Ohio Medicaid Member News

Ohio Medicaid Member News is a short, periodic email update on the progress of the ODM strategic initiatives for individuals who receive services through Ohio Medicaid’s managed care program.

In this issue:

The Ohio Department of Medicaid announced four managed care organizations to serve as the Next Generation MyCare plans!
Ohio Medicaid annual open enrollment is here – select your plan through November 30
Around 500 MyCare Ohio stakeholders attended our community listening sessions. Read to learn what we heard!

The Ohio Department of Medicaid announced four managed care organizations to serve as the Next Generation MyCare plans! On November 1, the Ohio Department of Medicaid (ODM) announced four managed care organizations that will serve as the Next Generation MyCare plans. MyCare Ohio is a managed care program designed for Ohioans who receive both Medicaid and Medicare benefits. The MyCare Ohio program combines Medicaid and Medicare benefits into one program, coordinated by a managed care plan. This approach to coordinating care keeps you at the center of focus.For more than a year, ODM has met with members across the state to understand your experience with the MyCare Ohio program. This feedback will inform ODM and the newly selected plans as they work together to implement a better person-centered experience for Ohioans across the state. ODM’s announcement and additional information can be found in the press release.

ODM awarded four managed care organizations as ODM’s Next Generation MyCare plans. The selected plans include a continued partnership of some of the MyCare Ohio plans who have served MyCare Ohio members in the current demonstration as well as the addition of new plans that have served in the Next Generation managed care program to allow you to have more choices to meet your healthcare needs. The four Next Generation MyCare plans are:

Friday’s announcement does not immediately impact current members of the MyCare Ohio program. You will continue to receive services with your current MyCare Ohio plan until the Next Generation MyCare plans begin serving you in January 2026 and will not lose coverage.

Starting in January 2026, the selected plans will support Ohioans who are dually 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. Before January 2026, ODM will support you by providing details about expected changes and where to receive help in navigating those changes.

Prior to the Next Generation MyCare plans beginning in January 2026, MyCare Ohio members in the 29 counties where MyCare Ohio is currently available will have the opportunity to select from the plans available to you.

MyCare Ohio members enrolled in Buckeye Health Plan, CareSource, or Molina HealthCare of Ohio

MyCare Ohio members enrolled in Buckeye Health Plan, CareSource, or Molina HealthCare of Ohio will continue to receive services through that plan until January 2026. If you would like to keep your current plan starting January 2026, no action is required. If you would like to change your plan, ODM will send out enrollment information in the mail ahead of the 2026 plan year for you to select from one of the Next Generation MyCare plans available.

MyCare Ohio members enrolled in Aetna Better Health of Ohio or United Healthcare Community Plan

MyCare Ohio members currently enrolled in Aetna Better Health of Ohio or United Healthcare Community Plan will continue to receive services through that plan until January 2026, but will need to select a Next Generation MyCare plan to begin serving you in January 2026. ODM will send out enrollment information in the mail for you to select from one of the Next Generation MyCare plans available. You can also contact the Ohio Medicaid Consumer Hotline at 800-324-8680 with questions or to select a new plan.

Next Generation MyCare program goals

The Next Generation MyCare program is modeled after the Next Generation managed care program, which focuses on the individual rather than the business of managed care. The Next Generation MyCare program aims to improve your experience by:

Focusing on the individual.
Improving individual and population wellness and health outcomes.
Creating a personalized care experience.
Supporting providers in continuously improving care.
Improving care for individuals with complex needs to promote independence in the community.
Increasing program transparency and accountability.

This is a new vision for Ohio’s MyCare program – one that focuses on the healthcare needs of Ohioans who are dually eligible. We look forward to continuing to work with you and hearing from you as we work together to better serve dually eligible Ohioans.

To learn more about the Next Generation MyCare program refer to the resources below:

MyCare Ohio program member frequently asked questions share commonly asked questions by members about the program.
MyCare Ohio program member one-pager provides you program information, including eligibility information and which plans are available in the counties where MyCare is currently available.
MyCare Ohio member webpage on medicaid.ohio.gov shares more program resources and is updated regularly to provide the most up to date information.

If you have questions about the Next Generation MyCare program, contact the Ohio Medicaid Consumer Hotline at https://www.ohiomh.com/ or call 800-324-8680. Representatives are available Monday through Friday 7 a.m. to 8 p.m. Eastern time (ET) and Saturday 8 a.m. to 5 p.m. ET.

If you have feedback about the Next Generation MyCare program, please contact MyCareConversionQuestions@medicaid.ohio.gov.

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Ohio Medicaid annual open enrollment is here – select your plan through November 30Ohio Medicaid’s annual open enrollment is underway.

We know that your needs change so if you have not selected a plan, you still have time!

You have through November 30 to choose the plan that best:

Works with all or most of your doctors.
Covers services with the hospitals, clinics, or specialists you want.
Offers a bit more support, such as extra unemployment assistance, access to nutritious foods, education, and wellness programs, or more vision and dental services.

If you would like to keep your current managed care plan, you do not have to do anything.

If you decide to switch, your new plan will begin covering you on the first day of the month following your selection. For example, if you decide to switch in October, coverage by your newly selected health plan begins November 1.

Helpful resources

Ohio’s Medicaid managed care plans must offer medical, vision, dental, and behavioral health services as defined by Centers for Medicaid and Medicaid Services and state law. However, to stand out from the pack, each offers their own value-added services ranging from transportation to pregnancy care to wellness rewards. To understand the differences, check out the resources below.

Managed Care Health Plan Comparison Guides offers insight into required managed care plan services for each plan year, as well as the unique value-added benefits each plan offers. Guides for 2024 and 2025 are available:
- 2024 Medicaid Managed Care Health Plan Comparison Guide
- 2025 Medicaid Managed Care Health Plan Comparison Guide
The Find a Managed Care Provider search tool can help identify the managed care plans contracting with (“in network”) your trusted providers.
The Open Enrollment Frequently Asked Questions answers questions related to annual managed care open enrollment.

In addition, each managed care plan has a member website that you can visit to learn more about their approach to serving you:

You can explore the managed care plans available and enroll by visiting www.ohiomh.com or by contacting the Ohio Medicaid Consumer Hotline at 800-324-8680 (TTY 711). Representatives are available 7 a.m.-8 p.m. Monday through Friday and 8 a.m.-5 p.m. Saturday, Eastern time. They can provide interpreters and answer member questions about open enrollment.

Around 500 MyCare Ohio stakeholders attended our community listening sessions. Read to learn what we heard!Over the past few months, the Ohio Department of Medicaid held MyCare Ohio community input sessions throughout the state with Ohioans who are eligible for Medicare and Medicaid. In these meetings, we heard about your experience with the MyCare Ohio program and navigating healthcare systems. Thank you for coming to these sessions and sharing your thoughts with us. This feedback about how we can improve the program is helping shape the Next Generation MyCare program, coming in January 2026.

The areas of feedback and suggestions we heard through our community input sessions included:

Access to care and choice

Continue to communicate about member choice and their ability to select the MyCare Ohio plan that best fits their healthcare needs.
Strengthen members understanding of the benefits available to them.
Expand the MyCare program statewide to help address issues members have receiving care when they move from one region to another in the middle of a month.

Member experience:

Provide additional guidance on billing and authorizations to providers, plans, and care coordinators to alleviate the burden on members to receive the services they need.
Share more insight on the benefits each plan offers aside of cash benefits to help members understand which plan best aligns to the healthcare experience they are seeking, not just cash benefits alone.

Member outreach:

Improve provider networks available in rural areas.
Conduct outreach to members where they are in the communities such as social events, and community centers.

Partner experience:

Create an easier and more streamlined process for those looking to become a self-directed caregiver.
Encourage plans to contract with local companies for transportation and community-based services.

Transportation:

Shorten pick-up and drop-off timeframes for members to mitigate long wait times and increase quality of member experience.
Increase the network of transportation providers for more member choice.
Simplify the scheduling process for member rides, including making scheduling more accessible for MyCare member populations.

Review the MyCare Ohio community input session presentation to learn more about the program and changes coming. If you were unable to come to a MyCare Ohio program community session and would like to share feedback, please email us at MyCareConversionQuestions@medicaid.ohio.gov.

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