MedicaidAdministrativeMedium impact
5160-58-03.2 - MyCare Ohio waiver: member choice, control, responsibilities and participant direction. (Amend/Final File)
Ohio Medicaid·OH · Physical Therapy, Occupational Therapy·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio's MyCare Ohio waiver program (Rule 5160-58-03.2) has been amended with new requirements for member choice, control, responsibilities and participant direction for HCBS waiver services. This affects billing and service delivery for Ohio Medicaid dual-eligible members enrolled in MyCare Ohio managed care plans.
Action Required
By January 1, 2026: Billing team must review MyCare Ohio waiver service protocols and ensure compliance with updated member choice and participant direction requirements. Update billing workflows for HCBS waiver services to reflect new member control provisions. Contact MyCare Ohio plans to confirm any changes to prior authorization or documentation requirements for waiver services.