The Next Generation Medicaid program in Ohio will launch in phases throughout 2022. This phased approach will help ensure continuity of care, limit confusion, honor member choice and reduce potential complexities tied to the anticipated end of the federal public health emergency.
On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems.
On October 1, 2022, Gainwell Technologies, the Single Pharmacy Benefit Manager (SPBM), will begin providing pharmacy services across all managed care plans and for all members.
Also on October 1, ODM will launch the Provider Network Management (PNM) module and Centralized Credentialing, which will reduce administrative burden on providers.
To prepare for these changes, providers should set up their OH|ID and associate their existing accounts. Through September 23, you can access the
OH|ID Pre-registration site. The OH|ID is necessary for anyone that will access the PNM or SPBM modules. Establishing login credentials during pre-registration will ease the transition and prevent disruptions to system access for providers ahead of the October 1 launch.
In preparation for the launch of the PNM and SPBM, ODM is offering a variety of trainings. These trainings are a great opportunity for providers to gain knowledge that will benefit our members.
Learn about available PNM and SPBM trainings
During the last three months of 2022, ODM will complete the launch of its Next Generation Medicaid program. That means Medicaid recipients in Ohio can choose Humana Healthy Horizons® in Ohio as their health plan.
ODM will send notices to providers about learning and training opportunities on various aspects of the Next Generation Program either via the mail and/or through announcements on the ODM website.
Humana Healthy Horizons has served Medicaid populations continuously for more than 2 decades and currently manages Medicaid benefits for nearly 800,000 members nationally. We developed expertise providing care management, care planning, and specialized clinical management for the complex needs of members within a social supports‐based framework.
We also developed significant expertise in integrating physical health, behavioral health, pharmacy and social services and supports for a whole-person centered approach to improve the health and well‐being of our members and the communities we serve.
In Ohio, Humana already serves 568,000 residents through Medicare Advantage, Medicare prescription drug plans, commercial employer-sponsored plans, commercial dental and vision coverage, and TRICARE.
By working closely with our providers, we can help our members in Ohio:
- Develop strong relationships with their primary care provider
- Get the right care in the right place at the right time
- Set and reach health goals
Once ODM completes implementation of its Next Generation Medicaid program, Humana Healthy Horizons in Ohio will administer care focused on Temporary Assistance for Needy Families, Expansion, and Assisted, Blind, and Disabled populations in the west, northeast, and central/southeast regions.
For additional information about joining our network:
Call: 877-856-5707, Monday – Friday, 8 a.m. – 6 p.m., Eastern time
Nationally, we serve Medicaid members through:
- Medicaid Managed Care (MMC)
- Managed Long-term Services and Supports (MLTSS) programs
- Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative Dual Demonstrations
- Medicare Advantage (MA)
- Dual Special Needs Plans (D-SNPs)
- Prescription drug plans (PDPs)
Humana Healthy Horizons in Ohio is a Medicaid product of Humana Health Plan of Ohio Inc.