OH MEDICAID MARKET
Ohio
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No current verified signal
Precapture is monitoring this market. No state-specific public intelligence item is currently published.
Plans in market
Plans in market 7
- AmeriHealth Caritas Ohio, Inc. · Next Generation Medicaid managed care · incumbent · source · as of 2026-10-25
- Anthem Blue Cross and Blue Shield · Next Generation Medicaid managed care · incumbent · source · as of 2026-10-25
- Buckeye Health Plan · Next Generation Medicaid managed care · incumbent · source · as of 2026-10-25
- CareSource Ohio, Inc. · Next Generation Medicaid managed care · incumbent · source · as of 2026-10-25
- Humana Healthy Horizons in Ohio · Next Generation Medicaid managed care · incumbent · source · as of 2026-10-25
Plans in this market
Parent, plan, and program come from the plan graph. Enrollment and share use the latest CMS reported count. Operations counts are CMS MCPAR. A dollar amount is not on this page.
Plans in this market 31
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| Independence Blue Cross | AmeriHealth | not reported | 142,802 (2024) | 5.4% calculated | 11 sanctions, 570 appeals resolved |
| CVS/Aetna | Aetna | not reported | 10,076 (2017) | 21.7% calculated | not reported |
| CVS/Aetna | Aetna | not reported | 16,261 (2024) | 19.1% calculated | not reported |
| CVS/Aetna | Aetna Better Health of Ohio | not reported | 11,117 (2018) | 20.8% calculated | not reported |
| CVS/Aetna | Aetna Better Health of Ohio | not reported | 10,882 (2021) | 18.9% calculated | 11 sanctions, 2,512 appeals resolved |
show all 31
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| CareSource | CareSource | not reported | 17,858 (2024) | 21.0% calculated | 12 sanctions, 19,067 appeals resolved |
| Centene | Buckeye Community Health Plan | not reported | 14,897 (2024) | 17.5% calculated | not reported |
| Centene | Buckeye Health Plan | not reported | 8,395 (2017) | 18.1% calculated | not reported |
| Centene | Buckeye Health Plan | not reported | 420,418 (2021) | 15.4% calculated | 13 sanctions, 2,882 appeals resolved |
| Centene | Buckeye Health Plan | not reported | 308,783 (2019) | 13.4% calculated | not reported |
| Elevance | Anthem | not reported | 209,166 (2024) | 7.9% calculated | 11 sanctions, 3,084 appeals resolved |
| Humana | Humana | not reported | 155,380 (2024) | 5.9% calculated | 7 sanctions, 468 appeals resolved |
| not reported | McGregor PACE | not reported | 664 (2024) | 100.0% calculated | not reported |
| Molina | Molina | not reported | 317,235 (2017) | 12.7% calculated | not reported |
| Molina | Molina Healthcare of Ohio, Inc. | not reported | 292,128 (2018) | 12.2% calculated | not reported |
| Molina | Molina Healthcare of Ohio, Inc. | not reported | 15,569 (2024) | 18.3% calculated | 15 sanctions, 5,225 appeals resolved |
| not reported | Paramount Advantage | not reported | 253,538 (2022) | 9.0% calculated | 3 sanctions, 459 appeals resolved |
| not reported | Paramount Advantage | not reported | 247,411 (2021) | 9.1% calculated | not reported |
| UnitedHealth | United Healthcare Community Plan of Ohio | not reported | 296,714 (2017) | 11.8% calculated | not reported |
| UnitedHealth | United Healthcare Community Plan of Ohio | not reported | 9,519 (2017) | 20.5% calculated | not reported |
| UnitedHealth | UnitedHealthcare Community Plan of Ohio, Inc. | not reported | 20,442 (2024) | 24.0% calculated | 34 sanctions, 4,344 appeals resolved |
| UnitedHealth | UnitedHealthcare Community Plan of Ohio, Inc. | not reported | 297,276 (2024) | 11.3% calculated | not reported |
| not reported | Aetna | not reported | 9,201 (2016) | 22.1% calculated | not reported |
| not reported | Buckeye Health Plan | not reported | 7,714 (2016) | 18.5% calculated | not reported |
| not reported | CareSource | not reported | 1,290,080 (2016) | 53.5% calculated | not reported |
| not reported | McGregor PACE | not reported | 388 (2016) | 100.0% calculated | not reported |
| not reported | McGregor PACE | not reported | 454 (2018) | 100.0% calculated | not reported |
| not reported | Molina | not reported | 7,562 (2016) | 18.1% calculated | not reported |
| not reported | Molina Healthcare of Ohio | not reported | 313,922 (2016) | 13.0% calculated | not reported |
| not reported | Paramount Advantage | not reported | 236,561 (2016) | 9.8% calculated | not reported |
| not reported | United Healthcare Community Plan of Ohio | not reported | 7,827 (2016) | 18.8% calculated | not reported |
CMS reported enrollment
CMS reporting years in this file run from 2016 through 2024. Retrieved 2026-11-01. The latest reporting year is 2024, which is behind the retrieval date. Enrollment figures are the CMS cell for that reporting year. Share is calculated from CMS reported total enrollment for that state, program, and year. Precapture does not combine rows. A year missing from a trend was not reported. A plan and region with more than one CMS row in a year has no trend and no year-over-year change. The dataset says a reported 0 may not truly represent 0 when a state suppressed a small count. CMS reported.
Medicaid Managed Care (Comprehensive MCO)
Medicaid Managed Care (Comprehensive MCO) 6
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Buckeye Health Plan | Centene Corporation | Centene | Statewide | not reported | not reported | not reported | not reported | 2016: 293,319; 2017: 307,382 |
| CareSource | CareSource | CareSource | Statewide | not reported | not reported | not reported | not reported | 2016: 1,290,080; 2017: 1,337,992 |
| Molina Healthcare of Ohio | not reported | unmatched | Statewide | not reported | not reported | not reported | not reported | 2016: 313,922 |
| Molina | Molina | Molina | Statewide | not reported | not reported | not reported | not reported | 2017: 317,235 |
| Paramount Advantage | ProMedica | Promedica | Statewide | not reported | not reported | not reported | not reported | 2016: 236,561; 2017: 245,275 |
show all 6
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| United Healthcare Community Plan of Ohio | UnitedHealthCare | UnitedHealth | Statewide | not reported | not reported | not reported | not reported | 2016: 279,230; 2017: 296,714 |
MyCare Ohio Opt-Out Program (Comprehensive MCO + MLTSS)
MyCare Ohio Opt-Out Program (Comprehensive MCO + MLTSS) 16
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health of Ohio | Aetna, Inc. | CVS/Aetna | Central, Northwest, Southwest | not reported | not reported | not reported | not reported | 2018: 11,117; 2019: 12,441 |
| Aetna Better Health of Ohio | Aetna, Inc. | CVS/Aetna | Northwest, Southwest, Central | not reported | not reported | not reported | not reported | 2020: 12,592 |
| Aetna Better Health of Ohio | Aetna, Inc. | CVS/Aetna | Northwest, Southwest, and Central regions | not reported | not reported | not reported | not reported | 2021: 10,882 |
| Aetna | Aetna, Inc. | CVS/Aetna | Northwest, Southwest, Central | CMS reported 16,261 (2024) | 19.1% | +1,189 (+7.9%) | +0.5 pts | 2022: 28,469; 2023: 15,072; 2024: 16,261 |
| Buckeye Community Health Plan | Centene Corporation | Centene | Northeast, Northwest, West Central | CMS reported 14,897 (2024) | 17.5% | -468 (-3.0%) | -1.5 pts | 2022: 28,410; 2023: 15,365; 2024: 14,897 |
show all 16
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Buckeye Health Plan | Centene Corporation | Centene | Northeast, Northwest, West Central | not reported | not reported | not reported | not reported | 2018: 9,647; 2019: 10,908; 2020: 11,841 |
| Buckeye Health Plan | Centene Corporation | Centene | Northeast, Northwest, and West Central regions | not reported | not reported | not reported | not reported | 2021: 10,739 |
| CareSource | CareSource | CareSource | East Central, Northeast, Northeast Central | not reported | not reported | not reported | not reported | 2018: 11,233; 2019: 12,428 |
| CareSource | CareSource | CareSource | Northeast, Northeast Central, East Central | CMS reported 17,858 (2024) | 21.0% | +1,693 (+10.5%) | +1.0 pts | 2020: 12,841; 2022: 33,287; 2023: 16,165; 2024: 17,858 |
| CareSource | CareSource | CareSource | Northeast, Northeast Central, and East Central regions | not reported | not reported | not reported | not reported | 2021: 11,601 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | Central, Southwest, West Central | not reported | not reported | not reported | not reported | 2018: 9,531; 2019: 10,780 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | Southwest, Central, West Central | CMS reported 15,569 (2024) | 18.3% | +888 (+6.0%) | +0.2 pts | 2020: 11,330; 2022: 28,922; 2023: 14,681; 2024: 15,569 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | Southwest, Central, and West Central regions | not reported | not reported | not reported | not reported | 2021: 9,906 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare | UnitedHealth | East Central, Northeast, Northeast Central | not reported | not reported | not reported | not reported | 2018: 11,880; 2019: 14,231 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare | UnitedHealth | Northeast, Northeast Central, East Central | CMS reported 20,442 (2024) | 24.0% | +820 (+4.2%) | -0.2 pts | 2020: 15,507; 2022: 28,689; 2023: 19,622; 2024: 20,442 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare | UnitedHealth | Northeast, Northeast Central, and East Central regions | not reported | not reported | not reported | not reported | 2021: 14,322 |
MyCare Ohio Opt-out (Comprehensive MCO + MLTSS)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Aetna | Aetna | CVS/Aetna | Central, Northwest, Southwest Regions | not reported | not reported | not reported | not reported | 2016: 9,201; 2017: 10,076 |
| Buckeye Health Plan | Centene | Centene | Northeast, Northwest, West Central Regions | not reported | not reported | not reported | not reported | 2016: 7,714; 2017: 8,395 |
| CareSource | CareSource | CareSource | East Central, Northeast, Northeast Central Regions | not reported | not reported | not reported | not reported | 2016: 9,420; 2017: 10,075 |
| Molina | Molina | Molina | Central, Southwest, West Central Regions | not reported | not reported | not reported | not reported | 2016: 7,562; 2017: 8,299 |
| United Healthcare Community Plan of Ohio | United Healthcare Community | UnitedHealth | East Central, Northeast, Northeast Central Regions | not reported | not reported | not reported | not reported | 2016: 7,827; 2017: 9,519 |
Ohio Medicaid Managed Care Program (Comprehensive MCO)
Ohio Medicaid Managed Care Program (Comprehensive MCO) 19
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| AmeriHealth | AmeriHealth | AmeriHealth | Statewide | CMS reported 142,802 (2024) | 5.4% | +61,675 (+76.0%) | +2.7 pts | 2023: 81,127; 2024: 142,802 |
| Anthem | Anthem | Elevance | Statewide | CMS reported 209,166 (2024) | 7.9% | -43,794 (-17.3%) | -0.5 pts | 2023: 252,960; 2024: 209,166 |
| Buckeye Community Health Plan | Centene Corporation | Centene | Statewide | CMS reported 364,914 (2024) | 13.9% | -82,947 (-18.5%) | -1.1 pts | 2023: 447,861; 2024: 364,914 |
| Buckeye Community Health Plan | Centene Corporation | Centene | – | not reported | not reported | not reported | not reported | 2022: 439,412 |
| Buckeye Health Plan | Centene Corporation | Centene | Statewide | not reported | not reported | not reported | not reported | 2018: 307,779; 2021: 420,418 |
show all 19
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Buckeye Health Plan | Centene Corporation | Centene | West, Northeast, Central/Southeast | not reported | not reported | not reported | not reported | 2019: 308,783; 2020: 371,043 |
| CareSource | CareSource | CareSource | Statewide | CMS reported 1,191,420 (2024) | 45.2% | -230,763 (-16.2%) | -2.2 pts | 2018: 1,254,635; 2021: 1,381,417; 2023: 1,422,183; 2024: 1,191,420 |
| CareSource | CareSource | CareSource | West, Northeast, Central/Southeast | not reported | not reported | not reported | not reported | 2019: 1,202,431; 2020: 1,274,938 |
| CareSource | CareSource | CareSource | – | not reported | not reported | not reported | not reported | 2022: 1,425,286 |
| Humana | Humana | Humana | Statewide | CMS reported 155,380 (2024) | 5.9% | +68,841 (+79.5%) | +3.0 pts | 2023: 86,539; 2024: 155,380 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | Statewide | CMS reported 272,830 (2024) | 10.4% | -68,530 (-20.1%) | -1.0 pts | 2018: 292,128; 2021: 325,478; 2023: 341,360; 2024: 272,830 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | West, Northeast, Central/Southeast | not reported | not reported | not reported | not reported | 2019: 276,396; 2020: 300,835 |
| Molina Healthcare of Ohio, Inc. | Molina Healthcare, Inc. | Molina | – | not reported | not reported | not reported | not reported | 2022: 334,195 |
| Paramount Advantage | ProMedica | Promedica | – | not reported | not reported | not reported | not reported | 2022: 253,538 |
| Paramount Advantage | Promedica | Promedica | Statewide | not reported | not reported | not reported | not reported | 2018: 244,867; 2021: 247,411 |
| Paramount Advantage | Promedica | Promedica | West, Northeast | not reported | not reported | not reported | not reported | 2019: 242,669; 2020: 215,708 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare, Inc. | UnitedHealth | Statewide | CMS reported 297,276 (2024) | 11.3% | -70,539 (-19.2%) | -1.0 pts | 2018: 296,760; 2021: 350,060; 2023: 367,815; 2024: 297,276 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare, Inc. | UnitedHealth | West, Northeast, Central/Southeast | not reported | not reported | not reported | not reported | 2019: 279,975; 2020: 347,751 |
| UnitedHealthcare Community Plan of Ohio, Inc. | UnitedHealthcare, Inc. | UnitedHealth | – | not reported | not reported | not reported | not reported | 2022: 362,126 |
Ohio PACE (Program of All-inclusive Care for the Elderly (PACE))
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| McGregor PACE | McGregor PACE | McGregor PACE | Cuyahoga County | not reported | not reported | not reported | not reported | 2016: 388; 2018: 454; 2020: 617 |
| McGregor PACE | McGregor PACE | McGregor PACE | Cuyahoga county | not reported | not reported | not reported | not reported | 2019: 543; 2021: 657 |
Ohio Program of All-Inclusive Care for the Elderly (Ohio PACE)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| McGregor PACE | McGregor PACE | McGregor PACE | Cuyahoga County | not reported | not reported | not reported | not reported | 2022: 651 |
Ohio Program of All-Inclusive Care for the Elderly (PACE)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| McGregor PACE | McGregor PACE | McGregor PACE | Cuyahoga County | CMS reported 664 (2024) | 100.0% | +24 (+3.8%) | 0.0 pts | 2023: 640; 2024: 664 |
PACE (Program of All-inclusive Care for the Elderly) (Program of All-inclusive Care for the Elderly (PACE))
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| McGregor PACE | McGregor PACE | McGregor PACE | Cuyahoga County | not reported | not reported | not reported | not reported | 2017: 416 |
Plan operations (CMS MCPAR)
Counts, rates, dates, and status are the CMS MCPAR cells for that plan, program, and reporting year. The appeal rate is calculated from CMS reported appeals resolved in favor of the enrollee divided by CMS reported appeals resolved. It is not a CMS-published rate. A plan links when the name matches one enrollment plan in that same state and program. Unmatched is shown and is not guessed. A sanction amount is not on this page. Retrieved 2026-11-02. CMS MCPAR.
National plan operations · Federal compliance deadlines
Appeals, grievances, and enrollment share (2024)
Appeals, grievances, and enrollment share (2024) 14
| Plan | Parent | Program | Appeals resolved | In favor of enrollee | Appeal rate | Grievances resolved | Medicaid enrollment share | Managed care enrollment share |
|---|---|---|---|---|---|---|---|---|
| Aetna Better Health of Ohio | CVS/Aetna | MyCare Ohio 12/27/2024 | 1,240 | 664 | 53.5% calculated | 1,340 | 20% | 20% |
| Buckeye Health Plan | Centene | MyCare Ohio 12/27/2024 | 211 | 73 | 34.6% calculated | 1,554 | 18.2% | 18.2% |
| CareSource Ohio, Inc. | CareSource | MyCare Ohio 12/27/2024 | 816 | 409 | 50.1% calculated | 2,038 | 22.7% | 22.7% |
| Molina Healthcare of Ohio | Molina | MyCare Ohio 12/27/2024 | 1,199 | 508 | 42.4% calculated | 2,660 | 19.4% | 19.4% |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | MyCare Ohio 12/27/2024 | 429 | 256 | 59.7% calculated | 725 | 19.7% | 19.7% |
show all 14
| Plan | Parent | Program | Appeals resolved | In favor of enrollee | Appeal rate | Grievances resolved | Medicaid enrollment share | Managed care enrollment share |
|---|---|---|---|---|---|---|---|---|
| AmeriHealth Caritas of Ohio | AmeriHealth | Ohio Medicaid Managed Care | 493 | 135 | 27.4% calculated | 823 | 3.6% | 4.1% |
| Anthem Blue Cross and Blue Shield | Elevance | Ohio Medicaid Managed Care | 2,603 | 1,798 | 69.1% calculated | 3,306 | 7.4% | 8.4% |
| Buckeye Health Plan | Centene | Ohio Medicaid Managed Care | 1,294 | 441 | 34.1% calculated | 25,971 | 12.5% | 14.2% |
| CareSource Ohio, Inc. | CareSource | Ohio Medicaid Managed Care | 7,812 | 1,621 | 20.8% calculated | 7,927 | 41.8% | 47.3% |
| Humana Healthy Horizons | Humana | Ohio Medicaid Managed Care | 368 | 136 | 37.0% calculated | 529 | 3.9% | 4.4% |
| Molina Healthcare of Ohio | Molina | Ohio Medicaid Managed Care | 1,140 | 623 | 54.6% calculated | 10,370 | 9.1% | 10.3% |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Ohio Medicaid Managed Care | 1,613 | 443 | 27.5% calculated | 18,519 | 9.9% | 11.2% |
| Gainwell Technologies | unmatched | Ohio Single Pharmacy Benefit Manager | 12,441 | 7,516 | 60.4% calculated | 567 | 88.2% | 100% |
| Aetna Better Health of Ohio, Inc. | CVS/Aetna | OhioRISE | 63 | 20 | 31.7% calculated | 293 | 0.9% | 1.1% |
Sanctions (2024)
Sanctions (2024) 79
| Plan | Parent | Topic | Date | Corrective action plan | Remediation status |
|---|---|---|---|---|---|
| Aetna Better Health of Ohio | CVS/Aetna | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Aetna Better Health of Ohio | CVS/Aetna | Other, specify (Network Adequacy Standards) | 2024-05-28 | Yes | Remediation in progress |
| Buckeye Health Plan | Centene | Other, specify (Implementation of Rate Changes) | 2024-04-09 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Other, specify (HEDIS/CAHPS Requirements) | 2024-03-22 | Yes | Remediation in progress |
show all 79
| Plan | Parent | Topic | Date | Corrective action plan | Remediation status |
|---|---|---|---|---|---|
| Buckeye Health Plan | Centene | Performance improvement (N/A) | 2024-01-03 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Other, specify (Implementation of Rate Changes) | 2024-04-09 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Performance improvement (N/A) | 2024-01-03 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Performance improvement | 2023-07-07 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Reporting | 2023-11-06 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Financial issues | 2023-07-20 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Standards) | 2024-03-04 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Reporting | 2023-11-09 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Late Deliverable/s) | 2023-07-13 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (HEDIS/CAHPS Requirements) | 2024-03-22 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Requirements) | 2024-05-28 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Standards) | 2023-07-27 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Performance improvement (N/A) | 2023-10-31 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Standards) | 2023-12-04 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (late deliverable/s) | 2023-11-07 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (Key staff requirements) | 2024-02-01 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (Network adequacy standards) | 2023-08-15 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (Network Adequacy Standards) | 2024-03-12 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Reporting | 2024-04-18 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (Delegation Requirements) | 2024-05-03 | Yes | Yes, remediated |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Remediation in progress |
| AmeriHealth Caritas of Ohio | AmeriHealth | Other, specify (late deliverable/s) | 2023-10-19 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (key staff requirements) | 2024-02-01 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (Network Adequacy Standards) | 2024-03-12 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (Network adequacy standards) | 2023-08-15 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (HEDIS/CAHPS requirements) | 2024-03-22 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Financial issues | 2024-04-24 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (Delegation Requirements) | 2024-05-02 | Yes | Yes, remediated |
| Anthem Blue Cross and Blue Shield | Elevance | Reporting | 2024-05-14 | Yes | Remediation in progress |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Remediation in progress |
| Anthem Blue Cross and Blue Shield | Elevance | Other, specify (state hearing requirements) | 2023-10-27 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Other, specify (Network Adequacy Standards) | 2024-03-12 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Other, specify (HEDIS/CAHPS requirements) | 2024-03-22 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Other, specify (Implementation of Rate Changes) | 2024-04-09 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Buckeye Health Plan | Centene | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Remediation in progress |
| CareSource Ohio, Inc. | CareSource | Other, specify (Network adequacy standards) | 2023-12-04 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Other, specify (late deliverable/s) | 2023-12-06 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Other, specify (HEDIS/CAHPS requirements) | 2024-03-22 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Other, specify (Delegation requirements) | 2024-04-04 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Other, specify (Implementation of Rate Changes) | 2024-04-09 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| CareSource Ohio, Inc. | CareSource | Financial issues | 2024-05-29 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Financial issues (N/A) | 2023-08-02 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Other, specify (Network Adequacy Standards) | 2024-03-12 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Other, specify (Implementation of Rate Changes) | 2024-04-09 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Other, specify (Network adequacy standards) | 2023-08-15 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Yes, remediated |
| Humana Healthy Horizons | Humana | Other, specify (late deliverable/s) | 2023-10-19 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Other, specify (Network adequacy standards) | 2023-12-04 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Other, specify (Key staff requirements) | 2024-02-01 | Yes | Remediation in progress |
| Molina Healthcare of Ohio | Molina | Other, specify (Network Adequacy Standards) | 2024-03-12 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Other, specify (Network adequacy standards) | 2023-08-15 | Yes | Yes, remediated |
| Molina Healthcare of Ohio | Molina | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Remediation in progress |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (late deliverable/s) | 2023-11-07 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Financial issues (N/A) | 2023-11-09 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network adequacy standards) | 2023-12-04 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Claims Dispute Requirements) | 2023-12-05 | Yes | Remediation in progress |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Financial issues | 2024-01-23 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Performance improvement | 2024-03-21 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (HEDIS/CAHPS requirements) | 2024-03-22 | Yes | Remediation in progress |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Performance improvement | 2024-04-29 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Standards) | 2024-05-01 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network Adequacy Standards) | 2024-06-07 | Yes | Yes, remediated |
| UnitedHealthcare Community Plan of Ohio | UnitedHealth | Other, specify (Network adequacy standards) | 2023-09-14 | Yes | Yes, remediated |
| Gainwell Technologies | unmatched | Other, specify (HIPAA/Privacy) | 2023-08-22 | Yes | Yes, remediated |
| Gainwell Technologies | unmatched | Other, specify (Failure to follow Ohio Administrative Code rule for Prior Authorizations) | 2023-09-28 | Yes | Remediation in progress |
Award history
- Next Generation MC RFA: awarded. A May 19, 2022 Joint Medicaid Oversight Committee timeline says the managed care RFA was posted September 30, 2020, and that on April 9, 2021 ODM announced six Next Generation MCOs. That announcement line does not print the six names. On April 23, 2021, Buckeye and Paramount protests were initiated. On July 13, 2021, Paramount filed a Franklin County complaint seeking an injunction of implementation. On August 12, 2021, ODM announced Buckeye joining the Next Generation MCOs for a total of seven. On February 15, 2022, the timeline says Paramount dropped the appeal of the trial court decision. The same deck schedules Next Generation readiness reviews for United Healthcare Community Plan of Ohio, Molina Healthcare of Ohio, Anthem Blue Cross and Blue Shield, Humana Health Plan of Ohio, CareSource Ohio, Buckeye, and AmeriHealth Caritas Ohio, and says Humana, AmeriHealth, and Anthem begin to provide services. It does not print evaluation scores or a contract end date.
Retrieved 2026-11-03. Sources and scores
Early procurement signals
No official early-procurement document has been retrieved for this state. This is not a finding that no signal exists. Early signals
Contract amendments
No official Medicaid managed-care contract amendment has been retrieved for this state. This is not a finding that no amendment exists. Contract amendments
Medicaid policy
Indiana rows are official policy instruments. Other states show only Federal Register notices of hearings on SPA disapprovals, which are a narrow slice and not waiver or SPA coverage.
Federal Register notices of hearings on SPA disapprovals are read from the Federal Register JSON API. That covers no approved SPAs, waivers, or section 1115 demonstrations.
Coverage not_collected.
No official Medicaid managed-care policy instrument has been retrieved for this state. This is not a finding that no waiver, state plan amendment, or rule exists. Medicaid policy
Federal Register SPA disapproval hearing notices (2015 or later): 0
Plan financials
No official Medicaid plan financial filing has been retrieved for this state. This is not a finding that no filing exists, and it is not a zero. Plan financials. Coverage: not_collected.
Federal compliance deadlines
Cited federal Medicaid managed care deadlines, with the Federal Register citation, the effective date, the compliance date, and the plan obligation.