Per CMS's most recent managed care enrollment data, report year 2024, Ohio Medicaid covered 2,719,479 members in managed care across 13 plans: 7 statewide comprehensive MCOs under the mainstream Next Generation program, 5 MyCare Ohio Opt-Out plans for dual-eligibles, and one small PACE plan (McGregor PACE, Cuyahoga County). This report-year roster predates the 2026 Next Generation MyCare Ohio transition to a new Fully Integrated Dual-Eligible Special Needs Plan model.
Ohio delivers most Medicaid coverage through the Next Generation managed care program, live since July 1, 2022. Seven managed care organizations hold statewide comprehensive MCO contracts (AmeriHealth Caritas, Anthem, Buckeye Community Health Plan, CareSource, Humana, Molina Healthcare of Ohio, and UnitedHealthcare Community Plan), with CareSource by far the largest at 1,191,420 of the program's 2,634,788 mainstream-MCO enrollees per CMS's 2024 data. Separately, MyCare Ohio serves Ohioans dually eligible for Medicare and Medicaid through an integrated managed care model; CMS's 2024 data reflects MyCare's prior 5-plan Opt-Out roster (Aetna, Buckeye, CareSource, Molina, UnitedHealthcare, 85,027 combined enrollees), already superseded by Next Generation MyCare Ohio, a Fully Integrated Dual-Eligible Special Needs Plan (FIDE-SNP) model that launched January 1, 2026 in the original 29 demonstration counties with statewide rollout completed April 1, 2026 under a new 4-plan roster (Anthem, Buckeye, CareSource, and Molina), with Aetna and UnitedHealthcare no longer participating in MyCare Ohio.
For Ohioans dually eligible for Medicare and Medicaid, long-term services and supports, including nursing facility care and home- and community-based waiver services, are coordinated directly through their MyCare Ohio plan. For the broader non-dual Medicaid population, LTSS remains outside the 7 mainstream Next Generation MCOs: it is delivered through standalone 1915(c) HCBS waiver programs, most administered on a fee-for-service, case-managed basis, including the PASSPORT Waiver (Ohio's largest, serving older adults), Ohio Home Care Waiver, Individual Options (IO) Waiver, Level One Waiver, Assisted Living Waiver, Ohio Choices Waiver, Self Empowered Life Funding (SELF) Waiver, and the Transitions DD and Transitions II Aging Carve-Out waivers.
Partially integrated into managed care
For the general Medicaid population, behavioral health is included within each mainstream MCO's comprehensive capitated benefit alongside medical and other services, not carved out to a separate statewide vendor. The one real, statewide carve-out is OhioRISE (Resilience through Integrated Systems and Excellence), launched July 1, 2022 for a specific subpopulation: children and youth with the most complex behavioral health needs. OhioRISE enrollees receive their behavioral health benefit exclusively through the single statewide OhioRISE plan, while medical, dental, and vision coverage continues through one of the 7 mainstream MCOs or fee-for-service.
Carved out
Dental coverage is embedded within each mainstream MCO's own comprehensive benefit rather than delivered through a single statewide dental vendor; individual MCOs subcontract their own dental network administration (LibertyDental Plan and DentaQuest are both active as MCO-level dental subcontractors in Ohio), so the specific vendor a member sees depends on which MCO they're enrolled with.
Gainwell Technologies has served as Ohio Medicaid's single statewide pharmacy benefit manager since October 1, 2022, replacing per-MCO pharmacy benefit administration.
Non-emergency medical transportation (NEMT) is brokered separately by each MCO rather than through one statewide vendor; active Ohio Medicaid NEMT brokers include Veyo, ModivCare, MTM, and Provide A Ride, with credentialing and access varying by which broker(s) a given MCO or fee-for-service population routes through.
Gainwell Technologies operates as Ohio Medicaid's fiscal intermediary, processing and paying fee-for-service claims through the state's Medicaid Management Information System, in addition to its role as pharmacy benefit manager. ODM's Provider Network Management (PNM) module serves as providers' single point for enrollment, centralized credentialing, and self-service.
62 agency updates tracked for Ohio. Available with Pro.
See them with ProIn an Ohio Capital Journal commentary, the author argues that record early voting and long lines in Ohio's 2026 midterm election reflected voter anger at the Trump administration's economic and policy record. The author cites, among other grievances, new Medicaid work requirements under Trump-backed legislation that the piece says could leave 356,000 Ohioans without health insurance after January, alongside rising gas and grocery prices and an expected 13% jump in ACA premiums. The piece also highlights the election of Dr. Amy Acton as Ohio's first elected woman governor. No new Medicaid policy action, rule, or timeline is reported beyond the author's characterization of the work-requirement impact.
University Hospitals, a Cleveland-based health system, still has no estimated timeline for restoring IT systems nearly two weeks after detecting unusual server activity on Oct. 22. A Nov. 2 update said facilities, emergency departments and physician offices remain open with most appointments proceeding as scheduled, but the MyChart patient portal is offline and the system cannot process payments at time of service since it operates cashless. Providers are using phone, Zoom or in-person visits in place of video calls, and printing, faxing or calling in prescriptions when e-prescribing is unavailable. UH has not disclosed the cause of the incident or whether patient data was compromised.
Covering Ohio's Nov. 3 election day, Ohio Capital Journal reports Democratic gubernatorial candidate Dr. Amy Acton cast her ballot in Bexley and told reporters she would "push back on D.C." over federal Medicaid changes if elected. Acton, running against Republican Vivek Ramaswamy, framed her candidacy around cross-partisan governance and opposition to recent federal Medicaid policy shifts affecting the state. The remarks came amid broader election-day coverage of races including state auditor and attorney general. No specific Medicaid policy or legal mechanism was detailed in her comments.
The American Medical Association and eight other physician groups filed a friend-of-the-court brief supporting a lawsuit brought by Columbus, Ohio and health advocates against HHS over its implementation of Medicaid work requirements. The suit, filed in U.S. District Court in Maryland, argues CMS's rule unlawfully requires "medically frail" enrollees to prove their conditions prevent them from working, contrary to the statutory exemption in the 2025 reconciliation law. Plaintiffs estimate the rule's added documentation burden could push national coverage losses to 8.2 million annually, roughly 30% above the law's original projections, with up to 143,000 Ohio expansion enrollees at risk. Work requirements largely take effect January 1, making the litigation's outcome time-sensitive for states implementing compliance systems.
Marietta, Ohio-based Memorial Health System is owed roughly $80 million in Medicaid supplemental payments that remain stuck pending CMS approval, CEO Scott Cantley told Becker's. About $60 million stems from the Ohio Rural Tax Pilot Program, a state-directed payment program for rural hospitals that has awaited CMS sign-off for 15 months, while another $20 million from the state's 2026 Hospital Additional Payments Program has also gone unpaid. The delay has stalled debt financing for a Women and Children's Hospital project in Belpre built in partnership with Akron Children's Hospital. The Ohio Medicaid department says it has completed all required submissions and the program now awaits CMS action, with Cantley pointing to CMS's September 2026 approval of a similar Texas county-funded program as a hopeful precedent.
24 active waivers tracked for Ohio. Available with Pro.
See them with ProNo active solicitations currently tracked for Ohio.
77 managed care contracts tracked for Ohio. Available with Pro.
See them with Pro52 bills tracked for Ohio. Available with Pro.
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