MyCare Ohio: how one of the country's largest dual-eligible demos works for caregivers in 2026.

A Columbus dementia-care coordinator I trust put it this way: “In MyCare counties, the parent has one phone number for everything. In the other 81 counties, the family figures out the seams.”

MyCare Ohio is one of the largest Medicare-Medicaid integrated managed care programs in the country, covering adults who qualify for both Medicare^? and Medicaid^? (“dual eligibles”) across seven county groupings that include most of Ohio’s major metros — Cleveland, Columbus, Cincinnati, Dayton, Toledo, Akron, and Youngstown.2Originally launched in 2014 as a CMS financial-alignment demonstration, the program has gone through a substantial restructuring during the 2024–26 transition to a Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP) framework.1 For caregivers of dual-eligible parents in the demo region, MyCare is the most important program to understand; for caregivers elsewhere in the state, knowing whether the parent could benefit from moving into a demo county is sometimes the right question to ask.

What MyCare Ohio integrates

The premise of an integrated dual-eligible program is that an adult who has both Medicare and Medicaid is typically navigating two separate insurance systems with overlapping benefits, conflicting paperwork, and parallel networks. MyCare consolidates these into a single MCO contract that handles:

• Medicare Part A (hospital). The MCO handles inpatient hospital admissions, skilled nursing rehabilitation, hospice, and home health under Medicare benefits.
• Medicare Part B (medical). Office visits, specialist care, durable medical equipment, ambulance, outpatient procedures.
• Medicare Part D (prescription drugs). Drug coverage is bundled in; no separate Part D plan is needed.
• Medicaid acute care.Services that Medicare doesn’t cover or covers only partially — dental, vision, hearing, transportation to medical appointments, certain behavioral-health services.
• Medicaid LTSS. The big one: nursing facility coverage, home- and community-based services (in-home aide hours, adult day services, home modifications, personal emergency response systems), and care coordination across all of the above.

A single MCO care manager works with the member and family across all these benefits. The MCO is paid a capitated rate by Medicare and Medicaid combined; the financial alignment creates an incentive for the MCO to invest in HCBS that keeps people out of more expensive institutional settings.

How the 2024–26 transition changed things

The original MyCare Ohio program was structured as a CMS “financial alignment” demonstration: a time-limited federal-state partnership with a defined end date and federally-administered evaluation criteria. Across the 2024–26 transition period, MyCare moved from that demonstration framework into a Medicare-statute-based Highly Integrated Dual Eligible Special Needs Plan (HIDE-SNP) structure.1

For most members and families, the day-to-day experience stayed similar: the same MCOs (with some changes in participating plans), the same integrated benefit package, the same care-coordination structure. What changed was mostly behind the scenes:

• The federal regulatory authority shifted from the demonstration framework to standing Medicare Advantage statute, which provides longer-term stability and clearer rules.
• Enrollment defaults changedas the demonstration’s passive-enrollment provisions phased out and the standard Medicare Advantage enrollment cycle applied.
• Some MCO participation moved. Plans that had been part of the demo cycle reorganized their Ohio HIDE-SNP offerings.4
• Care-coordination requirements tightened under the federal HIDE-SNP standards, including specific timeline requirements for initial assessments and care-plan updates.

The geography: who’s in MyCare and who isn’t

MyCare Ohio is not a statewide program. It operates in seven county groupings covering the major metros and the surrounding counties. The counties currently in the MyCare service area include Cuyahoga, Franklin, Hamilton, Montgomery, Lucas, Mahoning, and Summit (anchored on Cleveland, Columbus, Cincinnati, Dayton, Toledo, Youngstown, and Akron respectively), plus a number of adjacent counties that share the same MCO regions.2

For a dual-eligible parent in one of these counties, MyCare enrollment is the default; the parent can opt out of MyCare and use standard fee-for-service Medicare plus fee-for-service Medicaid, but the integration benefits go away with the opt-out.

For a dual-eligible parent in a non-MyCare county (Stark, Wayne, Athens, Tuscarawas, the rural counties), MyCare isn’t available. The available options are:

• PASSPORTfor HCBS-eligible Medicaid LTSS — the principal Medicaid waiver program outside MyCare.3
• Fee-for-service Medicare or a Medicare Advantage D-SNP for the Medicare side, standalone from the Medicaid side.
• Fee-for-service Medicaid acute care. ODM directly reimburses providers; care coordination is the family’s responsibility.

The two systems are roughly comparable on benefit scope for the member; the difference is in coordination. MyCare members have one MCO care manager handling all the moving parts. PASSPORT members have a PASSPORT case manager for HCBS but not for Medicare coordination.

The four planning questions for MyCare families

1. Is your parent in a MyCare county and actually enrolled?Some dual-eligibles in MyCare counties have opted out of MyCare into fee-for-service, often without realizing they did so (the original demonstration had complex passive- enrollment and opt-out flows). Confirm enrollment with ODM. If your parent isn’t enrolled and could be, re-enrolling captures the integration benefits.
2. Which MCO is your parent assigned to, and is it the right one? The MyCare MCOs differ in provider network depth, care-coordination approach, and ancillary benefits.4 ODM allows MCO changes during specific enrollment windows. If your parent’s primary specialists or preferred home-care agency aren’t in the current MCO’s network, switching MCOs is a decision worth running through.
3. Who is the assigned care manager and what is in the care plan?The MCO is required to develop an Individualized Care Plan for each member with an LTSS need. The plan documents authorized in-home hours, attending services, equipment, and care goals. If you haven’t seen your parent’s care plan, request it; the MCO is required to provide it.
4. What’s the LTSS scenario going forward? MyCare covers both home- and community-based services and nursing-facility care. For a parent currently at home, the question is whether the authorized HCBS hours are sufficient and whether the MCO is being responsive to changes in need. For a parent in a facility, the question is whether MyCare is paying appropriately and whether the facility is in network. Both are MCO-care- manager conversations.

The PASSPORT alternative

For dual-eligibles outside the MyCare demo region, or for those who opt out of MyCare, Ohio’s PASSPORT HCBS waiver is the principal pathway to Medicaid-funded home care.3 PASSPORT covers:

• In-home personal care from a contracted home-care agency;
• Adult day services at a licensed program;
• Home-delivered meals;
• Personal emergency response systems;
• Home modifications and medical equipment;
• Case management through one of the regional Area Agencies on Aging.

Eligibility requires Medicaid financial eligibility and a nursing-facility level-of-care determination. The PASSPORT case manager is the analog of the MyCare MCO care manager for HCBS; the difference is that PASSPORT doesn’t coordinate Medicare. A PASSPORT member still has separate Medicare coverage (fee-for-service or MA) for hospital, doctor, and drug benefits, with no single entity responsible for cross-coordination.

The dual-eligible-special-needs-plan question

Outside MyCare, the Medicare Advantage market in Ohio includes several Dual-Eligible Special Needs Plans (D-SNPs) — MA plans designed specifically for dual-eligibles, with care coordination across Medicare and Medicaid benefits even where the state hasn’t created a fully integrated program. D-SNPs operate in counties where MyCare doesn’t, providing some (but less complete) integration than MyCare. For a dual-eligible parent in a non-MyCare county, the D-SNP option deserves a look during the Annual Enrollment Period (October 15 to December 7).

The bottom line

MyCare Ohio is genuinely one of the more successful state dual-eligible integration programs nationally, and for families with a parent in a demo county, the integration is a substantive operational benefit. The 2024–26 transition to the HIDE-SNP framework stabilized the regulatory foundation without materially changing the member experience.

For families currently navigating MyCare, the highest-leverage move is engaging actively with the assigned MCO care manager rather than treating the program as automatic. The integration only works as well as the care plan, and the care plan only works as well as the family’s engagement with it. For families outside the MyCare region, the question of whether the program’s benefits would warrant a move into a demo county is rarely the right framing — the PASSPORT-plus-D-SNP combination outside MyCare is workable and most families won’t want to relocate a parent for a program enhancement. But knowing the option exists is worth the half-hour of reading.6