MedicaidCoverageMedium impact
5160-1-11 - Out-of-state coverage [except as provided through medicaid contracting managed care plans (MCPs)]. (Rescind/Final File)
Ohio Medicaid·OH·Managed Care
Effective date
Apr 4, 2021
We identified it
Jun 20, 2026
Summary
Ohio Rule 5160-1-11 regarding out-of-state Medicaid coverage (excluding managed care plans) has been rescinded and replaced with a new rule. This affects billing for Ohio Medicaid patients receiving care outside of Ohio.
Action Required
Billing team should review current procedures for Ohio Medicaid patients receiving out-of-state care. Verify that billing processes align with the new rule requirements for out-of-state coverage, particularly ensuring proper distinction between traditional Medicaid and managed care plan (MCP) coverage rules.