New Generation MyCare Program – What is it?

If you live in Ohio and have Medicare and Medicaid, or provide services to individuals who have this coverage, you are likely hearing a lot of chatter about Next Generation MyCare. This new structure allows for health insurance claims to be processed for both Medicare and Medicaid lines of business by one plan. This allows for more efficient claims processing, eliminating the confusion of which plan pays first in a dual coverage situation. By pairing a Medicare Advantage plan with a Medicaid Managed Care plan, the individual benefits from a more efficient process and coordination of benefits. The MyCare design focuses on the individual, improves individual and population wellness and health outcomes, creates a personalized care experience, improves care for individuals with complex needs to promote independence in the community, and increases program transparency and accountability. The Area Agency on Aging District 7 (AAA7) will be experiencing this new process along with everyone else, and I thought it might be helpful to first understand the history of how MyCare came to be.

In 2014, the State of Ohio began a demonstration project with the Centers of Medicaid and Medicare Services (CMS), with the focus of financially aligning Medicare and Medicaid benefits. Ohio selected 29 urban counties throughout the state for this demonstration. The motivation for the project was to decrease the cost shifting that happens when a person has both Medicare and Medicaid plans. This cost shifting typically results in higher expenditures for both the state and federal payers and poor quality outcomes for the patient. The demonstration period lasted for 10 years and ended on 12/31/25.

On January 1, 2026, Ohio began rolling out what is called a Fully Integrated Dually Eligible Special Needs program (FIDE-SNP) called Next Generation MyCare. All counties in Ohio will be participating, and a staggered implementation date has been set for each county. For the counties the AAA7 serves, we are set to go live on June 1st, 2026. Four plans have been chosen to provide this state-wide coverage and include: Anthem, Buckeye, CareSource, and Molina. Area Agencies on Aging (AAA) throughout Ohio have been designated by the State of Ohio as Waiver Service Coordinators for Next Generation MyCare, working directly with the plans, and will continue to be integral parts coordinating Long-Term Services and Support for our consumers. In AAA7’s district, many of our PASSPORT consumers will be impacted as a large number have both Medicare and Medicaid. We expect more than half of our PASSPORT consumers to transition to MyCare.

The Ohio Department of Medicaid has released a lot of good information for consumers and providers related to MyCare. To learn more about MyCare, you can visit our website’s Home Page at www.aaa7.org and find the link we have under “Current Updates”. As always, the AAA7 is here to help answer questions and assist. Next month, we will talk more about what to expect as MyCare rolls out in your area. In the meantime, if you have questions, please feel free to contact us at 1-800-582-7277 or email us at [email protected]