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The Ohio Department of Medicaid Announces Four Next Generation MyCare Plans

Client Alert

On November 1, 2024, the Ohio Department of Medicaid (ODM) announced four managed care organizations that will become ODM’s Next Generation MyCare plans starting January 2026. MyCare Ohio is a managed care program that supports Ohioans across 29 counties enrolled in both Medicare and Medicaid.

Currently, Buckeye Health Plan, CareSource, Molina HealthCare of Ohio, Aetna Better Health of Ohio, and United Healthcare Community Plan make up the MyCare plans available to plan participants. Ohioans will continue to receive coverage under the existing MyCare plans until the Next Generation MyCare plans take effect in 2026.  

ODM’s Next Generation MyCare program strives to enhance both the MyCare member and provider experience. ODM Director Maureen Corcoran shared that the Next Generation plans were selected “after more than a year of stakeholder engagement efforts that gathered patient feedback from members, family caregivers and other stakeholders across the state.”[1] She explained that these efforts helped ODM to “understand their experiences with healthcare and the associated life choices, with a focus on how to improve individual health outcomes and population wellness.”[2] As a result, ODM awarded the following plans to serve MyCare members starting in 2026:

  • Anthem Blue Cross and Blue Shield
  • Buckeye Health Plan
  • CareSource
  • Molina HealthCare of Ohio

Members currently enrolled in Aetna Better Health of Ohio or United Healthcare Community Plan will be required to select a new plan from the list of Next Generation MyCare plans. ODM will provide these members with enrollment information before their coverage lapses in January 2026.

For MyCare members currently enrolled in Buckeye Health Plan, CareSource, or Molina Healthcare of Ohio, no action is required for those who would like to continue with their existing plan. However, they may elect to change their coverage to a different Next Generation plan.

The newly selected plans promote the program’s goals of:

  • Focusing on the individual
  • Improving individual and population wellness and health outcomes
  • Creating a personalized care experience
  • Supporting providers in continuously improving car
  • Improving care for individuals with complex needs to promote independence in the community
  • Increasing program transparency and accountability

ODM stated that statewide expansion of the program is expected to follow the transition to the Next Generation MyCare plans.

If you have questions about the Next Generation MyCare program, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Kate Crawford at khcrawford@bmdllc.com.


[1] Ohio Medicaid Announces MyCare Ohio Plans Chosen to Serve Ohioans in Next Generation Program, Ohio Dept. of Medicaid (Nov. 1, 2024), https://medicaid.ohio.gov/news/press-release/odm-nextgen-mycare-ohio-plans.

[2] Id.


Sharp Rise in False Claims Act Cases - Navigating the FCA Waters

Recently, on April 18, 2023, the United States Supreme Court heard arguments regarding the FCA’s scienter, or mental state, requirement. To prove violation of the FCA, the statute requires that a defendant “knowingly” file false claims for payment. The term “knowingly” is defined within the statute to mean a person that acts with actual knowledge, deliberate ignorance, or reckless disregard. Circuit courts are split on how to interpret and apply the knowledge element of the FCA, and based on the Supreme Court’s decision, there will be a large impact on healthcare defendants and their businesses as well as anyone who contracts with, or receives money from, a federal program. A broader interpretation of the FCA would unnecessarily target and stifle healthcare, and other businesses, for simple errors in daily operations. This goes against the intended application of the FCA, which was to prevent fraudulent activity.

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On April 4, 2023, the Office of Management and Budget (OBM) approved an updated Advance Beneficiary Notice of Non-coverage (ABN) form CMS-R-131.[1] Providers can continue using the current ABN form with an expiration date of June 30, 2023.[2] However, all providers are mandated to use the new ABN starting on June 30, 2023, which has an expiration date of January 31, 2026.

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