ODM Releases Next Generation MyCare RFA

On May 31st, the Ohio Department of Medicaid announced the release of the Next Generation MyCare Request for Applications (RFA). This RFA is for managed care entities interested in becoming Next Generation MyCare managed care plans for Ohioans who are dually eligible for Medicaid and Medicare. Plans have until August 2nd to submit the RFA.  The selected plans will be an essential piece in improving the health and lives of Ohioans.

The Next Generation MyCare procurement aims to improve MyCare member and provider experience with the program. To do this, is transitioning the current program out of the Financial Alignment Initiative demonstration and moving towards a fully integrated dual-eligible special needs plan (FIDE-SNP). Plans awarded a contract following a competitive procurement process will need to notify CMS of their intent to establish a FIDE-SNP in Ohio by fall 2024 to be authorized to begin operations by the end of calendar year 2025. Beginning in January 2026, the selected FIDE SNPs will begin covering the full Medicare and Medicaid benefits for those who qualify in the current 29 demonstration counties, with statewide expansion as expeditiously as possible. ODM anticipates selecting not more than four managed care plans through this process.

With this release, ODM aligning the Next Generation Medicaid managed care principles into MyCare and has added additional provisions to support self-direction, transportation, and behavioral health care coordination. Selected plans will also be expected to leverage the Medicaid unified preferred drug list to support MyCare transitions, identify one care coordinator for Medicare and Medicaid services, increase transparency of claims and prior authorizations and more ODM oversight of both; and alignment of Medicare and Medicaid provider networks. 

For more information, review the RFA, press release, and pre-application conference slides.  Additionally, you can read more about the Next Generation MyCare plan on the ODM MyCare Ohio webpage.