- Medicaid
- Home- and Community-Based Services
Home- and community-based services (HCBS) allow Ohioans covered by Medicaid to get healthcare services and support in their own home or community instead of in a nursing home, hospital, or other long-term care facility. Ohio Department of Medicaid (Ohio Medicaid) and Ohio Department of Aging (ODA) administer and operate four HCBS waiver programs serving older adults and people with disabilities. Each program gives enrollees control over their care while remaining in their communities.
The dropdowns below provide information on current HCBS nursing facility waiver programs in Ohio, eligibility, enrollment, and other key resources. To expand all dropdowns and read the information, please click the “Expand All Sections” button. For a printable document containing the information provided below, please reference HCBS Nursing Facility Level of Care Waiver Programs.
HCBS Nursing Facility Waivers
The four HCBS nursing facility waiver programs offered in Ohio are listed below, along with links to the associated Ohio Administrative Code (OAC) chapter about the program.
ODA-operated waiver services
- Assisted Living serves people aged 21 and older who live in an ODA certified licensed residential care facility.
- OAC Chapter 5160-33.
- PASSPORT serves people aged 65 and older and people with physical disabilities aged 60-64. Services are provided in the home instead of a nursing home.
- OAC Chapter 5160-31.
Ohio Medicaid-operated waiver services
- MyCare Ohio serves people aged 18 and older who meet a hospital or nursing level of care. Managed care plans provide these services. MyCare Ohio is only available in certain counties. For a list of managed care plans available in MyCare counties, please visit MyCare Ohio FAQ.
- OAC Chapter 5160-58.
- Ohio Home Care Waiver serves people aged 0-59 with physical disabilities in the home.
- OAC Chapter 5160-46.
For overall information on Ohio Medicaid-administered waiver programs, such as definitions, an individual’s rights and responsibilities, provider enrollment, and other key resources, please see OAC Chapter 5160-45.
Waiver Eligibility
Nursing Facility Waiver Eligibility
All HCBS nursing facility waiver programs in Ohio require individuals to:
- Meet Medicaid eligibility criteria or be enrolled in Medicaid.
- For information on Medicaid eligibility criteria, visit the Medicaid Qualifications page.
- For information on how to enroll in Medicaid, follow this step-by-step guide.
- Meet a nursing facility level of care (LOC).
- For information on the conditions for meeting nursing facility LOC please refer to the "Level of Care" section below.
- Meet all waiver program eligibility requirements.
- Assisted Living: OAC Rule 5160-33-03.
- PASSPORT: OAC Rule 5160-31-03.
- MyCare Ohio: OAC Rule 5160-58-02.
- Ohio Home Care Waiver: OAC Rule 5160-46-02.
- Need and use at least one waiver service monthly.
- Agree to participate in the person-centered planning process.
In addition, services offered in the programs can meet health-related needs in ways that are safe for the enrollee while in a community setting instead of an institution or facility.
Level of Care
Level of care (LOC) is an evaluation of an individual’s physical, mental, social, and emotional status. LOC is used as one component to determine eligibility for certain Medicaid programs. To meet a nursing facility LOC, the following conditions must be met:
- Intermediate or skilled LOC; the person has a need for assistance with activities of daily living and/or taking medications. The person may need skilled nursing or rehabilitation services.
- Services are an alternative to institutional care.
A detailed description of the requirements for meeting a nursing facility LOC can be found in OAC Rule 5160-3-08.
Nursing Facility Waiver Comparison
The following section provides a high-level comparison of the HCBS nursing facility waivers in Ohio.
For a detailed comparison of all HCBS waivers in Ohio (including developmental disabilities waivers), please reference the HCBS Waiver Comparison Chart. For additional information on the number of individuals enrolled in HCBS waivers in Ohio, please visit HCBS Waiver Program Enrollment Numbers.
Assisted Living
Overview
- The Assisted Living Waiver is provided in a community-based residential facility. Individuals pay for their room and board. Services help with daily needs, nursing, meals, and social activity.
Eligibility
- Have a nursing facility LOC.
- Aged 21-64 with a physical disability; aged 65 or older.
- Can make room and board payments.
- Live in a residential care facility licensed by the Ohio Department of Health.
Administration and Case Management
- Operated by ODA.
- Case management provided by PASSPORT Administrative Agencies (PAAs).
Services Offered
Below is a list of services offered under the Assisted Living Waiver. Please refer to the linked OAC rule for additional information on the service.
- Assisted living, OAC Rule 173-39-02.16.
- Community transition, OAC Rule 5160-44-26.
PASSPORT
Overview
• The PASSPORT Waiver helps Ohioans ages 60 years and older to get services and supports they need to stay in their homes or other community settings, rather than enter nursing homes. Monthly service costs are limited to $14,700 per month.
Eligibility
- Have a nursing facility LOC.
- Aged 60-64 with a physical disability or aged 65 or older.
Administration and Case Management
- Operated by ODA.
- Case management provided by PAAs.
Services Offered
Below is a list of services offered under the PASSPORT Waiver. Please refer to the linked OAC rule for additional information on the service.
- Adult day services, OAC Rule 173-39-02.1.
- Alternative meals, OAC Rule 173-39-02.2.
- Community integration, OAC Rule 5160-44-14.
- Community transition, OAC Rule 5160-44-26.
- Enhanced community living, OAC Rule 173-39-02.20.
- Home care attendant, OAC Rule 5160-44-27.
- Home-delivered meals, OAC Rule 5160-44-11.
- Home-delivered meals (kosher option), OAC Rule 173-39-02.19.
- Home maintenance and chores, OAC Rule 5160-44-12.
- Homemaker, OAC Rule 173-39-02.8.
- Home modification, OAC Rule 5160-44-13.
- Home medical equipment and supplies, OAC Rule 173-39-02.7.
- Non-medical transportation, OAC Rule 173-39-02.18.
- Nutritional consultation, OAC Rule 173-39-02.10.
- Out-of-home respite, OAC Rule 5160-44-17.
- Personal care, OAC Rule 173-39-02.11.
- Personal emergency response system, OAC Rule 5160-44-16.
- Social work or counseling, OAC Rule 173-39-02.12.
- Waiver nursing, OAC Rule 5160-44-22.
MyCare Ohio
Overview
- The MyCare Ohio Waiver is a special program offered in 29 Ohio counties. It combines Medicare and Medicaid benefits. Individuals receive services through a MyCare Ohio managed care plan.
Eligibility
- Have a nursing facility LOC.
- Aged 18-64 with a physical disability or aged 65 or older.
- Eligible for Medicare parts A, B, and D.
- Live in one of these Ohio counties: Fulton, Lucas, Ottawa, Wood, Lorain, Cuyahoga, Lake, Geauga, Medina, Summit, Portage, Stark, Wayne, Trumbull, Mahoning, Columbiana, Union, Delaware, Franklin, Pickaway, Madison, Clark, Green, Montgomery, Butler, Warren, Clinton, Hamilton, and Clermont.
Administration and Case Management
- Operated by Ohio Medicaid.
- Case management provided by managed care plans: Aetna Better Health Ohio, Buckeye Health Plan, CareSource, Molina HealthCare of Ohio and United Healthcare Community Plan.
Services Offered
Below is a list of services offered under the Assisted Living Waiver. Additional information on all of the below services can be found in OAC Rule 5160-58-04, except for home-delivered meals (kosher option), which can be found in OAC Rule 173-39-02.19.
- Adult day services.
- Alternative meals.
- Assisted living.
- Choices home care attendant
- Community integration.
- Community transition.
- Enhanced community living.
- Home care attendant.
- Home maintenance and chores.
- Home medical equipment and supplies.
- Home modification.
- Home-delivered meals.
- Home-delivered meals (kosher option).
- Homemaker.
- Nutritional consultation.
- Out-of-home respite.
- Personal care.
- Personal emergency response system.
- Social work or counseling.
- Waiver nursing.
- Waiver transportation.
Ohio Home Care Waiver
Overview
- Ohio Home Care Waiver provides services to individuals at home and in the community instead of a nursing home, hospital, or other facility.
Eligibility
- Have a nursing facility LOC.
- Aged 0-59 with a physical disability.
Administration and Case Management
- Operated by Ohio Medicaid.
- Case management provided by Ohio Medicaid-contracted case management agencies.
Services Offered and OAC Rule Reference List
Below is a list of services offered under Ohio Home Care Waiver. Please refer to the linked OAC rule for additional information on the service.
- Adult day services, OAC Rule 5160-46-04.
- Community integration, OAC Rule 5160-44-14.
- Community transition, OAC Rule 5160-44-26.
- Home care attendant, OAC Rule 5160-44-27.
- Home maintenance and chores, OAC Rule 5160-44-12.
- Home medical equipment and supplies, OAC Rule 5160-46-04.
- Home modification, OAC Rule 5160-44-13.
- Home-delivered meals, OAC Rule 5160-44-11.
- Home-delivered meals (kosher option), OAC Rule 173-39-02.19.
- Out-of-home respite, OAC Rule 5160-44-17.
- Personal care, OAC Rule 5160-46-04.
- Personal emergency response system, OAC Rule 5160-44-16.
- Supplemental transportation, OAC Rule 5160-46-04.
- Waiver nursing, OAC Rule 5160-44-22.
Enrolling in a Waiver
Request to Enroll
You can request a HCBS nursing facility waiver several ways. A detailed process can be found in Ohio OAC Rule 5160:1-2-03.
The rule describes the following ways to submit a request:
- Make the request on the Medicaid application.
- Submit form ODM 02399 "Request for Medicaid HCBS Waiver" to either your local County Department of Job and Family Services (CDJFS) or the regional PAA.
- To find your local agencies, please reference the resources for enrollment below.
- Make the request verbally or in writing to the administrative agency, which is Ohio Medicaid.
- Make the request verbally or in writing to any Ohio Medicaid-approved long-term services and supports agency.
Resources for Enrollment
There are several resources for help accessing HCBS programs:
- For help accessing any HCBS program: Contact Ohio Benefits Long-Term Services and Support (OBLTSS).
- OBLTSS is a network in Ohio that connects individuals to information, resources, and community-based long-term services and supports. A support navigator will answer questions about OBLTSS, connect you to community resources, and may recommend that you complete a Medicaid application.
- To learn more, visit Ohio Medicaid - Benefits - Long-term Care - Home (ohiohelps.org).
- Requests can also be made by calling OBLTSS at 844-644‐6582.
- For general enrollment support for nursing facility waivers (Assisted Living, PASSPORT, MyCare Ohio, and Ohio Home Care Waiver): Contact your local CDJFS.
- To find a local agency please visit: County Directory (ohio.gov).
- For specific enrollment support for Assisted Living and PASSPORT: Contact your regional PAA. Note that case management for Assisted Living is also provided by PASSPORT administrative agencies.
- To find a local agency please visit: Local Office | Department of Aging (ohio.gov).
- For specific enrollment support for MyCare Ohio: MyCare members can request the waiver through their MyCare plan care manager.
- To learn more about MyCare and plan contacts, go here: MyCare-Ohio | Medicaid.
How to Enroll as a Nursing Facility Waiver Provider
The process for enrolling as a HCBS nursing facility waiver provider differs by administrative agency. Please reference the information below for guidance on provider enrollment. A comprehensive list of enrollment resources can be found on Ohio Medicaid Provider Enrollment.
Providers of Waiver Services Administered by Ohio Medicaid
Ohio Medicaid is partnering with Public Consulting Group (PCG) to improve the delivery of HCBS waiver services through enhanced provider recruitment, training, and support services. PCG Match is a provider and individual matching system that helps facilitate connections between in-home service providers and individuals receiving Ohio Home Care Waiver or MyCare Ohio services and/or Medicaid State Plan services.
- To enroll as a provider, visit PCG Provider Enrollment.
- To find a provider, visit the PCG Provider Match.
- You may also contact PCG at 877-908-1746.
Important Note: Bureau of Criminal Identification & Investigation reports for initial provider enrollments should only be sent to the following address:
The Ohio Department of Medicaid, Attention: BCII Coordinator, P.O. Box 183017, Columbus, Ohio 43218-3017
Providers of Waiver Services Administered by ODA
To enroll as a provider for ODA-administered HCBS nursing facility waivers (Assisted Living and PASSPORT), please visit ODA Provider Certification.
