MedicaidCoverageMedium impact
[Ohio] January 7, 2026 Policy Updates
CareSource·OH · Psychiatry·Medical Policy
Effective date
Feb 7, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is revising its Medical Policy MM-0034 regarding Interventions for Gender Dysphoria effective February 7, 2026. This is a revision to an existing policy, but the specific changes to coverage criteria, billing codes, or clinical guidelines are not detailed in this network notification document.
Action Required
By January 31, 2026: Billing and clinical staff must obtain and review the full revised policy MM-0034 from CareSource.com (Providers > Tools & Resources > Provider Policies > Ohio Medicaid > Medical Policies). Compare the revised policy against the previous version (available on the archived policy webpage) to identify specific changes to: (1) covered procedures and interventions, (2) medical necessity requirements, (3) applicable billing codes, and (4) prior authorization requirements. Update billing system rules, encounter forms, and clinical documentation templates accordingly. Flag any claims for gender dysphoria interventions submitted between now and February 7, 2026 for potential reprocessing under the new policy effective date.