The Ohio Department of Medicaid (ODM) has announced the NextGen MyCare Plans that will cover MyCare services effective January 1, 2026.
The plans are Anthem, Buckeye, CareSource, and Molina. Aetna and United will no longer cover Ohio MyCare enrollees starting January 1, 2026. You can review recipient eligibility records in Provider Network Management (PNM) to determine which new MyCare plan individuals currently covered by Aetna and United have chosen.
| 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 Does this mean for Providers?
As of 12/17/2025, you can add Anthem MyCare services into EVV.
You can begin updating recipient payers and authorizations for individuals already enrolled in MyCare who are transitioning plans. For individuals moving from PASSPORT or Ohio Home Care Waiver to MyCare, you can create new "MyC" and "MyCPD" programs. Here are some helpful resources on how to create a new Recipient, add a new Payer, and add new authorizations.
Providers using an Alternate (Alt) 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 EVV system will not need to make any adjustments unless a Recipient is changing from one payer to another.
If you need any assistance with the Sandata EVV solution please call our support line at 855-805-3505 or email 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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