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MyCare Ohio, Explained

A managed care program for Ohioans eligible for both Medicare and Medicaid, currently mid-restructuring.

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Short answer

A managed care program for Ohioans eligible for both Medicare and Medicaid that coordinates medical care, behavioral health, and long-term services and supports, including nursing facility and waiver services, through a single managed care plan.

Who it is for

MyCare Ohio serves people eligible for both Medicare and Medicaid, coordinating medical care, behavioral health, and long-term services and supports, including nursing facility and waiver services, through a single managed care plan.

Coverage area: MyCare Ohio's Northeast Ohio region covers all of Cuyahoga, Lake, Lorain, Medina, and Geauga counties, plus Summit and Portage counties, matching this site's full 7-county service area.
This program is actively changing. As of mid-2026, Ohio Medicaid was in the middle of a restructuring called Next Generation MyCare, with a first phase of counties transitioning effective January 1, 2026. Confirm current plan and county status directly with the Ohio Department of Medicaid before relying on program details, since this program is actively changing.

Source: Ohio Department of Medicaid: MyCare Ohio

How Cleveland families pay for care. Medicare does not cover assisted living. Ohio's long-term supports run through the Assisted Living Waiver, PASSPORT, and MyCare Ohio for dual-eligibles, none of which cover room and board in assisted living. Read the full explanation →

Questions Cleveland families ask

What actually happens during a state inspection of an assisted living facility in Ohio?

ODH surveyors conduct on-site inspections of licensed RCFs to check compliance with OAC 3701-16, reviewing records, observing care delivery, interviewing staff and residents, and checking the physical plant. Inspection findings and any resulting citations become part of the facility's licensing record, which families can review through the ODH Licensed Facilities, Services, and Program Search tool.

Are there minimum staffing rules for assisted living facilities in Ohio?

Staffing requirements are built into OAC 3701-16 and require facilities to maintain staff sufficient to meet residents' scheduled and unscheduled needs, though Ohio does not publish a single fixed resident-to-staff ratio for RCFs. Facilities must also ensure staff have training appropriate to residents' needs, including additional training obligations for staff working in a disclosed special care (memory care) unit.

Can a Cleveland assisted living resident get skilled nursing care without moving to a nursing home?

Yes, but only in a limited way. RCFs may provide skilled nursing services such as dressing changes, therapeutic diet supervision, and medication administration by licensed staff, capped at 120 days in any 12-month period under OAC 3701-16-02(D), unless the facility, resident, and physician agree in writing to extend it. Residents needing more than 8 hours a day of skilled nursing, ventilator support, or care for advanced pressure ulcers exceed what an RCF is licensed to provide.

Does Ohio's Medicaid expansion pay for a parent's assisted living or nursing home care?

No. Ohio's Medicaid expansion under the Affordable Care Act, effective January 1, 2014, covers adults age 19 to 64 up to 138 percent of the federal poverty level for acute and primary medical care. It's a completely separate pathway from the aged/blind/disabled Medicaid rules that govern nursing home and waiver eligibility for seniors. Long-term care coverage for seniors runs through Ohio's non-MAGI Medicaid rules, not the expansion population.

How does Ohio's Assisted Living Waiver work, and does it cover the full monthly bill?

The Assisted Living Waiver, administered by the Ohio Department of Aging through PASSPORT Administrative Agencies, pays for personal care and supportive services delivered inside a licensed Residential Care Facility for Medicaid-eligible adults 21 and older with a hands-on ADL need. It does not cover room and board; the resident pays that directly to the facility, capped at the SSI federal benefit rate minus a $50 personal needs allowance.

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