The Ohio Department of Medicaid (ODM) completed the Next Generation MyCare program rollout on August 1, 2026. Since the program rollout has concluded, this will be the final edition of the Next Generation MyCare Area Agencies on Aging (AAAs) Newsletter, originally created in 2025 to help prepare AAA staff for the program and share critical information throughout the rollout.  

You can still stay informed about the program and other important Medicaid topics: 

• Visit the Families & Individuals, Resources for Providers, or Stakeholders & Partners webpages to stay up to date, learn more about the program, and find answers to frequently asked questions. 
• If you are not already subscribed, you can receive news and updates from ODM through our monthly member newsletter, Ohio Medicaid Member News, and our bi-weekly provider newsletter, ODM Press by completing the Subscriber Form.

ODM appreciates your ongoing commitment to providing support for members and providers. 

The Next Generation MyCare program is now available across the state! This rollout represents another important milestone in strengthening care and providing enhanced healthcare benefits to Ohioans who have both Medicaid and Medicare.  

Area Agency on Aging (AAA) Impact 

In the program, AAAs partner with the plans to support members in getting the care they need by serving as a member’s care coordinator and/or waiver service coordinator. The plan's delegation model determines how you work together to serve members.     

• Full Delegation: AAAs serve as a member’s waiver service and care coordinator.     

• Partial Delegation: AAAs or the plan may serve as a member’s waiver service coordinator or care coordinator.     

You are encouraged to reach out to your care coordinators / waiver service coordinators, members, and providers in your area directly to help them understand the program and the steps they need to take.  

Member Impact

Timing of benefits depends on whether – and when – members select a Next Generation MyCare plan or are automatically assigned one. Members should locate their county to see when the program became available in their county.  

• Members in counties that rolled out in April, May, or June: They are now receiving care through a MyCare plan. 
• Members in counties that rolled out in July or August: 
  • If a member selected a plan before their county rollout date, they are now receiving care through their selected plan. 
  • If a member did not select a plan before their county rollout date, they will be automatically enrolled in one for their Medicaid benefits. They will begin receiving benefits through that plan 90 days after their county rollout date. If they have not already, members should receive a letter from ODM with more information about their plan and its start date. If a member wants to get their benefits through a Next Generation MyCare plan sooner or change their plan, they should contact the Ohio Medicaid Consumer Hotline at 800-324-8680.  
  • Members eligible for the MyCare Ohio Waiver: They will start receiving services through the waiver once their plan starts.  

Once a member is enrolled with their plan, they should receive a new member ID card and other materials explaining their benefits. View the Member Frequently Asked Questions (FAQ) to learn more.   

If a member has questions, wants to get their benefits through a MyCare plan sooner, or change their plan, direct them to contact the Ohio Medicaid Consumer Hotline at 800-324-8680 or visit www.ohiomh.com.   

Provider Impact

With the implementation of the program across the state, there are several changes providers should be aware of to continue providing services to MyCare members.  

Providing Services

If providers serve members who are changing plans or newly enrolled in the program, they can continue to provide services for a certain amount of time without having a contract with the MyCare plans.   

If providers want to continue to serve members past the transition period, they must enroll with ODM and contract the MyCare plans directly. Ohio Department of Aging enrolled providers can continue to provide services and submit claims but must contract with the plans if they have not already.  

Refer to the Credentialing Guide and Requirements Document or Provider FAQ for more information.  

Submitting Claims

Claims for MyCare members can be submitted to the plan’s portal using Direct Data Entry (DDE) or via Electronic Data Interchange (EDI). Encourage providers to view the Provider Claims Submission One-Pager or How Do I Submit Claims for Next Generation MyCare Members? Micro Video to learn more.  

Verifying Member Eligibility

Helping members receive care is ODM’s priority. When providers provide services to members, they can take the following actions to verify if an individual is enrolled in a MyCare plan:  

1. 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. 
2. Check member eligibility via Provider Network Management (PNM) or the EDI 270/271 process.  

If providers encounter issues verifying a member’s enrollment after completing these steps, they should contact Member Services and follow existing billing guidance.