Ohio

Ohio Medicaid Billing For Home Care Agencies

Ohio’s Medicaid system runs through multiple Managed Care Organizations (MCOs), each with its own enrollment steps, billing nuances, and reimbursement timelines. Paradigm is your single solution for handling it all: automating claims, flagging denials, and ensuring you get paid faster by every MCO you work with.

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How Paradigm Helps.

Billing

We manage the billing process end-to-end, aligning EVV and billing data for timely payments.

Enrollments

We help you access new payer lines, creating more income opportunities.

Eligibility

We monitor client eligibility and authorizations to ensure continuity of care and payments.

EVV Support

We optimize EVV and AMS configuration to ensure accurate Medicaid billing.

Training

We provide tools and education to help you grow your Medicaid census.
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Medicaid
in
Ohio
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Ohio is a strong market for Medicaid-funded home care, especially under waiver programs like PASSPORT and Ohio Home Care. With steady demand and solid reimbursement rates, agencies can build long-term, referral-driven growth while maintaining stable cash flow.

how evv works

Electronic Visit Verification

In Ohio, EVV is directly tied to Medicaid payment; if a visit isn’t entered and approved in Sandata, the claim won’t go through. With the state moving to hard EVV enforcement, agencies must ensure every visit is captured correctly and on time, or risk denials and delayed revenue.

EVV Requirements

Ohio uses a closed model; agencies must use Sandata for EVV. Alternate systems are not permitted for visit capture.

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EVV Aggregator

Sandata serves as both the EVV system and aggregator in Ohio. All visit data must be entered and approved in Sandata before claims can be billed.

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EVV Billing Process.

In Ohio, claims flow through Sandata after EVV data is approved. Timely visit entry is essential, as delays in EVV can directly block payments.

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Rates

How much does Medicaid pay for home care per hour in Ohio?

Most non-skilled services are reimbursed between $23 and $28 per hour, depending on the waiver program and payer. The PASSPORT waiver generally offers the highest rates, while other waivers may vary. Overtime and holiday pay are not automatically covered and must be negotiated through authorization.

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Payers

Ohio contracts with multiple MCOs that handle Medicaid billing under the Department of Medicaid and various waiver programs. Common MCOs include:

Buckeye Health Plan
CareSource
Molina
UnitedHealthcare Community Plan
Anthem / Amerigroup

Each payer has its own setup, EVV workflow, and claim filing timeline. Paradigm centralizes and simplifies the process so you can focus on care, not paperwork.

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Medicaid FAQs for Home Care Agencies.

Do home care agencies need to enroll with each Medicaid MCO in Ohio separately?

Yes, after state approval, you must submit credentialing paperwork to each individual MCO to receive authorizations and payments.

How does a home care agency get credentialed to bill Ohio Medicaid for non-medical home care?

You’ll need to enroll with the state under Provider Type 95 and get certified to participate in waiver programs. After that, you must contract separately with managed care organizations (MCOs). Paradigm can help with all of the above.

How long does Medicaid credentialing take for a home are agency in Ohio?

It usually takes three to five months, depending on how fast the state and each MCO process your application.

How much does Ohio Medicaid pay for non-medical home care?

Most waiver MCOs pay around $32.36 per hour for personal care aide services, but rates can vary slightly by plan and code.

What does it mean that Ohio is transitioning to EVV claims adjudication (”hard EVV”)?

Hard EVV means that all claims are denied for any shift that doesn’t the EVV record exactly. All EVV records must be submitted through Sandata. Ohio’s transition to hard EVV will be completed in early 2026.

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more about how Paradigm can help.