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Recent Updates from Ohio Medicaid for Physician Practices

The Ohio Department of Medicaid provided updates to the OSMA to share with members on several different topics:

  • 2021 Managed Care Open Enrollment Period

  • Unwinding of the Public Health Emergency

  • Go-Live of our Next Generation program.

2021 Managed Care Annual Open Enrollment

We know that you may receive questions from Ohio Medicaid managed care members, including about the 2021 Managed Care Annual Open Enrollment period. Please direct managed care members to contact the Ohio Medicaid Consumer Hotline with questions about their plan or how to change their plan.

  • Ohio Medicaid Consumer Hotline: 1-800-324-8680
    (Available Mon-Fri 7am-8pm and Sat 8am-5pm EST)
  • Ohio Medicaid Consumer Hotline Website:

We began mailing open enrollment letters to members today to let them know open enrollment is occurring, what their MCO choices are, and what actions are needed. Mailings will continue through mid-November, and the official open enrollment period runs from December 1 through December 31, 2021. If a member doesn’t choose a new MCO, they will stay with their current MCO.

Unwinding of the Federally-Designated Public Health Emergency

The COVID-19 public health emergency (PHE) was most recently renewed by the Secretary of Health and Human Services (HHS), Xavier Becerra, effective July 20, 2021. HHS guidance previously indicated that the COVID-19 PHE will likely remain in place for the entirety of calendar year 2021, and that HHS will provide states with 60 days’ notice prior to termination when a decision is made to terminate the PHE declaration or let it expire. On the basis of the January 2021 letter, Ohio and other state Medicaid agencies expect the PHE declaration to be renewed on October 17, 2021.

ODM has continued to complete eligibility renewals and process case changes during the PHE; however, under the Families First Coronavirus Response Act (FFCRA) continuous coverage requirement, we are unable to discontinue Medicaid coverage for members except when the individual voluntarily requests a discontinuance of eligibility, is no longer a resident of the state, or is deceased. As soon as the PHE ends, the State has a very short period of time within which to resume full eligibility operations. Specifically, State law enacted as part of the biennial budget gives ODM only 60 days after the PHE ends to complete and act on eligibility redeterminations for all members for whom a redetermination has not been conducted in the last 12 months and imposes other post-PHE eligibility actions. Our work will have to comport with CMS guidance regarding completing pending eligibility and enrollment actions including renewals, redeterminations based on changes in circumstances, and processing of verifications. In addition, we must complete a redetermination of eligibility prior to taking an adverse action with respect to any beneficiary. ODM is working with ODJFS to work through the details of operationalizing these requirements.

Go-Live for the Next Generation Ohio Medicaid Program

On August 25, 2021, ODM announced that Ohio Medicaid’s next generation program is projected to go-live on July 1, 2022. This date encompasses all of Ohio Medicaid’s next generation initiatives – Medicaid Managed Care, OhioRISE, Single Pharmacy Benefit Manager (SPBM), Provider Network Management (PNM) module and Centralized Credentialing, and Fiscal Intermediary (FI). To learn more about the announcement, please refer to our announcement press release.

Members will be able to select from the next generation plans during Member Transition Enrollment in spring 2022. Additional communications will be sent to members to provide directions on how to select from the new and continuing plans, and we will also be communicating with you frequently in the coming months to help support you in answering member questions about this process. Please direct Medicaid managed care members with questions about the next generation program to the Resources for Individuals page or the Ohio Medicaid Consumer Hotline.

Resources to Help You Answer Member Questions

In addition, we wanted to provide you with some FAQs (see attached) to help you and your staff in responding to Ohio Medicaid managed care member questions related to 2021 Managed Care Annual Open Enrollment and the next generation managed care program to go-live in July 2022. If you receive questions not covered by this document that you’d like ODM to provide assistance in responding to, please contact

Thank you again for your continued support and collaboration. Together, we will realize our mission to focus on the individual and do better for the people we serve.


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