MyCare Ohio: Ohio 2026 Guide

MyCare Ohio is Ohio’s program for people who have both Medicare and Medicaid. The Next Generation MyCare program, which began on January 1, 2026 in the 29 original MyCare counties and reached every Ohio county on August 1, 2026, uses Medicare Advantage dual eligible special needs plans that are aligned with each member’s Medicaid plan, so one plan coordinates doctors, hospitals, prescriptions and long-term care. The program is overseen by the Ohio Department of Medicaid.

Below we cover the 2026 eligibility rules for MyCare Ohio, the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in Ohio. For the full statewide rules on income, assets, spouses and the look-back, see our Ohio Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What MyCare Ohio is

MyCare Ohio plans cover Medicaid benefits, including home and community-based waiver services and nursing home care, and coordinate them with Medicare. Each member has a care coordinator. Members who are dual eligible and 21 or older are generally enrolled in MyCare Ohio for Medicaid. For Medicare, members can choose the aligned MyCare plan or other Medicare coverage, although choosing the same plan for both gives the most coordination.

Programs for people who have both Medicare and Medicaid try to bring the two together, so one plan coordinates hospital care, doctors, prescriptions and long-term care. Federal policy now favors dual eligible special needs plans (D-SNPs) aligned with Medicaid plans. See Dual eligible special needs plans.

Who qualifies in 2026

To get MyCare Ohio, a person generally has to pass two separate tests, one about care need and one about money, and then receive an opening. In general, an applicant must:

• be 21 or older;
• have Medicare Part A, B and D, and full Ohio Medicaid;
• live in Ohio (the program has been statewide since August 1, 2026); and
• for waiver services, meet a nursing facility level of care and Ohio’s long-term care financial rules.

Financial rules. For MyCare Ohio, the Ohio Department of Medicaid applies the long-term care Medicaid rules for income and assets, generally the same ones used for nursing home care. Countable assets include bank accounts, investments and property other than the home, while the home, one car, personal belongings and certain burial funds are usually not counted. Gifts and below-value sales in the last 60 months are reviewed, and a transfer penalty can push back the start of services.

In 2026, Ohio’s income cap for long-term care is $2,982 a month, with a Qualified Income Trust above that. The single-person asset limit is $2,000.

For reference, these are Ohio’s key 2026 long-term care Medicaid figures:

Couples. Spousal impoverishment rules generally apply to waiver applicants in Ohio, protecting a share of assets and income for the spouse at home. The spousal allowance pages explain how these amounts are figured.

Services MyCare Ohio can cover

Services under MyCare Ohio are authorized through the plan of care and can include:

• Medicare hospital, doctor and prescription coverage (in the aligned plan)
• Medicaid benefits, including dental and vision extras
• care coordination
• home and community-based waiver services, including personal care, adult day, meals, home changes and assisted living
• nursing facility care
• behavioral health services

What is usually not covered. Waivers pay for care and support, not rent, food or other living costs, so in an assisted living or residential setting the person usually pays room and board from their own income. Plans of care are built around any unpaid help family already gives, and doctor, hospital and drug coverage continue separately.

How to apply for MyCare Ohio

The usual sequence for MyCare Ohio is below. Running the financial application and the care assessment in parallel can shorten the wait.

1. Apply for Ohio Medicaid through the state’s benefits website or the county Job and Family Services office.
2. If eligible, the state’s enrollment broker sends information about MyCare plans.
3. Choose a plan, and choose whether to also get Medicare through the same plan.
4. For waiver services, ask the plan’s care coordinator for a level of care assessment.
5. Services start under the plan’s care plan.

Staying organized. Copy every form before you send it and keep a simple call log. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.

Waiting lists and timing

There is no waiting list to enroll in MyCare Ohio. Waiver services inside MyCare are also available without a separate wait for people who meet the rules.

Starting the process early keeps options open if a wait develops. Stopgaps can include state plan home care, adult day centers, PACE where it operates and local aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

Because one plan covers both home care and nursing facility care, a member who moves into a nursing home under MyCare Ohio usually stays with the same plan. In a nursing home, the member pays most of their income toward care and keeps a small personal needs allowance.

Tips for families

Network matters: check whether each plan includes the providers you already rely on. Get a written copy of the care plan, and if services are reduced, get the decision in writing and note the appeal deadline. Gather five years of financial records early, and get advice before moving money, because the look-back still applies.

Many families find it worthwhile to talk with a Certified Medicaid Planner before applying for MyCare Ohio. A planner who knows Ohio’s rules can review income and assets, explain which program fits, map the timing against any waiting list, and help with the paperwork. Costs range widely, from about $150 to $600 an hour, about $500 to $6,000 for application help, and about $2,500 to $15,000 or more for full planning.

Related pages

• Ohio Medicaid guide
• Ohio PASSPORT Waiver
• Ohio Assisted Living Waiver
• Dual eligible special needs plans
• Dual eligibility
• Managed long-term services and supports
• Medicaid vs. Medicare

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.