How to start a home health agency in Ohio

Ohio requires a Skilled home health services license from Ohio Department of Health to operate a home health agency. Fee: $250.

License required

Yes

License

Skilled home health services license

Issuing agency

Ohio Department of Health

Fee

$250

Fee details

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

Renewal

Every 3 years · License valid 3 years; a renewal is timely if filed at least 90 days before expiration with the renewal fee. ODH may align the date with Medicare certification or accreditation.

Insurance and bonds

$50,000 surety bond from an Ohio-licensed company for applicants not providing skilled home health services before September 30, 2021.

Accreditation

Accreditation by ACHC, CHAP, The Joint Commission or another CMS-approved body is one way to qualify; it is optional if another basis is used.

Medicare certification

Medicare certification is one way to qualify; not required if another basis is used. Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

ORC ch. 3740; OAC ch. 3701-60 (rule 3701-60-03)

1. Out-of-state agencies must first open an administrative office in Ohio
2. Complete the ODH application forms and pay the fee
3. Show one qualifying basis: Medicare certification, accreditation (ACHC, CHAP, TJC or other CMS-approved body), ODA certification, or a notarized attestation of meeting the Medicare conditions of participation
4. Show the agency was providing skilled home health before September 30, 2021, or file a $50,000 surety bond
5. Submit location, ownership, officer, service list, service-area and criminal records check policy details
6. Report changes to the director within 10 days

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.

Home health agencies — active organization NPIs (NPPES)

7,544 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

835 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Ohio Home health Medicaid rates, ranked →