Next Generation of Ohio Medicaid Managed Care
Ohio Medicaid’s Next Generation managed care plans provide a personalized approach to support your healthcare needs.
The Next Generation managed care plans changes do not apply to MyCare Ohio plans, which continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits. Additionally, OhioRISE enrollees continue to receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through their managed care organization or fee-for-service Medicaid.
The list of resources below is available to help you identify the Next Generation plan that best meets your healthcare needs:
- The Next Generation Health Plan Comparison provides an overview of the services that all Next Generation managed care plans provide as well as the specific value-added services available from each individual plan.
- The Find a Provider search tool can help you identify which Next Generation managed care plans your trusted providers are contracted or "in network" with.
- Each Next Generation managed care plan has a member website that you can visit to learn more about their approach to serving Ohio Medicaid managed care members:
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Call the Medicaid Consumer Hotline at (800) 324-8680 if you have additional questions about the Next Generation managed care plan options available.
- Representatives are available Monday through Friday 7am-8pm and Saturday 8am-5pm ET.
- The Ohio Medicaid Managed Care Member FAQ answers questions related to member transition and background about Ohio Medicaid's Next Generation program.
Selecting or Changing a Next Generation managed care plan
You can review and select among the seven Next Generation plan that best fits your healthcare needs and preferences. Ohio Medicaid managed care members are encouraged to review and select the Next Generation plan that best fits their healthcare needs.
- Starting on February 1st members can change their plan at any point within the first 90 days.
- Open enrollment occurs every year between November 1 – November 30. All members can change their plan during open enrollment. Additional information will be sent to you before November.
- At any time, if a member has concerns about access to the healthcare services they need, they can request to change or disenroll from their plan for Just Cause. To learn more about Just Cause, please refer to the “Learn about Just Cause” section of this webpage.
Any changes will be made effective on the first day of the month following your selection. To make a Next Generation plan selection or change, Ohio Medicaid members can either visit the Ohio Medicaid Consumer Hotline Portal at https://members.ohiomh.com or contact the Ohio Medicaid Consumer Hotline at (800) 324-8680.
- Representatives are available Monday through Friday 7am-8pm and Saturday 8am-5pm ET.
Members previously enrolled with Paramount Advantage
Paramount Advantage Medicaid has been acquired by Anthem Blue Cross and Blue Shield (Anthem). If you were previously enrolled with Paramount Advantage and did not select a new Next Generation managed care plan, you were automatically enrolled with Anthem Blue Cross and Blue Shield. Members can change their plan at any point within the first 90 days.
Members newly eligible for Medicaid managed care
The individuals listed below previously received care through Medicaid fee-for-service. On February 1, 2023, they may have transitioned to an Ohio Medicaid Next Generation managed care plan. This includes individuals who are:
- newly eligible for managed care,
- currently in Medicaid fee-for-service but not enrolled with a managed care plan,
- and those previously covered by Medicaid and returning to Medicaid with a gap in their eligibility of 91+ days
ODM and the plan each member has been transitioned to have notified impacted members. Newborns and case additions will continue to be added to managed care plans as they become eligible for Medicaid during this time. Members can change their plan at any point within the first 90 days following enrollment.
Members enrolled in the OhioRISE program
OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their medical, dental, vision and other health services through one of the seven Next Generation managed care programs or fee-for-service Medicaid.
Learn about Just Cause
If members have concerns about access to healthcare, they can request to change or disenroll from their plan at any time for Just Cause. Members can make a Just Cause request by contacting Ohio Department of Medicaid through the Consumer Hotline at 800-324-8680 or reaching out to their managed care plan.
A Just Cause for enrollment is a request to change or disenroll from plans outside of the annual open enrollment period or after the initial 90-day enrollment period. These requests are initiated by calling the Medicaid Hotline at 800-324-8680 Monday through Friday 7am-8pm and Saturday 8am-5pm ET.
Learn more about the Next Generation of Ohio Medicaid
To learn more about the other components of the Next Generation of Ohio Medicaid, please visit the websites below: