Ohio Department of Medicaid
Ohio Department of Medicaid is the state agency administering Ohio's Medicaid program, delivering healthcare coverage to more than 3 million Ohioans through seven managed care plans, a single pharmacy benefit manager, and 200,000+ healthcare providers.
- Company typePrivate
- Founded-
- HeadquartersColumbus, United States
- Headcount501–1,000
- GTM typeB2C
- OfferingServices
What Ohio Department of Medicaid does
Ohio Department of Medicaid (ODM) is the designated single state agency responsible for administering Ohio's Medicaid program under federal and state authority. The agency delivers healthcare coverage to more than 3 million Ohioans — including families, children, pregnant women, individuals with disabilities, and elderly beneficiaries — through a network of more than 200,000 healthcare providers and 2,600+ contracted pharmacies, making it Ohio's largest state agency by scope of service.
ODM operates the Next Generation Managed Care Program, under which seven managed care organizations (AmeriHealth Caritas Ohio, Anthem Blue Cross Blue Shield, Buckeye Health Plan, CareSource, Humana Healthy Horizons Ohio, Molina Healthcare of Ohio, and UnitedHealthcare Community Plan) provide coverage to approximately 90% of Medicaid members through capitation arrangements. Specialized programs include OhioRISE, a behavioral health managed care plan for children with complex needs operated by Aetna Better Health of Ohio, and the Next Generation MyCare program for dual Medicaid-Medicare eligible beneficiaries currently in Phase 2 rollout through August 2026. The core technology platform is the Ohio Medicaid Enterprise System (OMES), which includes the Provider Network Management (PNM) module operated by Maximus, a Single Pharmacy Benefit Manager (SPBM) operated by Gainwell Technologies, a Fiscal Intermediary for claims clearinghouse functions, an Electronic Data Interchange (EDI), the centralized Ohio|ID identity management system, and a HEDIS/CAHPS quality dashboard for accountability reporting.
The agency's funding derives from federal Medicaid matching funds and state budget appropriations; ODM does not sell products or services commercially. Operational priorities include reducing provider administrative burden through centralized credentialing and unified clinical policies, increasing program transparency through public dashboards, and addressing healthcare access and outcomes across the Medicaid population. Maureen Corcoran serves as Director under Governor Mike DeWine's administration, with the agency headquartered at 50 West Town Street, Columbus, Ohio.
Ohio Department of Medicaid firmographics
Firmographics- Name
- Ohio Department of Medicaid
- Legal name
- Ohio Department of Medicaid
- Website
- https://medicaid.ohio.gov
- Company type
- Private
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- Ohio Department of Medicaid is the state agency administering Ohio's Medicaid program, delivering healthcare coverage to more than 3 million Ohioans through seven managed care plans, a single pharmacy benefit manager, and 200,000+ healthcare providers.
- Ownership category
- akta.pro rank
Ohio Department of Medicaid industry classification
Industry- Product category
- Government Healthcare Administration
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000)
- akta.pro primary industry
- Managed Care Entity Administration for Medicaid (MCO/PHP/PIHP/PAHP) (HLAEAEAJ)
- akta.pro secondary industries
- Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH), Substance Use Disorder (SUD) Benefit Management (HLAEAHAF)
Keywords
Where Ohio Department of Medicaid is headquartered
LocationHeadquarters
- HQ city
- Columbus
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Ohio Department of Medicaid business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others
Revenue model
- Federal and State Medicaid Funding: Ohio Department of Medicaid is a government agency funded by federal and state government appropriations to administer Ohio's Medicaid program. ODM provides healthcare coverage funded through federal Medicaid matching funds and state budget allocations.
- Managed Care Capitation Payments: ODM pays managed care organization partners capitation payments for enrolled members. 90% of Medicaid members are covered by seven managed care organization partners.
Distribution channels8 records
Marketing channels12 records
Ohio Department of Medicaid product offering
Product offeringCore offering
Ohio Department of Medicaid (ODM) is the designated single state agency responsible for administering Ohio's Medicaid program, providing healthcare coverage to more than 3 million eligible Ohioans through a network of 200,000+ providers. The agency administers comprehensive medical, pharmacy, mental health, and substance use disorder services primarily through seven managed care organization partners (covering 90% of members), a Single Pharmacy Benefit Manager for pharmacy benefits, and fee-for-service options for non-managed care members. Specialized programs include OhioRISE for children with complex behavioral health needs and Next Generation MyCare for dual-eligible beneficiaries.
Product overview
Ohio Department of Medicaid operates a multi-component public health insurance program platform providing Medicaid coverage to over 3 million Ohioans through a network of more than 200,000 providers. The portfolio consists of a core Next Generation Managed Care Program (covering 90%+ of members across seven managed care plans) supplemented by a Single Pharmacy Benefit Manager (SPBM) Web Portal operated by Gainwell Technologies, which manages pharmacy benefits for both managed care and fee-for-service members through features including the Unified Preferred Drug List (UPDL), prior authorization workflows, and pharmacy directory searches. Specialized sub-products include OhioRISE (a behavioral health managed care plan for children with complex needs, administered by Aetna), the Next Generation MyCare Program (dual Medicaid-Medicare integration), the Provider Network Management (PNM) Module (centralized provider enrollment and credentialing), a HEDIS/CAHPS quality dashboard, a Drug Utilization Review (DUR) Program with prospective/retrospective/concurrent review phases, a Coordinated Services Program for controlled substance management, and a Fiscal Intermediary for claims processing. The P&T Committee and DUR Board provide clinical governance over drug coverage and utilization.
Differentiator
Problem solved
Functional benefit
Brands
- Single Pharmacy Benefit Manager (SPBM): Gainwell Technologies operates as the SPBM for Ohio Medicaid, administering pharmacy benefits for managed care members.
- OhioRISE
- Next Generation MyCare
Products and services
- Next Generation Managed Care Program Ohio Medicaid's redesigned managed care program delivering health coverage to more than 3 million Ohio residents (over 90% of members), emphasizing wellness, personalized care, transparency, and reduced provider administrative burden through consolidated systems and unified clinical policies.
- OhioRISE (Resilience through Integrated Systems and Excellence) A specialized Medicaid managed care plan for youth with complex behavioral health and multisystem needs (ages 0-20), administered by Aetna Better Health of Ohio, offering enhanced behavioral health services, care coordination, and a 1915(c) Home and Community Based Services waiver.
- Next Generation MyCare Program Enhanced healthcare program for Ohioans with both Medicaid and Medicare coverage, providing integrated benefits through a single plan with streamlined provider processes and clinical coverage policies.
- Single Pharmacy Benefit Manager (SPBM) Program Gainwell Technologies-operated pharmacy benefit management program for Ohio Medicaid managed care and fee-for-service members, providing drug coverage lookups, prior authorization submissions, pharmacy directory searches, claims management, and member eligibility inquiries across approximately 50,000 line items from nearly 600 therapeutic categories.
- OhioRISE 1915(c) Home and Community Based Services Waiver Home and Community Based Services Medicaid waiver within OhioRISE offering out-of-home respite, transitional services and supports, and secondary flex funds for qualifying children and youth with serious emotional disturbance diagnoses and documented functional impairment.
- Drug Utilization Review (DUR) Program
Quantifiable outcome
- More than 3 million Ohioans receive healthcare coverage through ODM
- +4 more outcomes
Companies that use Ohio Department of Medicaid
Customer profileNamed customers2 records
Segments5 records
Ideal customer profiles3 records
Ohio Department of Medicaid technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature8 records
Ohio Department of Medicaid partnerships and signals
Strategic signalPartnerships
14 partnerships are on record, tiered core and supporting.
- Gainwell TechnologiescoreGainwell Technologies serves as the Single Pharmacy Benefit Manager (SPBM) for Ohio Medicaid, processing pharmacy claims for both fee-for-service and managed care members. The company also provides the SPBM Web Portal, technical help desk support (833-491-0344), and handles prior authorizations, claims processing, and provider enrollment. Gainwell has contracted with more than 2,600 pharmacies across Ohio.
- AmeriHealth Caritas OhiocoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- Anthem Blue Cross Blue ShieldcoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- Buckeye Health PlancoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- CareSourcecoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- Humana Healthy Horizons OhiocoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- Molina Healthcare of OhiocoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- UnitedHealthcare Community PlancoreOne of seven managed care organizations providing Medicaid coverage to Ohio beneficiaries
- Aetna Better Health of OhiocoreAetna Better Health of Ohio serves as the OhioRISE managed care plan, providing specialized behavioral health services for children with complex needs enrolled in the OhioRISE program. Children receive behavioral health benefits through Aetna while physical health services come from a separate MCO or fee-for-service Medicaid.
- OptumcoreOptum serves as the clinical vendor for Ohio Medicaid's Pharmacy and Therapeutics (P&T) Committee, handling clinical comments and UPDL feedback from interested parties. Optum manages the Unified Preferred Drug List (UPDL) clinical criteria and processes rebate and financial information inquiries.
- MaximuscoreMaximus operates the Provider Network Management (PNM) module for Ohio Medicaid Enterprise Systems, which handles provider enrollment, credentialing, and provider data management.
- Myers and StauffersupportingProvides the Cost Reporting tool for enhanced tracking of turnaround times for claims and prior authorizations as part of Ohio Medicaid's provider tools.
- State Health and Human Services AgenciescoreODM collaborates with other state agencies including Ohio Department of Job and Family Services, Ohio Department of Mental Health and Addiction Services, and Ohio Department of Health to administer the Medicaid program and modernize services.
- Pharmacy NetworkcoreOver 2,600 contracted pharmacies across Ohio serve Medicaid members through the SPBM network, providing prescription drug coverage and pharmacy services.
Scale indicators5 records
Recent moves10 records
Expansion highlights6 records
Ohio Department of Medicaid competitors and assessment
Company assessmentDirect peers
- New York State Department of Health (NYSDOH) - Medicaid Program: Administers New York's Medicaid program covering over 7 million beneficiaries through managed care plans and a centralized pharmacy benefit program. Operates as a direct state Medicaid counterpart to ODM with comparable scope, MCO contracting, and waiver programs.
- Pennsylvania Department of Human Services (DHS) - Office of Medical Assistance Programs: Pennsylvania's state Medicaid agency (HealthChoices managed care program) covering over 3 million beneficiaries with comparable MCO structure and pharmacy benefit management. Direct state-level peer to ODM in managed care program design.
- Texas Health and Human Services Commission (HHSC): Administers Texas Medicaid and CHIP covering more than 4 million beneficiaries. Functions as a state Medicaid agency with managed care delivery and centralized pharmacy operations, structurally analogous to ODM's role in Ohio.
- Florida Agency for Health Care Administration (AHCA): Florida's state agency responsible for administering the Florida Medicaid program, including managed care plan oversight and a Statewide Medicaid Managed Care program. Comparable to ODM as a state Medicaid single agency with managed care contracts.
- Illinois Department of Healthcare and Family Services (HFS): Administers Illinois Medicaid (HFS Medical Programs) covering roughly 3.5 million beneficiaries with managed care and FFS components. State Medicaid agency comparable in scale and structure to ODM.
- California Department of Health Care Services (DHCS): California's single state Medicaid agency administering Medi-Cal to roughly 15 million beneficiaries — the largest Medicaid program in the U.S. Directly comparable to ODM as a state-level Medicaid administering agency with managed care contracts and pharmacy benefit programs.
Regional players
- Michigan Department of Health and Human Services (MDHHS) - Medicaid: Regional Midwest peer administering Michigan Medicaid to roughly 2.5 million beneficiaries through managed care plans. Comparable structure and regional policy alignment to ODM, though serving a different state.
Others
- Aetna Better Health of Ohio: Aetna's Ohio Medicaid managed care plan serving as the specialized OhioRISE behavioral health plan and one of Ohio's contracted MCOs. Operational channel partner to ODM rather than a peer agency.
- Gainwell Technologies: Core technology vendor to ODM operating the Single Pharmacy Benefit Manager (SPBM), provider portal, and claims processing infrastructure. A key operational dependency rather than a true peer — included because its performance is structurally tied to ODM's service delivery.
Broad incumbents
- Centers for Medicare & Medicaid Services (CMS): Federal agency that establishes the regulatory framework under which ODM operates, administers the federal Medicaid matching funds, and approves state plan amendments and waivers (e.g., 1915(c) HCBS waivers used by OhioRISE). Not a direct peer but the governing counterpart for ODM.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Ohio Department of Medicaid social profiles
Digital presenceOhio Department of Medicaid compliance and trust
Trust signalCompliance3 records
Ohio Department of Medicaid financial estimates
Financial estimateRevenue estimate
Valuation estimate
Ohio Department of Medicaid leadership team
Management profileNumber of profiles
Profiles1 record
Ohio Department of Medicaid funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Ohio Department of Medicaid M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Ohio Department of Medicaid
What does Ohio Department of Medicaid do?
Ohio Department of Medicaid (ODM) is the designated single state agency responsible for administering Ohio's Medicaid program, providing healthcare coverage to more than 3 million eligible Ohioans through a network of 200,000+ providers. The agency administers comprehensive medical, pharmacy, mental health, and substance use disorder services primarily through seven managed care organization partners (covering 90% of members), a Single Pharmacy Benefit Manager for pharmacy benefits, and fee-for-service options for non-managed care members. Specialized programs include OhioRISE for children with complex behavioral health needs and Next Generation MyCare for dual-eligible beneficiaries.
Is Ohio Department of Medicaid a public or private company?
Ohio Department of Medicaid is a private company. It is classified as state government owned and is currently operating.
When was Ohio Department of Medicaid founded?
Ohio Department of Medicaid was founded in -1. It employs 501 to 1,000 people.
Where is Ohio Department of Medicaid based?
Ohio Department of Medicaid is headquartered in Columbus, United States, in the North America region.
How does Ohio Department of Medicaid make money?
Two revenue lines are on record. Federal and State Medicaid Funding is the primary driver. The others are managed Care Capitation Payments.
Who are Ohio Department of Medicaid's main competitors?
Direct peers on record are New York State Department of Health (NYSDOH) - Medicaid Program, Pennsylvania Department of Human Services (DHS) - Office of Medical Assistance Programs, Texas Health and Human Services Commission (HHSC), Florida Agency for Health Care Administration (AHCA), Illinois Department of Healthcare and Family Services (HFS) and California Department of Health Care Services (DHCS). Michigan Department of Health and Human Services (MDHHS) - Medicaid is listed as a regional player. Others are Aetna Better Health of Ohio and Gainwell Technologies. Centers for Medicare & Medicaid Services (CMS) is listed as a broad incumbent.
Does Ohio Department of Medicaid have an API?
No public API is recorded for Ohio Department of Medicaid.
What industry is Ohio Department of Medicaid in?
Ohio Department of Medicaid's product category is Government Healthcare Administration. Its primary akta.pro industry code is HLAEAEAJ, Managed Care Entity Administration for Medicaid (MCO/PHP/PIHP/PAHP), with a secondary code of BPAIAKAH, Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage). Its SIC code is 6324.