09/24/2025

Next Generation MyCare Program Coming in 2026

 

What is the Next Generation MyCare program?

The Next Generation MyCare is an improved healthcare program for Ohioans who have both Medicaid and Medicare. This program helps members get the care they need all in one plan.

Ohio's 12 Area Agencies on Aging (AAAs) will partner with the MyCare Ohio plans to support members in receiving care. AAAs will assist in assessing individuals for eligibility and enrollment in the MyCare Ohio waiver and help find the right services for them.

​For more information about the Next Generation MyCare Ohio program, please see the information provided by the Ohio Department of Medicaid (ODM) below. You may also find the answers you need in ODM's Next Generation MyCare Member Frequently Asked Questions (FAQ) or Next Generation MyCare Provider Frequently Asked Questions (FAQ).

Who is eligible for the Next Generation MyCare program?

Starting January 1, 2026, members are in the Next Generation MyCare program if they*:

• Have full Medicaid
• Have Medicare parts A, B, and D
• Are 21 or older
• Live in one of the 29 counties where MyCare Ohio is available today or until the program is available in their county

*If individuals are on a Program for All-Inclusive Care for the Elderly (PACE) or a Developmental Disabilities waiver (Individual Options, Self-Empowered Life Funding, or Level One) or have health insurance that covers both inpatient hospital stays and doctor visits, they will not be enrolled in the Next Generation MyCare program.

What plans will be available in the Next Generation MyCare program?

In the Next Generation MyCare program, ODM selected four plans. Three of the plans are available for members to select statewide. The plans include some current MyCare Ohio plans and a new plan to the program. All plans will cover a member’s Medicare and Medicaid benefits.  

The Next Generation MyCare plans available statewide are: 

• Anthem Blue Cross and Blue Shield
• CareSource 
• Molina HealthCare of Ohio 

Buckeye Health Plan won't be an option for new members or for those currently receiving care through another MyCare Ohio plan starting in the 2026 plan year. If a member receives care through Buckeye Health Plan today and wants to keep their plan, no action is required. 

What are the benefits of having one plan for both Medicaid and Medicare services?

If a member enrolls in a Next Generation MyCare plan for both their Medicare and Medicaid benefits, they will have:

• One care coordinator for both their Medicaid and Medicare benefits.
• One organization responsible for both their Medicaid and Medicare benefits, including long-term care services and behavioral health services.
• One set of communications.
• One organization to contact if they need to appeal a denial.

A member’s plan may also give them extra benefits like additional transportation, rewards, and more.

If the member’s Next Generation MyCare plan only covers their Medicaid benefits, they may have:

• Multiple care coordinators for both their Medicaid and Medicare benefits.
• Multiple organizations responsible for both their Medicaid and Medicare benefits, including long-term care services and behavioral health services.
• Multiple sets of communications.
• Multiple organizations to contact if they need to appeal a denial.

What improvements are coming to the Next Generation MyCare program for members?

ODM changed the MyCare Ohio program to give members the best care possible. These changes include:

• More support for members to receive the care they need through a care team.
• Better transportation options to get members to and from their appointments.
• More in-home providers available to members.
• Shorter wait time for prior authorizations.

Additional Resources:

• Next Generation MyCare Overview One-Pager helps stakeholders understand what the Next Generation MyCare program is, who it serves, and where to go for more information.
• Next Generation MyCare Member Help Desk One-Pager shares contact information by topic in one place, so members know who to contact when they have questions or need help.
• Next Generation MyCare Member Frequently Asked Questions (FAQ) answers the most common questions from members about the current and Next Generation MyCare program.
• Next Generation MyCare Member ID Card One-Pager provides an overview of the card template. All MyCare Ohio members will receive a new Next Generation member identification (ID) card that will be used at their appointments. 
• MyCare Ohio Waiver One Pager outlines eligibility, enrollment, and services included in the MyCare Ohio Waiver for members.
• Next Generation MyCare Provider Help Desk One-Pager shares contact information by topic in one place, so providers know who to contact when they have questions or need help.
• Next Generation MyCare Provider Frequently Asked Questions (FAQ) answers the most common questions from providers about the current and Next Generation MyCare program.