The Ohio Department of Medicaid (ODM) has announced the NextGen MyCare Plans who will be covering MyCare services effective January 1, 2026. Those plans include Anthem, Buckeye, CareSource, and Molina. This means Aetna and United will no longer be covering Ohio MyCare enrollees, but Anthem will begin covering services rendered to those individuals. Please see the chart below that outlines EVV system changes effective January 1, 2026.
| Payer | Payer Program | Procedure Code | Start Date | End Date |
|---|---|---|---|---|
| Aetna | SP | G0156 | 12/31/2025 | |
| Aetna | SP | G0299 | 12/31/2025 | |
| Aetna | SP | G0300 | 12/31/2025 | |
| Aetna | SP | T1000 | 12/31/2025 | |
| Aetna | SP | T1001 | 12/31/2025 | |
| Aetna | SP | T1001, Modifier: U9 | 12/31/2025 | |
| Aetna | SP | G0151 | 12/31/2025 | |
| Aetna | SP | G0152 | 12/31/2025 | |
| Aetna | SP | G0153 | 12/31/2025 | |
| Aetna | MyC | S5125 | 12/31/2025 | |
| Aetna | MyC | T1002 | 12/31/2025 | |
| Aetna | MyC | T1003 | 12/31/2025 | |
| Aetna | MyC | T1019 | 12/31/2025 | |
| Aetna | MyC | ECL | 12/31/2025 | |
| Aetna | MyCPD | T2025 | 12/31/2025 | |
| Aetna | MyCPD | S5125** | 12/31/2025 | |
| Aetna | MyCPD | T1002** | 12/31/2025 | |
| Aetna | MyCPD | T1003** | 12/31/2025 | |
| Aetna | MyCPD | T1019** | 12/31/2025 | |
| UHC | MyC | S5125 | 12/31/2025 | |
| UHC | MyC | T1002 | 12/31/2025 | |
| UHC | MyC | T1003 | 12/31/2025 | |
| UHC | MyC | T1019 | 12/31/2025 | |
| UHC | MyC | ECL | 12/31/2025 | |
| UHC | MyCPD | T2025 | 12/31/2025 | |
| UHC | MyCPD | S5125** | 12/31/2025 | |
| UHC | MyCPD | T1002** | 12/31/2025 | |
| UHC | MyCPD | T1003** | 12/31/2025 | |
| UHC | MyCPD | T1019** | 12/31/2025 | |
| Anthem | MyC | S5125 | 1/1/2026 | |
| Anthem | MyC | T1002 | 1/1/2026 | |
| Anthem | MyC | T1003 | 1/1/2026 | |
| Anthem | MyC | T1019 | 1/1/2026 | |
| Anthem | MyC | ECL | 1/1/2026 | |
| Anthem | MyCPD | T2025 | 1/1/2026 | |
| Anthem | MyCPD | S5125** | 1/1/2026 | |
| Anthem | MyCPD | T1002** | 1/1/2026 | |
| Anthem | MyCPD | T1003** | 1/1/2026 | |
| Anthem | MyCPD | T1019** | 1/1/2026 |
Note: ** MyCPD services S5125, T1002, T1003, T1019 are self-directed services through a Financial Management Services (FMS) entity. Currently, the FMS for MyCare waiver recipients is Public Partnership, LLC (PPL).
What Providers Need to Do
Providers using an Alternate EVV system need to confirm with their Alt vendor that they are prepared for the upcoming changes. Please be sure to share the current alt EVV technical specifications available on the ODM EVV webpage and presented during the September 29 Alt EVV Townhall.
Providers using Sandata Electronic Visit Verification system will not need to make any adjustments unless a Recipient is changing from one payer to another. If a recipient has chosen to switch from one payer to another, such as moving from Buckeye to Anthem under the new MyCare Ohio program, please review the process for updating payer details and ensure that you end date your old authorization before creating a new Recipient authorization for their new payer. For new Recipients that are now EVV eligible you will need to create a new Recipient record.
If you need any assistance with the Sandata EVV solution please contact our Support line at 855-805-3505 or via email at ODMCustomerCareEmail@Sandata.com. If you need EVV help and are using an alternate EVV vendor call 844-289-4246 or email OHAltEVV@Sandata.com.
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