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Medicare and Medicaid in Ohio

Ohio replaced MyCare Ohio with Next Generation MyCare in 2026. Here is how the program works, who it is for, and what the state has said about 2027.

Last updated October 23, 2026 · 7 min read

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By Alexander James, Licensed Independent Insurance Agent · NPN 19291077

Part of our guide to Medicare and Medicaid together. For general Medicare help in Ohio, see Medicare in Ohio.

Ohio at a glance

  • Medicaid is run by

    Ohio Department of Medicaid

  • Current state programs

    Next Generation MyCare; PASSPORT, Assisted Living and Ohio Home Care waivers

  • Published Medicaid figures

    3 figures below, each with the date it applies

  • Federal change, January 1, 2027

    One D-SNP per area for full-benefit duals, generally, where a company also offers a Medicaid plan

Sources: the Ohio Department of Medicaid (linked below) and 42 CFR 422.514.

Ohio's Medicaid program for people with Medicare

Medicaid in Ohio is run by the Ohio Department of Medicaid. The state decides who qualifies for Medicaid; a Medicare plan or an agent cannot.

Next Generation MyCare
Ohio's integrated program for adults with Medicare and full Medicaid, run through FIDE SNPs. It replaced the MyCare Ohio demonstration.
PASSPORT, Assisted Living and Ohio Home Care waivers
Ohio Medicaid home- and community-based waiver programs named by the Ohio Department of Medicaid.

Next Generation MyCare in 2026

Next Generation MyCare started January 1, 2026 in the 29 original MyCare counties. The Ohio Department of Medicaid scheduled the remaining counties to follow region by region on April 1, May 1, June 1, July 1 and August 1, 2026.

Members can choose a dual-benefit option, with Medicare and Medicaid from the same plan, or a Medicaid-only option from a Next Generation plan. The state says members with the dual-benefit option can change plans monthly through Medicare.

Coordination-only D-SNPs were still offered in Ohio during 2026, alongside the integrated program.

Who can join Next Generation MyCare

According to the Ohio Department of Medicaid, you need all of the following:

  • Full Medicaid
  • Medicare Parts A, B and D
  • Age 21 or older
  • Not enrolled in PACE, a developmental disabilities waiver or an intermediate care facility
  • No other coverage for hospital and doctor services

What Ohio has said about 2027

In a July 10, 2026 presentation to its MyCare advisory council (a deck marked draft), the Ohio Department of Medicaid said it plans not to extend its state contracts with coordination-only D-SNPs for 2027. Until the state confirms, treat that as the state's stated plan. The federal one-D-SNP-per-area rule that starts January 1, 2027 also applies.

If you have QMB, SLMB or QI only

Next Generation MyCare requires full Medicaid, so people who qualify only for a Medicare Savings Program are not eligible for it. If that is you, ask the Ohio Department of Medicaid or a licensed agent which Medicare plan types are open to you for 2027.

Ohio Medicaid figures, as the state publishes them

These are the figures the Ohio Department of Medicaid publishes for 2026. Medicare Savings Program figures are shown as Ohio lists them, before the $20 income disregard.

Ohio: published Medicaid figures, with the date each applies

  • Aged, blind or disabled Medicaid income standard (monthly)

    Amount
    $994 single, $1,491 couple
    As of
    2026

  • Nursing-home and home-care waiver income cap (300% of SSI)

    Amount
    $2,982 a month
    As of
    2026

  • QMB / SLMB / QI monthly income (one person)

    Amount
    $1,330 / $1,596 / $1,796
    As of
    2026

Your own eligibility depends on your full situation and is decided by the state. Federal figures that apply in every state are in our guides to the Medicare Savings Programs, Extra Help and Medicaid long-term care.

What works the same in every state

Some rules are federal. Medicare pays first and Medicaid pays last. Since 2025, people with Medicaid or Extra Help have a once-a-month option to change drug coverage, and full-benefit duals have a once-a-month option to join an integrated plan that matches their Medicaid plan. Starting January 1, 2027, federal rules generally limit companies to one D-SNP per area for full-benefit duals where they also offer a Medicaid plan. Our guide to integrated D-SNPs explains each step, and Will I lose my Medicaid if I join a D-SNP? covers what changes when you join one.

Who pays first when you have Medicare and full Medicaid

  1. Step 1

    You get a Medicare-covered service

    A doctor visit, a hospital stay or a prescription that Medicare covers.

  2. Step 2

    Medicare pays first

    Through Original Medicare or your Medicare plan. Your prescription drugs are covered by a Medicare drug plan, not by Medicaid.

  3. Step 3

    Medicaid pays last

    After Medicare and any other health insurance you have. Medicaid can also cover some services Medicare does not, depending on your state.

Source: Medicare.gov, “Medicaid” (people who have both Medicare and full-benefit Medicaid).

Before you change anything

FAQ

Medicare and Medicaid questions from Ohio

Sources

Each page was read on October 23, 2026.

Guides for other states

Continue learning

Related reading

Questions about Medicare and Medicaid in Ohio?

A licensed agent can explain how the plans they offer in your area work with your Medicaid and check your doctors first. No pressure, and no obligation to enroll.

Talk with a licensed agent Schedule a consultation

Or call (954) 601-3544.

Educational content. Insurance products are subject to underwriting; rates and availability vary by health, age, state, and carrier. Licensed Insurance Advisor | NPN: 19291077 | Licensed in 25+ states.