MedicaidAdministrativeMedium impact
5160-58-08.4 - Appeals and grievances for "MyCare Ohio". (Rescind/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid is rescinding the current MyCare Ohio appeals and grievances rule and replacing it with a new rule titled 'Grievances, appeals, and state fair hearings for MyCare Ohio' effective January 1, 2026. This represents a complete replacement of the existing appeals process framework for MyCare Ohio managed care plans.
Action Required
Before January 1, 2026: Billing and patient services teams should review the new grievances, appeals, and state fair hearings procedures for MyCare Ohio. Update internal appeals handling processes and staff training materials to align with the revised rule framework. Contact Ohio Department of Medicaid at 614-752-3877 for clarification on specific procedural changes.