Next Generation of Ohio Medicaid Managed Care
On February 1, 2023, Ohio Medicaid’s Next Generation managed care plans will provide a more personalized approach to support your healthcare needs. Ohio Medicaid managed care members can review and compare the seven Next Generation managed care plans available and choose the Next Generation plan that best fits their healthcare needs during annual open enrollment November 1 through November 30.
The Next Generation managed care plans changes do not apply to MyCare Ohio plans, which will continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits. Additionally, OhioRISE enrollees will 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 below list of resources 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:
- Call the Medicaid Consumer Hotline at (800) 324-8680 if you have additional questions about the Next Generation managed care plan options available.
- 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 the Next Generation plan that best fits your healthcare needs. Ohio Medicaid managed care members are encouraged to review and select the Next Generation plan that best fits their healthcare needs during annual open enrollment, November 1- November 30.
Members can also change their plan at any point within the first three months after their new plan selection becomes effective. Any changes will be made effective on the first day of the month following your selection. You can also request to change your current plan at any time for just cause. To learn more about just cause, please refer to the “Learn about just cause” section of this webpage.
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.
Current members enrolled with Buckeye, CareSource, Molina, or UnitedHealthcare
Current Ohio Medicaid managed care members who do not select a plan - will continue receiving healthcare coverage through their current plan.
Current Ohio Medicaid managed care members that selected a new Next Generation managed care plan – Anthem Blue Cross and Blue Shield, AmeriHealth Caritas, or Humana Healthy Horizons - will begin receiving services from that plan February 1, 2023.
Current Ohio Medicaid managed care members that selected a different continuing plan - Buckeye, CareSource, Molina, or UnitedHealthcare - from their current plan will begin receiving services from that plan on December 1, 2022.
Current members enrolled with Paramount Advantage
Paramount Advantage Medicaid has been acquired by Anthem Blue Cross and Blue Shield (Anthem). Anthem is working with Paramount Advantage to continue providing your healthcare coverage and you will continue receiving healthcare coverage through Paramount Advantage until the Next Generation managed care plans begin providing healthcare coverage. At that time Anthem will be your Next Generation managed care plan. You do not need to take any action to begin receiving healthcare benefits through Anthem and there will be no disruption in your care. All Ohio Medicaid managed care members can select a different plan until the end of open enrollment on November 30.
Members newly eligible for Medicaid managed care
The individuals listed below will receive care through Medicaid fee-for-service until February 1, 2023, when they are transitioned to an Ohio Medicaid Next Generation 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 with a gap in eligibility of 91+ days
ODM will notify impacted members which plan they have been transitioned to. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment which ends on November 30, 2022. Newborns and case additions will continue to be added to managed care plans as they become eligible for Medicaid during this time.
Members enrolled in the OhioRISE program
OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical 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 initial 90-day period after enrollment. These requests are initiated by calling the Medicaid Hotline at 800-324-8680 Monday through Friday from 7 a.m.-8 p.m. and Saturday from 8 a.m.-5 p.m.
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: