Statewide MyCare Is Moving Forward
This year marks a major milestone in Ohio’s journey to provide better care for some of its most vulnerable residents: After more than a year of study and consultation with stakeholders across the state and a review of its selection process, the Ohio Department of Medicaid (ODM) is ready to begin planning with four managed-care organizations to go statewide with Next Generation MyCare, the state’s integrated approach to serving “dual-eligible” Ohioans — those who qualify for both Medicare and Medicaid benefits.
MyCare has been in place as a pilot project in 29 counties for a decade and has demonstrated clearly the benefits of the approach, which features care coordination based on the member’s needs. Through MyCare, each member is served by a team that coordinates all of the medical and behavioral health care the member requires as well as any necessary long-term supports and services.
OAHP is very excited that MyCare is now poised to be delivered to all dual-eligibles in Ohio, starting in January 2026. Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource and Molina HealthCare of Ohio will administer the program.
MyCare features a focus on the individual’s holistic needs and strengths, rather than a fee-for-service model under which siloed providers perform services and procedures with little consideration of the member’s overall medical and life needs. The results are tangible: A report on Ohio’s MyCare demonstration project by the U.S. Centers for Medicare and Medicaid Services found that, over six years, people enrolled in MyCare were more likely than other dual-eligible Ohioans to have a 30-day follow-up after a mental-health visit. They were less likely to be admitted to a hospital as an inpatient, be readmitted within 30 days after discharge, or be admitted to a skilled-nursing or long-term-nursing facility.
These improvements are important for two reasons: They enable dual-eligible Ohioans to be healthier and happier and, by reducing hospital and nursing-home use, they save taxpayers substantially. That’s especially significant for the dual-eligible population; prior to the MyCare project, this population made up 5% of the Medicaid population, accounting for 26% of Medicaid spending.
Keeping them healthier and happier at home while lowering Medicaid spending is a win-win of the highest order.
The General Assembly provided for statewide expansion of MyCare in July 2023, as part of the 2024-25 state budget. We’re excited to see the implementation process move forward and stand ready to work with the Ohio Department of Medicaid in building a statewide program.
