MedicaidCoverageMedium impact
5160-58-03 - MyCare Ohio plans: covered services. (Amend/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has finalized amendments to Rule 5160-58-03 regarding covered services for MyCare Ohio plans (Ohio's dual-eligible special needs plans for Medicare-Medicaid beneficiaries). The specific changes to covered services are not detailed in this filing document, but this represents an update to the state's managed care program for individuals eligible for both Medicare and Medicaid.
Action Required
By January 1, 2026: Billing teams serving MyCare Ohio members should review the full rule text (available via the provided link) to identify specific changes to covered services. Update billing systems and prior authorization requirements as needed based on the detailed policy changes. Contact the Ohio Department of Medicaid at 614-752-3877 for clarification on specific coverage changes.