enrolled in a MyCare plan:
-
Check the member ID card. If the ID card has a Next Generation MyCare program logo, it is indicative that the member is a Next Generation MyCare member.
- Check member eligibility via Provider Network Management (PNM) or the EDI 270/271 process.
If you encounter issues verifying a member’s enrollment after completing these steps, contact Member Services and follow existing billing guidance.
Need help or want to learn more?
-
For questions about claims, prior authorizations, contracting, member eligibility or other provider-specific functions, contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov from Monday through Friday, 8 a.m. – 4:30 p.m. Eastern Time.
-
View the Provider Help Desk One-Pager to learn more about where to go for help.
|
Return to Top
Summer break is ending and a new school year is beginning. For many young people, this shift can bring excitement but also stress or uncertainty. That’s why September, Suicide Prevention Awareness Month, is a crucial reminder of how important connection and support can be during times of change.
Prevention starts with connection. One simple question can open an important conversation. Listen without judgment, take concerns seriously, and ask a young person how they are really doing.
Support for Ohio Youth
Families do not have to face mental, emotional, or behavioral health needs alone.
Help is here.
Mobile Response and Stabilization Services (MRSS)
Since September 2025, MRSS has been available in all 88 Ohio counties, so every family across the state can reach this support at no cost to the youth or family. MRSS is a crisis service for all Ohio youth ages 20 and younger who feel overwhelmed by mental, emotional, or behavioral distress or trauma. Here is how it works:
-
Call 988 on behalf of a young person who is struggling and ask for MRSS.
-
Trained professionals respond within 60 minutes at the youth's home, school, or another safe place.
-
They help calm the situation, keep the youth safe, and start a plan with up to 42 days of follow-up support.
-
After hours, providers offer support by phone.
OhioRISE
Some young people need more than short-term crisis support, and OhioRISE was built to meet that need. Launched by the Ohio Department of Medicaid in July 2022, OhioRISE serves children and youth with significant or complex mental health or substance use needs. It works alongside a family's regular Medicaid coverage to add services that support youth at home, in school, and in their community.
OhioRISE surrounds each young person and family with a team:
-
Anyone can refer a child, including a parent, therapist, school counselor, or doctor.
-
Every enrolled youth works with a care coordinator who helps the family understand their options, build a support team, and create a care plan.
-
Services can include, but are not limited to, Intensive Home-Based Treatment, Behavioral Health Respite for caregivers, and Psychiatric Residential Treatment for a higher level of care.
-
Youth and families have voice and choice. OhioRISE helps keep children in their community and close to home, making sure they are active partners in their care, so they feel heard and respected.
Connecting Youth and Families to Support
Help is available, whether a young person needs crisis support or ongoing care. For immediate crisis support, call or text 988 and ask about MRSS. To learn more about OhioRISE, call 1-833-711-0773 or visit the OhioRISE website.
This September, and all year long, let's make sure every young person in Ohio knows that support is close by and that asking for help is always a sign of strength.
Return to Top
Looking to stay up to date on OhioRISE data? The OhioRISE Enrollment Dashboard and OhioRISE Service Expansion Report are now on the OhioRISE Monthly Program Updates webpage.
The OhioRISE Enrollment Dashboard helps you see how enrollment changes over time and shows information about OhioRISE members as a group, like their ages and backgrounds. For tips on using the dashboard, view the User Guide.
The OhioRISE Service Expansion report is the first report from the new OhioRISE Data Reporting Initiative. It helps you see how more members are using behavioral health services over time and shares a story from an OhioRISE family about how the program made a difference in their lives.
Visit the OhioRISE Monthly Program Updates webpage to learn more and stay tuned for more data resources in the future.
|
Return to Top
The Ohio Department of Medicaid (ODM) is excited to share the August 2026 edition of the OhioRISE “Closing the Loop” flyer; a snapshot of what ODM and partners heard during the previous month’s community meetings and events, and how they’re responding to feedback and supporting communities in Ohio!
The August 2026 OhioRISE Closing the Loop Flyer includes:
- A highlight on Mobile Response and Stabilization Services (MRSS), which gives free, fast crisis prevention and response to help young people thrive at home, in school, and in their communities.
- A spotlight on how OhioRISE works with schools to provide support to children, youth, and families.
- Information on a new Child and Adolescent Needs and Strengths (CANS) rule to improve the quality of the CANS assessment process, tentatively effective July 2027.
The "Closing the Loop" flyer is regularly published on the OhioRISE website on the Monthly Program Updates tile.
Have questions, feedback, or a Success Story for the OhioRISE program? Share your thoughts by emailing OhioRISE@medicaid.ohio.gov.
|
Return to Top
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.
 Return to Top
|
