How to start a home care agency in Ohio

Ohio requires a Nonmedical Home Health Services license (a Skilled Home Health Services license also covers nonmedical services) from Ohio Department of Health to operate a home care agency. Fee: $250.

License required

Yes

License

Nonmedical Home Health Services license (a Skilled Home Health Services license also covers nonmedical services)

Issuing agency

Ohio Department of Health

Fee

$250

Fee details

$250 non-refundable license fee by cashier's check or postal money order payable to 'Treasurer, State of Ohio'.

Renewal

Every 3 years · Renewal requires the same application and $250 fee; file at least 90 days before the license expires. Licenses are valid for three years.

Insurance and bonds

$20,000 surety bond from a company licensed in Ohio for nonmedical applicants not operating before September 30, 2021 ($50,000 for a skilled license).

Accreditation

Optional. Agencies accredited by ACHC, CHAP, the Joint Commission or another CMS-approved body, or certified by the Ohio Department of Aging, have several application items waived.

Regulation

Ohio Rev. Code Chapter 3740; Ohio Adm. Code 3701-60-02 to 3701-60-05

1. Register the business with the Ohio Secretary of State
2. Obtain a $20,000 surety bond (unless the agency was already providing nonmedical services on or before September 30, 2021)
3. Adopt a written criminal records check policy
4. Primary owner submits fingerprint impressions
5. Submit the ODH application forms with the $250 fee and required documents
6. Answer any ODH request for more information within 14 days
7. Notify ODH within 10 days of changes to application information; renew every 3 years, at least 90 days before expiry

Staffing

• Before a criminal records check, check each direct-care applicant/employee against SAM, the HHS-OIG exclusion list, the Ohio DODD abuse registry, the Ohio sex offender database, the ODRC inmate database and the Ohio nurse aide registry
• Do not employ direct-care staff with disqualifying findings

Program

Ohio Medicaid (Ohio Department of Medicaid, ODM)

Enrollment portal

Provider Network Management (PNM) module of the Ohio Medicaid Enterprise System (OMES)

Application fee

Organizational provider types pay a non-refundable fee of $750 per application in 2026 (42 CFR 455.460 and OAC 5160-1-17.8), paid online in PNM. Individual practitioners and practitioner groups do not pay it. The fee is waived if paid to Medicare or another state's Medicaid program within the past five years for new enrollments; ODM's revalidation FAQ uses a two-year window for revalidations. The application cannot be finished until the fee is paid or proof is uploaded.

Fingerprinting

ODM requires BCI&I criminal record checks for certain providers, notably Ohio Home Care Waiver non-agency providers, who have done annual checks. ODM is moving these providers to RAPBACK, the retained-applicant fingerprint database, which gives continuous criminal-history updates at no cost to the provider. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under OAC 5160-1-17.8, some providers get pre- and post-enrollment on-site screening visits. Public Consulting Group (PCG) does the visits for providers not already screened by another state or federal agency. The visits are unannounced, and not cooperating can affect enrollment. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

ODM revalidates under 42 CFR 455.414 (at least every 5 years). It sends a notice about 120 days before the deadline, one per provider number, and also posts it in PNM correspondence. Do not start revalidation until the notice arrives. Revalidating with Medicare does not replace Ohio revalidation. ODM may do an on-site visit as part of it.

Full Ohio Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (long-term care)

Agency

Ohio Department of Health (Director of Health)

Services covered

• long-term care facilities: licensed nursing homes and skilled nursing / long-term care beds (including county homes and hospital-registered long-term care beds)
• new long-term care facilities, increases in bed capacity, and relocation of beds between sites

Ohio certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• home health nursing and aide
• private duty nursing
• waiver nursing, aide and home care attendant
• personal care (waiver homemaker/personal care)

Alternate EVV allowed

Yes

Program

https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/electronic-visit-verification

Ohio EVV requirements →

State minimum wage

$11.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $11.40 on 2027-01-01 ($5.70 tipped) for employers above the gross-receipts threshold.

Rate pass-through

HB 33 (FY2024-25 budget) requires DODD waiver provider rate increases to be used to raise wages and workforce supports; the bill's specific $17/$18 per hour rate language was vetoed, but the funding remained.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

2,493 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,597,852 (as of Jun 1, 2026)

All Ohio Home care Medicaid rates, ranked →

• OH Assisted Living Waiver (1915(c))
• OH Home Care Waiver (1915(c))
• OH Individual Options (IO) Waiver (1915(c))
• OH Level One Waiver (1915(c))
• OH MyCare Ohio Waiver (1915(c))
• OH OhioRISE Waiver (1915(c))
• OH PASSPORT Waiver (1915(c))
• OH Self Empowered Life Funding (SELF) Waiver (1915(c))

Ohio waivers and waiting lists →