Next Generation MyCare: A Major Step Forward for Integrated Care in Ohio

After years of collaboration, advocacy and planning, Ohio has reached an important milestone in caring for some of its most vulnerable residents — those who qualify for both Medicare and Medicaid. Following the launch of Next Generation MyCare in 29 counties at the start of the year, the state will begin rolling out the program to Ohio’s other 59 counties beginning April 1.

For many of us who have worked to advance this program, this moment feels like a celebration. Health plans, health care providers, community partners and policymakers have spent years developing an integrated approach to care for these individuals, often referred to as “dual eligibles.” Now, the next generation of MyCare is here, and Ohioans across the state will benefit. All of us in Ohio should be proud of this truly innovative approach to solving a difficult health care problem.

Why MyCare Matters 

Navigating the health care system can be difficult for anyone. But for individuals who receive benefits from both Medicare and Medicaid, the system can be especially complicated. These individuals frequently manage multiple chronic conditions, see numerous providers and rely on a variety of services. Historically, the fact that Medicare and Medicaid operate as separate programs has created confusion and fragmentation, making it harder for people to get the coordinated care they need.

Recognizing these challenges, the Ohio Department of Medicaid (ODM) launched the MyCare Ohio pilot program in 2014. The goal was straightforward but ambitious: bring Medicare and Medicaid benefits together into one plan so members could experience a simpler, more integrated system of care. Instead of navigating two different programs, members enrolled in MyCare receive their services through a single managed care plan. The approach puts the individual at the center of the process and helps ensure that every part of a person’s care works together.

Initially launched in 29 counties, the MyCare pilot proved that integrated care can make a real difference. The program has helped improve health outcomes, reduce unnecessary emergency room visits and hospitalizations, and provide a more seamless experience for members and their families. Now, Ohio is building on that success and making sure that more dual eligibles can experience these same benefits.

Introducing Next Generation MyCare 

On January 1, ODM launched Next Generation MyCare, the next evolution of this innovative program, to individuals in the 29 counties where MyCare has been available. The updated iteration of the program will be rolled out to the state’s remaining counties between April and August of this year. The new model reflects more than 10 years of experience and input from stakeholders across Ohio’s health care system.

The foundation remains the same: bringing Medicare and Medicaid benefits together in one plan to provide better care coordination. But Next Generation MyCare includes important improvements. Members continue to benefit from the simplicity that made the original program successful — one plan, one ID card and one care coordinator helping to guide their care — while gaining access to enhanced services and supports, such as:

• Expanded behavioral health services.
• More transportation options to help members access care.
• Stronger support for long-term care and community-based living.
• Reduced wait times for care authorizations.
• More personalized care coordination.

Four health insurance providers offer a Next Generation MyCare plan: Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare of Ohio and Buckeye Health Plan (for existing members). These health plans partner with ODM, health care providers, Area Agencies on Aging (AAAs) and social service agencies to ensure members receive not only medical treatment, but also the broader services that support good health, including transportation, home-based care and community resources. This kind of coordinated, person-centered approach reflects an important truth: improving health outcomes often requires addressing more than just medical needs.

The expansion of Next Generation MyCare to all Ohio counties represents a significant step forward for Ohio’s health care system. It builds on more than a decade of progress and reflects a shared commitment to improving care for individuals, especially those with complex needs. For the many partners who have worked to bring this program to life, the rollout is both a milestone and a moment of pride. Next Generation MyCare represents an investment in better health for Ohioans — and a powerful example of what can happen when public and private partners work together to improve care.