Ohio Medicaid Billing for Home Care Agencies
This page provides an overview of Ohio programs, waivers, payers, and EVV requirements relevant to home care (non-medical) and home health (skilled) providers operating in the state of Ohio.
Electronic Visit Verification
Ohio uses an Open Vendor Model for EVV, with Sandata as the state-designated system and aggregator. Agencies may use Sandata directly or an alternate EVV vendor that integrates with the Sandata Aggregator. EVV compliance applies to services across ODA, ODM, DODD, MyCare Ohio Plans and MCO programs—regardless of where claims are billed.
Sandata
Open
- EVV claims adjudication is rolling out across Ohio Medicaid programs.
- MyCare Ohio is the final program scheduled for EVV implementation.
Waivers & Programs
Ohio Department of Aging (ODA)
PASSPORT Waiver Supports older adults who require assistance with activities of daily living and wish to remain in their homes rather than enter a nursing facility.
Ohio Department of Medicaid (ODM)
MyCare Ohio Waiver
Ohio Department of Developmental Disabilities (DODD)
- Level One Waiver
- Individual Options (IO) Waiver
- Self-Empowered Life Funding (SELF) Waiver
Payers
Ohio Area Agencies on Aging (AAA):
Local agencies that coordinate and administer aging services throughout Ohio.
AAA Directory & Contact Map:
MyCare Ohio NextGen Dual-Eligible Managed Care Plans
- Buckeye Health Plan (Centene)
- CareSource Ohio
- Molina HealthCare of Ohio
- Anthem Blue Cross and Blue Shield
Waivers & Programs
Ohio Department of Aging (ODA)
PASSPORT Waiver
Ohio Department of Medicaid (ODM)
- MyCare Ohio Waiver
- Home Care Waiver
Ohio Department of Developmental Disabilities (DODD)
- Level One Waiver
- Individual Options (IO) Waiver
- Self-Empowered Life Funding (SELF) Waiv
Payers
Ohio Area Agencies on Aging (AAA)
AAA Directory & Contact Map:
MyCare Ohio NextGen Dual-Eligible Managed Care Plans
- Buckeye Health Plan (Centene)
- CareSource Ohio
- Molina HealthCare of Ohio
- Anthem Blue Cross and Blue Shield
Medicaid Managed Care Organizations (MCOs)
- Ohio Medicaid
- AmeriHealth Caritas Ohio
- Anthem Blue Cross and Blue Shield
- Buckeye Health Plan (Centene)
- CareSource Ohio
- Humana Healthy Horizons in Ohio
- Molina HealthCare of Ohio
- UnitedHealthcare Community Plan of Ohio
Frequently Asked Questions
Yes. Ohio requires EVV for Medicaid-funded personal care and home health services delivered in the home. Agencies must use an approved EVV system and comply with state requirements related to visit capture, documentation, and claims submission. Failure to meet EVV compliance standards may result in claim denials or additional oversight.
The Next Generation MyCare Ohio program is Ohio Medicaid’s managed care program for individuals who are eligible for both Medicaid and Medicare. The program coordinates physical health, behavioral health, long-term services and supports, and waiver services through participating managed care plans. Providers serving these members typically must contract with participating MyCare plans.
Most states operate Medicaid waiver or community-based care programs that allow reimbursement for non-skilled services such as personal care, homemaker services, respite care, and attendant care. These programs are often administered through Home and Community-Based Services (HCBS) waivers, aging programs, disability waivers, or managed long-term services and supports (MLTSS) programs. Eligibility criteria, covered services, and billing requirements vary by state.
In many states, yes. Enrolling with the state Medicaid program is typically the first step, but agencies may also need to complete separate contracts, credentialing applications, or network enrollment with individual Medicaid MCOs before claims can be submitted for reimbursement. Requirements vary by state and payer, largely depending on whether the state operates an MLTSS (Managed Long Term Services and Supports Program).
Credentialing timelines vary by state and payer, but most home care agencies can expect the Medicaid enrollment and credentialing process to take anywhere from 60 to 180 days. Delays are often caused by incomplete applications, missing ownership documentation, background check issues, or required site visits. Agencies seeking participation with Managed Care Organizations (MCOs) should also account for additional contracting and payer credentialing timelines.
How Paradigm can Help
Paradigm offers a combination of tech and highly skilled people to bridge the gaps in:
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
& Eligibility
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Credentialling
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
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