On August 1, the Next Generation MyCare Ohio program rolled out in Hocking, Perry, Morgan, Noble, Monroe, Washington, Athens, and Meigs counties, providing enhanced healthcare benefits to Ohioans who have both Medicaid and Medicare. AAAs partner with managed care plans to support members in getting the care they need by serving as a member’s care coordinator and/or waiver service coordinator.
Impacts to Members
Timing of benefits depends on whether – and when – members select a plan or are automatically assigned one. Additionally, those who are eligible for the MyCare Ohio Waiver will start receiving services through the waiver once their plan starts. Once a member is enrolled with their plan, they should receive a new member ID card and other materials explaining their benefits.
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 www.ohiomh.com.
To learn more about the program, members can visit the Ohio Department of Medicaid's Families & Individuals webpage or view the Member Frequently Asked Questions (FAQ), Member Help Desk One-Pager, or Learn More About the Next Generation MyCare Member ID Cards Micro Video.
Impacts to Providers
In the Next Generation MyCare program, providers must enroll with ODM and contract with the MyCare plans to provide services to members. Ohio Department of Aging enrolled providers can continue to provide services and submit claims but must contract with the plans if they haven’t already. Claims for MyCare members can be submitted to the plan’s portal using Direct Data Entry or via Electronic Data Interchange.
If providers have questions related to claims, prior authorizations, member eligibility, provider contracting, waiver support, or general Medicaid billing, they can contact the Ohio Department of Medicaid's Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov.
To learn more about the program, providers can visit the Ohio Department of Medicaid's Resources for Providers webpage or view the Provider FAQ and Provider Help Desk One-Pager.