Source: Ohio Department of Medicaid
The Ohio Department of Medicaid (ODM) is implementing Next Generation MyCare Thursday, January 1, 2026, for the 29 counties where MyCare Ohio is currently available. Statewide expansion will follow as quickly as possible.
This is a new vision for Ohio’s MyCare program – one that focuses on the healthcare needs of Ohioans who are dually eligible for both Medicare and Medicaid healthcare coverage. The program will better serve Ohioans through expansion of the program statewide, enhanced benefits and services, Next Generation MyCare plans, and more! Keep reading to learn more about the exciting changes coming.
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. ODM will share more information on these improvements prior to Thursday, January 1, 2026.
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:
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.
Where to Learn More or Ask Questions
You can contact the Ohio Medicaid Integrated Helpdesk by calling 800.686.1516 or emailing 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 shares more resources for providers including updates about the program, actions required, and the conversion charter. ODM regularly updates this page.
To be a 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.