Next Generation of Ohio Medicaid Managed Care
On February 1, 2023, Ohio Medicaid implemented the Next Generation managed care plans, the new Electronic Data Interchange, and Fiscal Intermediary. These changes are providing Ohio Medicaid managed care members enhanced healthcare services that best fit their individual healthcare needs and improve the provider experience by increasing transparency and visibility of care and services
In 2019, Ohio Department of Medicaid (ODM) launched the Medicaid Managed Care Procurement process with a bold, new vision for Ohio’s Medicaid program – one that focuses on the individual and not just the business of managed care. This is the first structural change since Centers for Medicare and Medicaid Services' (CMS) approval of Ohio’s program in 2005.
The Next Generation managed care plan changes do not apply to the MyCare Ohio program, which will continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits, with enhanced coordination of medical, behavioral, and long-term care services.
The Next Generation Ohio Medicaid program emphasizes strong cross-agency coordination and partnership among MCOs, vendors, sister state agencies, and ODM to support specialization in addressing critical needs.