Ohio’s Next Generation MyCare Expansion: What Home Health Agencies Need to Know

On April 1, the Ohio Department of Medicaid (ODM) took another major step in transforming care delivery with the Phase 2 rollout of the Next Generation MyCare Ohio program.

With expansion into ten additional counties and a broader statewide rollout underway, this initiative will reshape how home health agencies operate within Ohio’s Medicaid landscape.

For agencies serving dual-eligible populations, the implications extend far beyond policy. They directly affect referrals, authorizations, billing, and cash flow.

A Program Designed for Coordination, But Not Without Complexity

The Next Generation MyCare program aims to improve care coordination for more than 250,000 Ohioans eligible for both Medicare and Medicaid. By integrating benefits under managed care organizations like Anthem, CareSource, and Molina, the program seeks to:

• Enhance access to preventive and behavioral health services
• Strengthen long-term services and supports (LTSS)  
• Expand transportation and community-based resources  

While these improvements are meaningful for patients, they also introduce new layers of administrative oversight for providers.

Key Operational Impacts for Home Health Agencies

1. Increased Managed Care Complexity: With multiple statewide plans coordinating both Medicare and Medicaid benefits, agencies must now navigate payer-specific rules, billing requirements, and authorization processes, often for the same patient population.

2. Authorization and Eligibility Challenges: Transitions like Phase 2 frequently create gaps or inconsistencies in eligibility data and authorizations, particularly as members move between plans or counties. Without strong intake and verification processes, agencies risk:

• Delivering services without valid authorization  
• Experiencing delayed or denied payments  
• Increased administrative rework ‍

3. Authorization and Eligibility Challenges: Transitions like Phase 2 frequently create gaps or inconsistencies in eligibility data and authorizations, particularly as members move between plans or counties. Without strong intake and verification processes, agencies risk:

‍Revenue Cycle Disruptions: Changes in payer structure often lead to:

• Slower claims adjudication
• Increased denial rates  
• Confusion around billing responsibility between Medicare and Medicaid  

For agencies operating on tight margins, even small disruptions can significantly impact cash flow.

Where Agencies Should Focus Now

To successfully navigate the MyCare transition, agencies should prioritize strengthening key areas of their revenue cycle:

✔ Network Participation: Contract with each MyCare plan and make the agreement accessible.

✔ Intake & Eligibility Verification: Ensure staff are verifying coverage across MyCare plans in real time and confirming coordination of benefits.

✔ Authorization Management: Implement processes to track and validate authorizations across multiple managed care organizations.

✔ Claims Accuracy & Submission: Align billing practices with each plan’s requirements to reduce denials and rework.

✔ Denial Management: Proactively identify trends tied to MyCare transitions and implement rapid resolution workflows.

Turning Change Into Opportunity

While the Next Generation MyCare program introduces complexity, it also creates opportunities for agencies that are operationally prepared. Organizations that invest in strong revenue cycle infrastructure will be better positioned to:

• Scale with increased patient volume  
• Maintain consistent cash flow  
• Build stronger relationships with managed care plans  
  How Paradigm Supports Ohio Agencies

At Paradigm, we specialize in helping home health providers navigate exactly these types of transitions. From intake through reimbursement, our team works alongside agencies to:

• Improve eligibility and authorization workflows
• Reduce claim denials and days in Accounts Receivable  
• Optimize processes across multiple Medicaid managed care plans

As Ohio continues its statewide rollout of MyCare, having the right partner can make the difference between disruption and growth.

Final Thoughts

The Phase 2 expansion of Next Generation MyCare is more than a policy update. It’s a structural shift in how care is delivered and reimbursed in Ohio.

Home health agencies that act now to strengthen their operational and revenue cycle strategies will be best positioned to thrive in this evolving environment.