05/06/2022

Medicaid Managed Care Next Generation Program to Launch In Three Stages

The Ohio Department of Medicaid (ODM) will begin to launch its Next Generation of Ohio Medicaid program beginning July 1, 2022, with the implementation of OhioRISE, a coordinated care program for children with complex behavioral health needs. Other Medicaid programs will be implemented in the following months on a staggered basis to keep the focus on the individual and honor member choice to allow for a smooth transition. This staggered start ensures continuity of care, limits confusion, and reduces complexities surrounding the anticipated end of the federal public health emergency (PHE) and provides the necessary time for provider testing and training.  

The staggered implementation will occur in three stages: 

• Stage 1: On July 1, 2022, OhioRISE will begin providing specialized services, which will help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.  
• Stage 2: In October 2022, Centralized Provider Credentialing will begin through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module, which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
• Stage 3: During the last three months of 2022, ODM will finish implementing the Next Generation program with all seven Next Generation managed care plans beginning to provide healthcare coverage under the new program. ODM will also complete the OMES implementation including the Fiscal Intermediary (FI) which will simplify and streamline the provider process for submitting claims and prior authorizations.

Ohio Medicaid is committed to launching the Next Generation of Ohio Medicaid correctly. The staggered timeline assures no disruption to members’ care or provider support. Eligible members will continue to receive the full complement of Medicaid benefits available today, and providers will continue serving the 3.34 million Ohioans covered by Medicaid, working with current managed care organizations using processes and procedures practiced today.

Please contact ODMNextGen@medicaid.ohio.gov with any questions.