11/13/2025

Highlights from the November MyCare Advisory Workgroup

The Ohio Department of Medicaid (ODM) shared key updates ahead of the January 1 launch of Next Generation MyCare Ohio.

Plan Comparison Tool
ODM released an updated MyCare Plan Comparison Guide showing all plans side-by-side, including Medicaid-specific and value-added benefits not shown on Medicare’s Plan Finder. It’s available on the Ohio Medicaid MyCare webpage under ‘Compare MyCare Ohio Plans.’

AAA Delegation Models
As with the original MyCare program, the health plans have the option to delegate only service coordination to the Area Agencies on Aging, or fully delegate both waiver service coordination as well as care management. Medicaid confirmed the final delegation arrangements as follows:

• Anthem, Buckeye, Molina: AAAs coordinate waiver services for members 60+; plans handle other care.
• CareSource: full delegation (AAA coordinates both waiver & care) only in NE Ohio regions 10A–11; partial elsewhere.

System Improvements
During the call, Medicaid highlighted improvements anticipated in the MyCare NExt Gen program, as a result of feedback from 38 community visits:

• Shorter prompt-pay timelines and dedicated provider-relations staff for HCBS.
• Simpler member communications at lower reading levels.
• Transportation and claims process updates to improve reliability

Appeals & External Medical Review
ODM reviewed differences between member appeals and grievances and outlined a new External Medical Review (EMR) process—an independent, no-cost option for providers after internal appeals.

Next Steps
ODM will host public Next Generation MyCare webinars:

• Providers register here.: Nov 14 (10 a.m.)
• Members register here. : Nov 21 (3 p.m.)

LeadingAge Ohio members are encouraged to participate in the November 14 webinar. Questions regarding MyCare roll-out may be directed to Eli Faes at efaes@leadingageohio.org.