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: See Map here
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: See Map here
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
MyCare Ohio NextGen Dual-Eligible Managed Care Plans
- Buckeye Health Plan (Centene)
- CareSource Ohio
- Molina HealthCare of Ohio
- Anthem Blue Cross and Blue Shield
Frequently Asked Questions
MyCare Ohio is a Dual-Eligible program, meaning that it's for individuals who qualify for both Medicare and Medicaid. The other MCOs are for Medicaid only individuals.
Home health in Ohio uses a base rate plus unit rate structure. For example, RN services pay $68.44 for the first hour (35–60 minutes) and $9.25 for each additional 15-minute unit (~$37/hr).
Ohio began EVV claims validation on March 1, 2025 and expanded it on June 1, 2025. All EVV-covered services will require matching visit data by Q1 2026 or claims will be denied.
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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