The Ohio Department of Medicaid (ODM) provided an early status update on the Next Generation MyCare Ohio rollout during its January MyCare Advisory Work Group meeting, about three weeks after the program’s Jan. 1 launch in 29 counties.
ODM officials said the phased rollout approach—limited initially to counties already participating in MyCare—was intended to reduce disruption for members, providers, plans, and waiver service coordinators. Approximately 60,000 members transitioned from exiting plans, including about 15,000 receiving home- and community-based waiver services, which require more complex, individualized care plan transfers.
Among the notable changes in the Next Generation MyCare program is a new claims submission process. Claims now flow through ODM’s centralized “one front door” portal before reaching managed care plans, aligning MyCare with the state’s broader managed care system. ODM reported that claims are generally moving through as expected, though some early issues arose when providers or trading partners used Medicare identifiers instead of Medicaid member IDs.
ODM acknowledged reports of member and provider confusion during the transition, particularly related to enrollment communications, auto-assignments, and Medicare Part D plan notices for members whose prior MyCare plans exited the program. Officials emphasized that while outreach by plans before Jan. 1 was intended to support continuity of care, overlapping notices sometimes created uncertainty for members.
Provider payment concerns also surfaced during the meeting, especially among non-agency home- and community-based service providers. ODM reiterated MyCare’s prompt pay requirements, noting that most clean claims must be paid within 14 to 21 days depending on provider type, and said it is actively following up on reports of delayed payments.
ODM staff encouraged continued feedback as the rollout progresses and said the agency is closely monitoring enrollment transitions, claims processing, and provider payment issues as the program expands to additional counties later in 2026.