On December 31, 2025, the Ohio Department of Medicaid (ODM) implemented the Next Generation MyCare program to provide healthcare benefits to many Ohioans who have both Medicaid and Medicare. The program is available in 29 counties and will become available in remaining counties on a schedule that runs from April 1 through August 1.

A subcommittee of the Health and Public Benefits Taskforce has been monitoring the transition from the MyCare pilot to the full-fledged program now rolling out across the state. 

“The biggest wrinkle we’ve noticed so far,” said Pro Seniors Staff Attorney Erin Campbell who chairs the subcommittee, “is that some managed care plans did not tell their brokers that people who were on [Developmental Disability] waivers could not be enrolled in MyCare.” 

Though eligible for the MyCare pilot program, Medicaid Developmental Disability (DD) waiver enrollees were not included in the revised program. Some received MyCare insurance cards anyway. Then, on December 30, affected individuals were canceled from their MyCare plans. Pro Seniors’ Helpline attorneys began receiving calls about the cancellation notices. 

Campbell reached out to ODM, and the agency confirmed that some carriers had mistakenly enrolled individuals with DD waivers into MyCare beyond the pilot program, but the individuals have now been re-enrolled in Medicaid Fee-For-Service and their former Medicare plan.

FOR LEGAL AID ATTORNEYS

As MyCare rolls into non-pilot counties, Campbell encourages legal aid advocates to be on the lookout for some of the issues that the original counties encountered during the pilot program. 

“Transportation was a big problem with the original MyCare,” Campbell said, citing examples like difficulty getting through to their plan's transportation contractor, or non-emergency transportation leaving a client at their destination and not coming back to get them. MyCare offers expanded transportation benefits, so it will take time to develop relationships with dependable transportation providers in the rural communities that are new to MyCare. 

Campbell also recommends that advocates familiarize themselves with the some of the benefits and drawbacks of MyCare, so they can help clients get the information they need to make an informed decision.

“MyCare is not right for everyone,” Campbell explained. While MyCare Medicaid is required for many dual eligibles, individuals can opt out of MyCare for Medicare. “For some people there is a benefit to having two insurance companies, because it could increase the chance that at least one of the companies will offer coverage.” Individuals with a Medicare Supplemental or Retiree plan could lose their valuable plan and benefits if they enroll in MyCare for Medicare, so they should consider opting out. "But for many people, having one provider and one number to call makes dealing with everything easier,” Campbell said.

The biggest MyCare plusses for Campbell’s clients have been the transportation benefits and the medical debit cards. The monthly Medicaid Personal Needs Allowance (PNA) is $75 for people living in nursing homes, $30-$50 for people in assisted living, and $30 for people with SSI. However, individuals enrolled in MyCare can get $200/month on their medical debit cards. In addition to traditional medical expenses, those with certain conditions can use the medical debit card funds for food and utilities. 

Campbell suggests recommending clients start by ensuring their providers accept MyCare insurance plans. They can check on the Ohio Medicaid Consumer Hotline page or contact the provider directly. 

If you have questions about MyCare, contact your Public Benefits team or one of the members of the Health and Public Benefits Taskforce MyCare Committee: Ashley Socha and Joshua Goodwin from LASCO, Karla Perry from The Legal Aid Society of Cleveland, Michelle Wrona Fox from Community Legal Aid, Rebecca Steinhauser from ABLE, Nia Shuler, and Erin Campbell from Pro Seniors.