MedicaidAdministrativeMedium impact
5160-58-08.4 - Grievances, appeals, and state fair hearings for MyCare Ohio. (New/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio is implementing a new rule (5160-58-08.4) that expands the grievances, appeals, and state fair hearings process for MyCare Ohio beneficiaries, replacing the previous appeals and grievances rule. This change affects how healthcare providers must handle patient disputes and appeals for Ohio Medicaid managed care plans.
Action Required
Before January 1, 2026: Billing and administrative teams must review and update patient grievance and appeal procedures for MyCare Ohio (Ohio Medicaid managed care) patients. Update staff training materials to include the new state fair hearings process. Ensure patient notification materials reflect the expanded appeals rights under the new rule.