News

The Ohio Department of Medicaid (ODM) implemented the Next Generation MyCare program on Jan. 1, 2026, to provide enhanced healthcare benefits to Ohioans who have both Medicaid and Medicare. It is now available in the 29 counties where the previous MyCare Ohio program was available, including in Council on Aging’s (COA) five-county service area (Butler, Clermont, Clinton, Hamilton and Warren counties). Later in the year, it will be available in the rest of Ohio.

With this program, members get more support and services to help manage their health. That includes a care team, better transportation options, more in-home providers, and shorter wait times for prior authorizations. The program also helps providers better serve members through streamlined processes, better integration with the plans, and enhanced clinical coverage policies.

In the program, Area Agencies on Aging (AAA) such as COA 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.

COA is contracted to serve as waiver service coordinator for members in its service area. View the Next Generation MyCare Care Coordination One-Pager to learn more. 

Member Benefits and Impacts

Eligible individuals living in COA’s service area started receiving care through a Next Generation MyCare plan on Jan. 1.

• For members who previously got care through Molina HealthCare of Ohio:
  • If they did not make a selection during open enrollment, which ended Dec. 9, 2025, they still get their care through the same plan.
  • If they did pick a new plan, they get their care through the plan they selected.

• Members who previously got care through Aetna Better Health of Ohio are no longer receiving their care through Aetna because it is not in the program.
  • If they did not pick a new plan during open enrollment, they were automatically enrolled in one for their Medicaid benefits. This plan has as many of their current doctors as possible.
  • If they did pick a new plan, they get their care through the plan they selected.

• Members who are eligible for the program and previously got care through Medicaid fee-for-service should have received a letter from ODM that gives them information about their plan, when it starts, and options to change their plan.

• Members who were in the Ohio Home Care, Assisted Living, or PASSPORT Waiver when they were enrolled in the program are now enrolled in the MyCare Ohio Waiver. In the wavier program, they have the same benefits, or more, available to them.

• Members who live in a county where the program will be available later in 2026 will get information from ODM once the program is available in their county.

Members should have received a new member ID card and other information from their plan. If a member has a plan for both their Medicaid and Medicare benefits, they have only one member ID card to be used at their appointments. If their plan only covers their Medicaid benefits, they could have up to three cards for their benefits. To learn more about member ID cards, view the Next Generation MyCare Member ID Card One-Pager.

Resources are available to answer questions members may have. If members have questions related to eligibility, enrollment, benefits, plan selection, or finding a doctor, they can contact the Ohio Medicaid Consumer Hotline at 800-324-8680 or visit https://ohiomh.com/. Representatives are available Monday through Friday 7 a.m.–8 p.m. and Saturdays 8 a.m.–5 p.m. Eastern time. Members can also view the Next Generation MyCare Member Help Desk One-Pager to learn where else they can go for help.

To learn more about the program, members can visit the Next Generation MyCare Families & Individuals webpage or view the Next Generation MyCare Program Overview One-Pager or Next Generation MyCare Member Frequently Asked Questions (FAQ).

Provider Benefits and Impacts

In the program, providers must enroll with ODM and contract with the Next Generation MyCare plans to provide services to members. Ohio Department of Aging (AGE) enrolled providers can continue to provide services and submit claims but must contract with the Next Generation MyCare plans if they have not already.

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

There may be changes to the services they provide to members depending on their contract with each plan. Providers should contact the plans to learn more or view the Credentialing Guide and Requirements Document.

• Anthem Blue Cross and Blue Shield: 833-727-2170
• Buckeye Health Plan: 833-998-4892
• CareSource: 800-488-0134
• Molina HealthCare of Ohio: 855-322-4079

The process for submitting Electronic Data Interchange (EDI) claims in the program has changed. If a provider is not an Ohio Medicaid provider, their claims will be rejected.

• If a provider is submitting their claims to the plans portal using Direct Data Entry (DDE), they should submit a single claim to the plan via their existing process. The plans do not accept paper claims.
• If a provider is submitting an EDI claim for a dual benefit member or for a Medicaid-only member where Medicaid is the primary payer, they should submit the claim through the one front door, to the Ohio Medicaid Enterprise System (OMES). Providers must use the member’s Medicaid ID number. The submitted file must use the Next Generation MyCare Plan Receiver ID and the appropriate Payer ID in the 2010BB loop for claims to be directed to the correct plan for processing.
• If a provider is submitting an EDI claim for a Medicare covered service for a Medicaid-only member, they should submit the claim to the primary payer.
  • If Medicare is the primary payer, providers should submit the claim to Medicare using their normal process. Claims for members will be automatically crossed-over to the plan.
  • If the primary payer is a Medicare Advantage/Part C plan, providers should submit the claim to that payer using their normal process. Once the primary payer has adjudicated the claim and returned the Remittance Advice, submit the claim through the OMES one front door as described for a dual benefit claim.

Claim submissions through the OMES one front door are based on the date of submission. Any claims submitted starting Jan. 1, 2026, should be submitted to the OMES one front door, even if the date of service was before Jan. 1, 2026.

Aetna Better Health of Ohio and United Healthcare Community Plan are no longer MyCare plans as of Dec. 31, 2025, however, they will continue to pay claims for up to 365 days from the end of the year and are responsible for any claims that have dates of service through Dec. 31, 2025. Any claims should be submitted to Aetna or United using existing processes. Refer to the Companion Guides for more information.

Resources are available to answer questions providers may have. If providers have questions about claims, prior authorizations, contracting, or other provider-specific functions, they can contact ODM Integrated Helpdesk at 800-686-1516 or [email protected] from Monday through Friday, 8 a.m. – 4:30 p.m. Eastern Time. Providers can also view the Next Generation MyCare Provider Help Desk One-Pager to learn more about the additional help desks.

To learn more about the program, providers can visit the Next Generation MyCare Resources for Providers webpage or view the Next Generation MyCare Program Provider FAQ.