The Next Generation MyCare program officially launched in Ohio on January 1, 2026, marking a major shift in how care is delivered to individuals who are dually eligible for Medicare and Medicaid. This new program is replacing the previous MyCare Ohio model and is part of Ohio’s broader Medicaid modernization efforts.
For home care and home health care providers across Ohio, understanding what Next Generation MyCare means is essential for maintaining continuity of care, compliance, and operational success.
This guide breaks down what providers need to know, which counties are impacted, what future phases mean, and how to prepare.
What Is the Next Generation MyCare Program?
Next Generation MyCare is Ohio’s redesigned managed care program for individuals who receive both Medicaid and Medicare. Its goal is to simplify care delivery by integrating both benefits into a single health plan.
Instead of navigating separate Medicaid and Medicare systems, members now have:
- One health plan
- One ID card
- One care coordinator
- One point of accountability for all services
For providers, this integrated approach is intended to reduce administrative burden, improve care coordination, and streamline billing, authorizations, and communication with plans.
Phase 1 Launch: January 1, 2026 (29 Counties)
Phase 1 of Next Generation MyCare began on January 1, 2026, in the same 29 counties that previously participated in MyCare Ohio. These counties include:
- AAA1: Butler, Warren, Clinton, Hamilton, Clermont
- AAA2: Montgomery, Clark, Greene
- AAA4: Lucas, Fulton, Ottawa, Wood
- AAA6: Franklin, Delaware, Union, Madison, Pickaway
- AAA10a: Lorain, Cuyahoga, Medina, Lake, Geauga
- AAA10b: Summit, Portage, Stark, Wayne
- AAA11: Columbiana, Mahoning, Trumbull
Providers in these counties are already serving Next Generation MyCare members as of January 1. Members were transitioned automatically, with continuity of care protections in place to prevent service disruptions.
What Future Phases Mean for Providers Statewide
While Phase 1 is underway, Next Generation MyCare is expanding statewide throughout 2026. Providers in counties not yet live should begin preparing now.
The remaining rollout schedule is as follows:
- April 1, 2026: Additional counties in northwest and central Ohio
- May 1, 2026: Expansion into west-central and north-central Ohio
- June 1, 2026: Southern Ohio counties
- July 1, 2026: Eastern Ohio counties
- August 1, 2026: Southeast Ohio counties
By August 2026, Next Generation MyCare will be available in all 88 Ohio counties.
If your agency operates in multiple counties, you may experience staggered implementation, meaning different workflows depending on location. Early preparation will help avoid disruptions as new regions go live.
What Home Care and Home Health Providers Need to Do
1. Ensure Medicaid Enrollment with ODM
To serve Next Generation MyCare members, providers must be actively enrolled with the Ohio Department of Medicaid. Providers who only billed Medicare in the past should complete Medicaid enrollment as soon as possible.
2. Contract with Next Generation MyCare Plans
Next Generation MyCare is delivered through managed care plans. Providers must contract with the plans they wish to serve.
The participating plans include:
- Anthem Blue Cross and Blue Shield
- CareSource
- Molina Healthcare of Ohio
- Buckeye Health Plan (existing members only)
Contracting early helps ensure uninterrupted care and timely reimbursement once your county goes live.
3. Support Continuity of Care
Continuity of care protections allow members to continue receiving services from their existing providers during transition periods. Providers can often continue serving members temporarily even if contracts are still in progress.
Clear communication with plans and care coordinators is key to ensuring services continue without interruption.
What’s Changing for Providers
Next Generation MyCare introduces several improvements designed specifically to support providers:
- Faster prior authorization turnaround times
- Standardized clinical coverage policies across plans
- Reduced authorization requirements for certain waiver services
- Independent external medical review process for denied services
- Centralized claims submission through Ohio’s Medicaid Enterprise System
- Improved network requirements for home- and community-based providers
These changes aim to reduce administrative complexity, improve transparency, and allow providers to focus more on care delivery.
How GEOH Can Help
Navigating Next Generation MyCare can feel overwhelming, especially as the program expands into new counties and workflows change.
GEOH is here to help Ohio home care and home health providers every step of the way. Whether you need assistance with:
- Plan contracting readiness
- Billing and claims workflows
- EVV and compliance
- Operational planning for upcoming rollout phases
Our team understands Ohio Medicaid and the Next Generation MyCare transition and can help you prepare with confidence.
If you want to meet with one of our team members to discuss these changes, you can do so here.
