Ohio Medicaid and AAA7 Launch Stakeholder Drive for Next Gen MyCare

The upcoming meeting between the Area Agency on Aging District 7 (AAA7) and the Ohio Department of Medicaid (ODM) marks a critical milestone in the state’s multi-year overhaul of its managed care infrastructure. Next Generation MyCare represents the evolution of Ohio’s dual-eligible program, designed to simplify the complex intersection of Medicare and Medicaid for the state’s most vulnerable populations. By moving toward a more integrated model, Ohio aims to address the long-standing fragmentation that often leaves dual-eligible individuals—those who qualify for both Medicare and Medicaid—navigating two separate sets of benefits, provider networks, and administrative hurdles.

Ohio’s "Next Generation" Medicaid model, which began its phased rollout in 2022, focuses on a person-centered approach that emphasizes data transparency and a "single point of entry" for providers. MyCare Ohio, which has historically operated as a demonstration program in 29 of Ohio’s 88 counties, is now being reimagined to provide a consistent, statewide experience. This expansion is not merely a geographic one; it represents a fundamental shift in how the state manages high-need populations, particularly seniors and individuals with disabilities who require long-term services and supports (LTSS).

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The upcoming meeting between the Area Agency on Aging District 7 (AAA7) and the Ohio Department of Medicaid (ODM) marks a critical milestone in the state’s multi-year overhaul of its managed care infrastructure.

For dual-eligible individuals, the transition to Next Generation MyCare promises to reduce the administrative friction that has historically plagued the system. Under the current framework, members often carry multiple ID cards and deal with conflicting prior authorization requirements between their Medicare and Medicaid plans. The Next Generation model seeks to integrate these into a single managed care plan that handles the full spectrum of care, from primary physician visits to home-based nursing and pharmacy benefits. This integration is expected to improve health outcomes by ensuring that care coordinators have a 360-degree view of the patient’s medical history and social needs.

As the Area Agency on Aging for District 7, AAA7 plays a pivotal role as the local coordinator for ten counties in Southern Ohio, including Highland, Adams, and Ross. These agencies are the primary link between the state’s regulatory framework and the actual delivery of home and community-based services (HCBS). Their involvement in these public meetings is essential for ensuring that the transition does not disrupt the existing relationships between seniors and their local caregivers. AAA7’s expertise in managing the social determinants of health—such as nutrition, transportation, and housing—will be a cornerstone of the Next Generation MyCare strategy.