Ohio Consumer Direction (2026): PPL Setup, EVV, Timesheets, and Tax Mechanics for Paid Family Caregivers

Ohio's paid-family-caregiver landscape has two structurally different employment pathways, and most families do not understand the distinction until they are halfway through the enrollment paperwork. The first is the agency-employed pathway: the family caregiver becomes a W-2 employee of a home care agency, the agency holds the contract with Ohio Medicaid, and the family caregiver works under the agency's supervision, training program, and quality standards. The second is consumer direction (sometimes called participant direction or self-direction): the Medicaid recipient (or their authorized representative) becomes the legal employer of record, hires the family caregiver directly, schedules the worker, supervises the work, and signs off on timesheets. Payroll, tax withholding, workers' compensation, and Medicaid billing are handled by a Financial Management Service (FMS) entity that contracts with the state, not by the recipient.

This guide is the operational deep-dive on the consumer-direction pathway in Ohio. It covers the four Ohio consumer-direction services (Choices Home Care Attendant Service, Consumer-Directed Personal Care Service, Structured Family Caregiving, and DODD Participant-Directed Homemaker/Personal Care), the role of Public Partnerships LLC as Ohio's primary fiscal employer agent, the Sandata-anchored Electronic Visit Verification mechanics that determine whether your hours will actually be paid, the federal Difficulty of Care exclusion under IRS Notice 2014-7 that exempts many live-in caregivers from federal income tax on their wages, the narrow conditional pathway at OAC 5160-44-32 under which an Ohio spouse can be paid, and the operational mistakes that delay the first paycheck by weeks or months. For the high-level overview of all six Ohio paid-caregiver pathways (including agency-employed, VA programs, and personal-service contracts), see the companion guide at /caregiver/ohio/how-to-get-paid-family-caregiver. This article is the how-to.

By Brevy Care Team

• Consumer direction in Ohio runs through four service codes: Choices Home Care Attendant Service (C-HCAS), Consumer-Directed Personal Care Service (CD-PCS), Structured Family Caregiving (SFC), and the DODD-side Participant-Directed Homemaker/Personal Care (PD-HPC).
• The FMS is Public Partnerships LLC for the Ohio Medicaid HCBS waivers (PASSPORT, Ohio Home Care Waiver, MyCare Ohio Waiver). PPL's worker-facing tools are the Time4Care mobile app and the MyAccount web portal. DODD waivers use a different FMS structure.
• Electronic Visit Verification is mandatory and unforgiving. Ohio's EVV aggregator is Sandata. Visits that are not properly EVV-verified are not paid, full stop.
• W-2 employment, not 1099. Consumer-direction workers in Ohio are employees of a co-employment model: the participant is the managing employer, the FMS is the common-law employer of record for tax and payroll purposes. Workers receive a W-2 at year-end.
• The Difficulty of Care exclusion can zero out federal income tax on consumer-direction wages for caregivers who share a household with the recipient under IRS Notice 2014-7. It does not exempt FICA. It does not apply to non-live-in caregivers.
• Spouses generally cannot be paid through consumer direction, but the narrow conditional pathway at OAC 5160-44-32 opens a workaround when no other willing-and-able provider exists, subject to a weekly hour cap and employment through an FMS or agency.
• The number-one operational delay for new Ohio consumer-direction workers is incomplete onboarding paperwork. The number-two delay is failed background checks. The number-three delay is EVV visits that do not match the authorized service plan.

The Four Ohio Consumer-Direction Services

Ohio's consumer-direction options sit inside four distinct service codes, each with its own rate structure, eligible-worker rules, and operational mechanics. Picking the right one is the first decision a family makes, and the choice depends on whether the caregiver lives with the recipient, how many hours of care the recipient needs, and whether the recipient is on a Medicaid HCBS waiver vs. a DODD waiver.

Choices Home Care Attendant Service (C-HCAS)

C-HCAS is the higher-touch, hourly consumer-direction service for adults on PASSPORT (age 60+), the Ohio Home Care Waiver (age 0-59 with disability), or the MyCare Ohio Waiver (dual eligibles in Next Gen MyCare counties). Under C-HCAS, the participant is the managing employer: they recruit, hire, train, supervise, schedule, evaluate, and fire the worker. The rate is set by the participant within a state-defined range, from minimum wage up to a ceiling set by ODM; contact your Area Agency on Aging for the current rate schedule in your region. Higher rates within the range come out of the same monthly budget, so a higher hourly rate trades against fewer total hours.

C-HCAS is the right structure when the family wants a defined hourly relationship, the worker is providing ongoing personal-care attendant services (bathing, dressing, transferring, toileting, meal preparation, light housekeeping, transportation, supervision), and the worker is not living with the recipient. C-HCAS pays for actual hours worked, verified through EVV, billed in 15-minute increments.

Consumer-Directed Personal Care Service (CD-PCS)

CD-PCS is the lower-touch, lower-rate sibling of C-HCAS. The structural mechanics are similar (participant is the managing employer, FMS is the common-law employer of record, payment is hourly), but the state-set rate is fixed by ODM at a rate below C-HCAS and the documentation requirements are lighter. CD-PCS is appropriate for participants who need supervisory presence and IADL support without the higher-acuity personal-care work that warrants the C-HCAS rate. Many participants who could qualify for C-HCAS choose CD-PCS for its simpler administrative workflow.

Structured Family Caregiving (SFC)

SFC under OAC 5160-44-33 is operationally different from C-HCAS and CD-PCS. SFC is a daily-rate, live-in model, not an hourly service. The family caregiver shares a residence with the recipient, provides 24/7 supervision and personal care, and receives a daily stipend. Stipend tiers vary by recipient acuity and care plan; contact the SFC agency for current tier rates. SFC is delivered through an SFC agency that serves as both the employer of record for tax purposes and the clinical-oversight entity, providing care coordination, training, and respite arrangement.

SFC is the right structure when a single family caregiver (usually an adult child or sibling) has moved in with the recipient or has had the recipient move into their home, and that caregiver is providing the bulk of the day-to-day care. SFC's daily-rate structure avoids the EVV-per-visit mechanics of C-HCAS and CD-PCS, simplifying day-to-day operations but limiting the maximum income compared to high-hour C-HCAS arrangements.

DODD Participant-Directed Homemaker/Personal Care (PD-HPC)

Ohioans with intellectual or developmental disabilities are on a separate set of waivers administered by the Ohio Department of Developmental Disabilities (DODD) rather than ODM or ODA. The DODD waivers (Individual Options, SELF, and Level One) all offer the Participant-Directed Homemaker/Personal Care service, which is DODD's consumer-direction option. PD-HPC operates on similar principles to C-HCAS (participant is the managing employer, hourly payment, EVV required), but the FMS structure is different (DODD waivers use a different fiscal-management agency than the ODM HCBS waivers, with Acumen Fiscal Agent and other contractors holding the DODD FMS work) and the rate structure is set under DODD's appendix to the IO, SELF, and Level One waivers.

The conditional spousal exception at OAC 5160-44-32 applies to DODD PD-HPC on the same terms as to C-HCAS and CD-PCS.

Public Partnerships LLC: The FMS for the Ohio Medicaid HCBS Waivers

Public Partnerships LLC (PPL) is the statewide fiscal employer agent for C-HCAS, CD-PCS, and (in operation) SFC under the three Ohio Medicaid HCBS waivers (PASSPORT, OHCW, and MyCare Ohio). PPL is the company that actually issues your paycheck, withholds your taxes, manages your timesheets, handles your background check, and bills Ohio Medicaid on the participant's behalf.

What PPL does

In the co-employment model, the participant is the managing employer (in their role as employer of the worker: hiring, training, supervising, scheduling, firing) and PPL is the common-law employer of record for tax, payroll, and benefits purposes. The split matters legally: the participant cannot be held personally liable for payroll taxes or workers' compensation because PPL holds those obligations, and the worker is a W-2 employee of PPL for tax reporting, not a 1099 contractor of the participant.

PPL's specific operational responsibilities include enrolling the participant and the worker into PPL's systems (Time4Care and MyAccount); running federal and state background checks on the worker under OAC 5160-1-17.8 standards; processing the worker's onboarding paperwork (I-9, W-4, state W-4, direct-deposit setup); collecting and validating timesheets through the Time4Care app and the MyAccount portal; verifying that timesheet entries match EVV records (more on EVV below); computing gross pay based on the authorized hourly rate; withholding federal income tax, FICA (Social Security and Medicare), FUTA where applicable, Ohio income tax, school district tax where applicable, and municipal tax in the localities that levy one; issuing paychecks via direct deposit on a defined schedule; submitting the Medicaid claim for the authorized service; issuing W-2s at year-end; and managing the Difficulty of Care exclusion under IRS Notice 2014-7 for caregivers who share a household with the recipient.

Time4Care and MyAccount

Two PPL-operated platforms handle the day-to-day operational work of consumer direction in Ohio.

Time4Care is the worker-facing mobile app. The worker uses Time4Care to clock in and out for each visit, capturing the visit start time, end time, location (via GPS), service code, and recipient identifier. Time4Care is the front-end interface to the Sandata EVV system; Time4Care submits the visit data to Sandata, Sandata validates it against the authorized service plan, and the validated record flows back to PPL for payroll processing.

MyAccount is the participant-facing and worker-facing web portal. Participants use MyAccount to approve timesheets, view their service budget and remaining hours, manage the worker roster, and submit personnel actions (hiring, terminating, changing pay rates). Workers can use MyAccount to view their pay history, submit corrections to EVV entries when needed, manage W-4 elections, and download pay stubs.

The single most common operational mistake new participants make is failing to approve timesheets promptly in MyAccount. PPL operates on a defined payroll cycle (typically biweekly for the Ohio Medicaid waivers, with a published cutoff time each pay period). A timesheet that is not approved by the cutoff does not get paid in that pay cycle, and the worker waits until the next cycle. Set a recurring calendar reminder for the day before each cutoff to ensure timesheets are approved on time.

Worker onboarding: the steps and the timeline

The end-to-end onboarding timeline for a new Ohio consumer-direction worker, from "we have decided who will be the paid caregiver" to "the worker receives the first paycheck," typically runs four to eight weeks, sometimes longer when paperwork is incomplete or the background check is delayed. The steps in approximate order:

1. The participant identifies the worker and confirms with the case manager (AAA case manager for PASSPORT, ODM case manager for OHCW, MyCare plan care manager for MyCare Ohio) that consumer direction has been added to the service plan.

2. The participant and the worker complete PPL enrollment paperwork. PPL provides an onboarding packet that includes the participant's Common Law Employer Agreement, the worker's I-9 and W-4 forms, direct-deposit setup, state W-4, and the worker's background-check authorization. The paperwork can be completed online through MyAccount or on paper; the online path is faster.

3. PPL runs the background check under OAC 5160-1-17.8. The check runs against Ohio's criminal records database, federal records, the Ohio Nurse Aide Registry, the Ohio Sex Offender Registry, the federal OIG and SAM exclusion lists, and (for workers serving children) the Ohio Child Abuse and Neglect Registry. Most background checks clear within five to ten business days; checks that hit a flag (an unresolved arrest, an incomplete record, a name discrepancy) can take weeks to resolve.

4. PPL provides training documentation. The state-mandated baseline training for Ohio consumer-direction workers is minimal compared to agency-employed workers (one of consumer direction's advantages), but workers are typically required to complete a brief orientation covering EVV use, timesheet submission, and emergency-reporting protocols. Some waivers add waiver-specific training (e.g., medication-administration awareness).

5. The worker is approved and added to the participant's roster in MyAccount. The worker can now begin recording visits in Time4Care.

6. The first visit is recorded in Time4Care. The worker clocks in via the app, completes the visit, and clocks out. Sandata validates the entry.

7. The participant approves the timesheet in MyAccount after the visit (or in batch at the end of the pay period).

8. PPL processes the pay cycle. The first paycheck typically arrives in week 6 to 8 from the start of onboarding, depending on the timing of background-check completion and the participant's first timesheet approval.

The single most-important step families miss is step 1: confirming with the case manager that consumer direction has been formally added to the service plan and that the worker has been authorized for the specific number of hours per week. Workers cannot be paid for hours beyond the authorized amount, and hours worked before formal authorization are not retroactively paid.

EVV: How Sandata Decides Whether You Get Paid

The 21st Century Cures Act requires Electronic Visit Verification for all Medicaid-paid personal-care and home health services. Ohio's EVV aggregator is Sandata, and the practical implications of EVV for consumer-direction workers are real and ongoing.

What gets verified

EVV captures six data points on every visit: the type of service provided, the recipient receiving the service, the worker delivering the service, the date of the visit, the start and end times of the visit, and the location of the visit (verified by GPS for the mobile app or by the recipient's registered phone number for IVR). The EVV record is the system of record for whether the visit happened; the participant's timesheet approval confirms that the service was satisfactory.

The three verification modes

Ohio consumer-direction workers can verify visits through one of three modes, depending on the worker's circumstances and the recipient's preferences.

Mobile app (preferred). The worker uses the Time4Care app on their smartphone to clock in at the start of the visit and clock out at the end. The app captures the worker's GPS location at clock-in and clock-out to confirm the worker was at the recipient's address. This is the default mode and the one PPL pushes new workers to use.

Interactive Voice Response (IVR) phone. The worker calls a PPL-provided phone number from the recipient's registered home phone to clock in and clock out. IVR is appropriate for workers without smartphones or in homes with poor cellular coverage. The recipient's home phone must be registered with PPL in advance, and the call must originate from that phone (or PPL's caller-ID validation will reject the entry).

Fixed Visit Verification (FVV) device. A small device installed in the recipient's home that the worker uses to clock in and out by entering a code or pressing a button. FVV is used when neither the mobile app nor IVR is workable. It is the least common mode in practice.

What goes wrong with EVV

Several recurring EVV failures cause unpaid hours and operational friction.

The app fails to capture GPS. When the worker's phone has location services disabled, the GPS coordinates do not flow to Sandata, and the visit is flagged for manual review. To prevent this, workers should enable location services for the Time4Care app permanently and confirm the app has GPS access at the start of each shift.

The worker clocks in at the wrong location. Sandata validates the clock-in GPS against the recipient's registered home address. A worker who arrives early and clocks in from a coffee shop a block away, or who clocks in from their car in the driveway with imprecise GPS, can get flagged. Clock in only once inside the recipient's home.

The worker forgets to clock out. A shift that is clocked in but never clocked out shows as a clock-in event with no end time. Sandata will not pay the visit until the clock-out is recorded. If a worker forgets to clock out, the worker should submit a correction request through MyAccount or call PPL the next business day; the correction has to be approved by both the worker and the participant.

The visit duration does not match the authorized service plan. A worker scheduled for 4 hours per day who consistently clocks in for 5 hours will see those extra hours flagged and ultimately unpaid (the worker is paid only for authorized hours). Conversely, a worker who clocks in for 3 hours on a day they were scheduled for 4 has only 3 hours of paid time.

The recipient cannot be EVV-verified during the visit. Some EVV systems require verification by the recipient (a phone call or signature). When the recipient has dementia or is non-verbal, an authorized representative can stand in.

The Sandata-PPL data sync fails. Occasionally an EVV record sits in Sandata but does not flow to PPL within the expected timeline. This is rare but happens; the resolution is to call PPL with the visit details and the Sandata visit ID.

The rule of thumb: if a paycheck arrives short, check the EVV record first. Most consumer-direction payroll disputes resolve at the EVV layer.

Tax Mechanics for Ohio Consumer-Direction Workers

W-2 employment through PPL means standard payroll tax treatment, with one important exception that can substantially increase the worker's net pay.

The standard withholding

For a consumer-direction worker who does not qualify for the Difficulty of Care exclusion (typically a worker who does not share a household with the recipient), the gross hourly rate is subject to:

• Federal income tax withholding based on the worker's W-4 elections.
• FICA (Social Security and Medicare) withheld from the worker's gross pay, with PPL paying the matching employer share.
• Federal Unemployment Tax (FUTA) paid by PPL, not withheld from the worker.
• Ohio income tax withholding based on the worker's Ohio IT-4 elections.
• School district income tax withholding in the school districts that levy one.
• Municipal income tax withholding in the localities that levy one (most Ohio cities and many suburbs levy a local income tax that is withheld at the source).

IRS Notice 2014-7: the Difficulty of Care exclusion

The federal Difficulty of Care exclusion under IRS Notice 2014-7 is the single most-valuable tax rule for live-in family caregivers under Ohio Medicaid waivers, and many caregivers do not know it exists.

The exclusion provides that payments received under a state Medicaid HCBS waiver for personal-care services delivered to an eligible individual who lives in the worker's home are excluded from the worker's federal gross income. The eligibility criteria are: the payment is made under a state Medicaid waiver, the payment is for services delivered in the worker's home (the worker and the recipient share a residence), the recipient is an eligible individual (which the Medicaid waiver enrollment establishes), and the worker has not exceeded the per-worker cap described in IRS Notice 2014-7.

When the exclusion applies, the worker's W-2 from PPL shows the qualifying Medicaid waiver payments in Box 1 as $0 (or excluded from Box 1) for federal income tax purposes. The worker still owes FICA on those wages (the exclusion is from federal income tax, not from Social Security and Medicare), and the wages still appear in Box 3 (Social Security wages) and Box 5 (Medicare wages). At the state level, Ohio income tax conforms to federal Adjusted Gross Income as the starting point, so excluded Medicaid waiver payments are typically also excluded from Ohio state income tax, though the worker should verify against the current Ohio IT-1040 instructions.

For a live-in adult-child caregiver, the Difficulty of Care exclusion can eliminate federal and state income tax liability entirely, leaving only the FICA share. The net effect is a significant reduction in annual tax liability, and over a multi-year caregiving stint it adds up to meaningful family wealth.

PPL administers the Difficulty of Care exclusion automatically when the worker self-certifies on the PPL onboarding paperwork that they share a household with the recipient. The worker is responsible for notifying PPL if the household-sharing status changes (e.g., the worker moves out, the recipient moves into a facility). Misrepresenting household-sharing status to claim the exclusion when it does not apply is tax fraud; the exclusion is a legitimate benefit for legitimate live-in caregivers and should be claimed accurately.

Estimated tax considerations

A live-in caregiver claiming the Difficulty of Care exclusion typically does not owe federal income tax on Medicaid waiver wages, so the worker does not need to make federal estimated tax payments on those wages. The worker may still owe federal tax on other income (a second job, investment income, retirement distributions). For non-live-in caregivers, federal withholding is handled by PPL through the W-4, so estimated tax payments are generally not required.

Workers should consult a tax preparer familiar with Notice 2014-7 (or who is at least willing to read it) before filing the first tax return after starting consumer-direction work. The exclusion is well-established but many tax preparers see it for the first time when a client brings it up.

The OAC 5160-44-32 Conditional Spousal Pathway

The federal Section 1915(c) waiver default and Ohio's traditional Medicaid rules both exclude spouses from being paid as personal-care attendants for the spouse who is the Medicaid recipient. The reasoning is that spousal caregiving is presumed to be part of the marital relationship and not separately reimbursable. Most consumer-direction systems in Ohio enforce this exclusion by default.

OAC 5160-44-32 opens a narrow conditional pathway under which a spouse can be paid as a direct care worker. The conditions are:

1. No other willing-and-able provider is available to provide the authorized services in the recipient's home. The case manager documents that the available worker pool (agency providers, other family members willing to take on the role, friends) has been exhausted before recommending the spousal pathway.

2. Employment is through an agency or fiscal management service (PPL for the Medicaid HCBS waivers). The spouse cannot be paid as an independent provider or under a personal services contract; the W-2 employment structure is required.

3. Total weekly hours stay within the state-set cap. This limit prevents the spouse from displacing a full-time agency worker entirely and limits the financial-displacement effect on Ohio Medicaid.

4. ODM, ODA, or DODD confirms health and safety. The state agency reviews the care plan to confirm that the spouse can safely provide the authorized services and that the recipient's clinical needs are being met.

The OAC 5160-44-32 pathway is narrower than Tennessee's Freedom for Family Caregiving Act, narrower than New York's CDPAP, and narrower than the spousal-permissive arrangements in several other states. But it is a real pathway for the Ohio family that genuinely has no alternative paid provider. For veterans, VA Veteran-Directed Care is a parallel pathway that does not impose the spousal exclusion and is typically a better answer when a wartime veteran is in the household.

Service Plan and Hours Authorization

Consumer direction in Ohio operates against a service plan and an hours authorization that the case manager (AAA case manager for PASSPORT, ODM case manager for OHCW, MyCare plan care manager for MyCare Ohio, or DODD Service and Support Administrator for DODD waivers) develops with the participant.

How the service plan is built

After a participant is determined eligible for a Medicaid HCBS waiver, the case manager conducts an assessment using Ohio's standardized assessment instrument. The assessment captures the participant's ADL and IADL function, medical and behavioral needs, informal-support network, home environment, and goals. From the assessment, the case manager constructs a Person-Centered Service Plan (PCSP) that authorizes a specific set of services at specific frequencies, including consumer-direction hours.

The hours authorization for C-HCAS and CD-PCS is typically expressed as a weekly hour count (e.g., "30 hours per week of C-HCAS"), and the participant's worker can bill up to that authorized amount per week against EVV-verified visits. Hours that go unused do not roll over to subsequent weeks. Hours that exceed the authorization are not paid.

Service plan reviews

The case manager reviews the service plan at least annually under Ohio waiver rules, often more frequently when the participant's needs change. Family caregivers should engage the case manager any time the recipient's needs increase or decrease materially; an under-authorized service plan leaves the caregiver doing unpaid work, and an over-authorized plan generates EVV-flagged hours that do not get paid.

When hours run out before the week ends

A recurring operational issue is what happens when the worker has used all 30 authorized weekly hours by Thursday and the recipient still needs Friday and Saturday coverage. Several options:

• Stop billing. The worker can still work the remaining unpaid hours, but those hours will not be reimbursed and the EVV system will flag them.
• Switch to a second worker for the remaining hours. A second worker on the participant's roster can cover the remaining hours within their own pay rate, but the participant must still have authorized hours remaining in the overall service plan budget.
• Request a service plan increase. If the pattern persists, the participant or family caregiver should contact the case manager to request an increase in the weekly authorization based on documented need.
• Use NFCSP or county-levy respite for the gap. The National Family Caregiver Support Program and county senior-services levies can sometimes provide respite hours that fill gaps in the Medicaid service plan; see /caregiver/ohio/respite-care.

Common Operational Problems and How to Solve Them

The following are the recurring operational problems Ohio consumer-direction workers and participants encounter, with practical resolution steps.

Background check delays. The most common onboarding delay. If a background check is still pending after 10 business days, call PPL at the worker-services line and ask for a status update. Common causes: the worker's middle name or date of birth was entered incorrectly on the BCI&I authorization, the worker has a common name and the system is matching multiple records, the worker has a juvenile record that requires manual review. Most issues resolve within a few days of correction.

EVV clock-in failures. When the Time4Care app cannot clock in due to GPS issues, network connectivity, or app malfunction, the worker should call the PPL IVR backup line and clock in via phone. The IVR call must originate from the recipient's registered home phone or PPL will reject the entry. If the worker forgets to clock in entirely, submit an EVV exception request through MyAccount with the visit details; the participant approves the exception and PPL processes it manually.

Timesheet approval delays. The participant (or their authorized representative) must approve each timesheet in MyAccount by the pay-cycle cutoff. A common failure mode is the participant forgetting to log in. Set a recurring calendar reminder for the day before each cutoff, or designate an authorized representative (an adult child of the participant, for example) who handles the approvals on the participant's behalf.

Workers' compensation claims. PPL holds the workers' compensation policy under Ohio's Bureau of Workers' Compensation framework. If a consumer-direction worker is injured on the job (a back strain during a transfer, a slip on icy steps), the worker should report the injury to PPL immediately and follow PPL's BWC claim process. Do not file independently; PPL is the policyholder.

Worker tax document issues. W-2s for the prior tax year are issued by PPL by January 31. Workers who do not receive a W-2 by mid-February should call PPL to confirm the mailing address on file. For workers who qualified for the Difficulty of Care exclusion during the prior year, the W-2 should show $0 in Box 1 for the excluded wages; if the W-2 shows the full wages in Box 1, the exclusion was not applied and the worker should call PPL to request a corrected W-2.

Pay rate changes. Participants can adjust the worker's hourly rate within the authorized range, but the rate change must be submitted in MyAccount before the start of the pay period in which it takes effect. Mid-pay-period rate changes typically apply to the next full pay period.

Worker termination. Participants can terminate a worker at any time. The termination is submitted in MyAccount; PPL processes the termination and generates the final paycheck and any required state separation paperwork.

Recipient hospitalization. When the recipient is hospitalized, consumer-direction services are typically suspended for the duration of the inpatient stay (Medicaid will not pay both inpatient room-and-board and home-based personal care for the same period). The worker should not clock in for visits during the inpatient period. When the recipient returns home, services resume.

Recipient death. When the recipient passes away, the service plan ends. The worker should submit a final timesheet for visits delivered through the date of death; visits after the date of death are not payable. PPL provides standard end-of-relationship paperwork to close the consumer-direction arrangement.

When Consumer Direction Is Not the Right Fit

Consumer direction is the right model when the family has identified a specific worker (a family member, a friend, a known caregiver) and wants the control and flexibility of being the employer. It is not the right model in several common scenarios.

Agency-employed is better when no specific worker is identified. If the family does not have an obvious paid caregiver in mind and needs the home care agency to provide the worker, the agency-employed pathway (PASSPORT-certified or AL-Waiver-certified home care agencies, OHCW agencies, MyCare plan agency networks) is the right structure. The agency recruits, trains, supervises, and provides backup coverage; the family is not responsible for finding or replacing the worker.

Agency-employed is better when the worker needs heavy supervision or training. Consumer-direction workers receive minimal state-mandated training. If the worker needs comprehensive training (complex transfers, dementia behavior management, medication-administration certification, post-surgical wound care), the agency-employed model provides the training infrastructure.

SFC is better than C-HCAS for a single live-in caregiver providing 24/7 care. SFC's daily-rate structure compensates for round-the-clock supervisory presence in a way C-HCAS's hourly rate cannot match. A C-HCAS arrangement at 40 hours per week leaves 128 hours per week of supervisory time unpaid; SFC's daily rate compensates the whole arrangement.

The agency-employed pathway is better for the conditional spousal exception. Even when OAC 5160-44-32 opens the spousal pathway, the agency-employed model often runs more smoothly than the consumer-direction model for spouses, because the agency provides oversight and documentation that strengthens the case for the "no other willing-and-able provider" finding.

VA Veteran-Directed Care is better for wartime veterans with a spouse caregiver. VDC is more permissive for spouses than Ohio Medicaid consumer direction and integrates with VA services.

Frequently Asked Questions

What is the difference between consumer direction and agency-employed paid caregiving in Ohio?

Consumer direction (also called participant direction or self-direction) makes the Medicaid recipient the managing employer who recruits, hires, trains, supervises, schedules, and fires the worker. A Financial Management Service (Public Partnerships LLC for the Ohio Medicaid HCBS waivers) handles payroll, tax withholding, workers' compensation, and Medicaid billing. Agency-employed paid caregiving makes the family caregiver a W-2 employee of a home care agency that holds the contract with Ohio Medicaid; the agency provides supervision, training, scheduling, and backup coverage. Consumer direction offers more control and flexibility at the cost of more administrative responsibility for the participant.

How long does it take to start getting paid as a consumer-direction worker in Ohio?

Four to eight weeks from "we have decided who will be the paid caregiver" to "the worker receives the first paycheck," typically. The largest variable is the background check timeline. Workers should not begin providing paid services until PPL has confirmed that the worker is approved and added to the participant's roster in MyAccount; hours worked before formal approval are not retroactively paid.

What is Public Partnerships LLC and what does it do?

Public Partnerships LLC (PPL) is the statewide Financial Management Service (FMS) contractor for the Ohio Medicaid HCBS waivers (PASSPORT, Ohio Home Care Waiver, MyCare Ohio Waiver). PPL functions as the common-law employer of record in a co-employment model: the participant is the managing employer and PPL handles enrollment, background checks, timesheet processing, EVV integration, payroll, tax withholding, workers' compensation, Medicaid billing, and W-2 issuance. PPL's worker-facing platforms are the Time4Care mobile app (for EVV clock-in/clock-out) and the MyAccount web portal (for timesheet approval, worker management, and pay history).

How do I clock in and out for my visits as an Ohio consumer-direction worker?

Use the Time4Care mobile app on your smartphone. Enable location services for the app permanently so the GPS verifies the visit location. Clock in once you are inside the recipient's home (not from your car or a coffee shop). Clock out before you leave. If your phone is unavailable, the IVR backup is calling PPL's worker phone line from the recipient's registered home phone. If neither works, a Fixed Visit Verification device installed in the recipient's home is the fallback. Visits that are not EVV-verified are not paid.

Will I owe federal income tax on my consumer-direction wages?

It depends. If you live in the same household as the Medicaid recipient and you are paid for personal-care services under one of the Ohio Medicaid HCBS waivers, the Difficulty of Care exclusion under IRS Notice 2014-7 typically excludes those wages from federal gross income. You still owe FICA (Social Security and Medicare, 7.65% withheld), and the wages still appear in Box 3 and Box 5 of your W-2. Ohio income tax conforms to federal AGI as the starting point, so excluded payments are typically also excluded from Ohio state income tax. PPL administers the exclusion automatically when you self-certify household-sharing on the onboarding paperwork. If you do not share a household with the recipient, standard payroll tax withholding applies.

Can I be paid to care for my spouse through Ohio consumer direction?

Generally no, but a narrow conditional pathway exists. The federal §1915(c) default and most Ohio waivers exclude spouses from paid personal-care attendant work. The conditional pathway at OAC 5160-44-32 allows spousal payment when no other willing-and-able provider is available, the employment runs through an agency or FMS, the weekly hours stay within the state-set cap, and the state agency confirms health and safety. For wartime veterans, VA Veteran-Directed Care is a more permissive parallel pathway with no spousal exclusion.

What rate does Ohio consumer direction pay?

For C-HCAS: the rate is set by the participant within a state-defined range from minimum wage up to a ceiling set by ODM; contact your Area Agency on Aging for the current rate schedule. Higher rates trade against fewer total hours within the same monthly budget. For CD-PCS: the state-set rate is fixed by ODM at a rate below C-HCAS; contact your case manager or PPL for the current rate. For Structured Family Caregiving: a daily stipend (not hourly) that varies by recipient acuity and care plan tier; contact the SFC agency for current rates. For DODD PD-HPC: the rate structure is set under the DODD waiver appendix and is similar to C-HCAS in mechanics but uses a different fiscal-management agency.

What happens if my consumer-direction worker is sick or unavailable?

The participant is responsible for arranging backup coverage. Consumer direction does not include the agency-provided backup that a home care agency offers. Practical strategies: maintain a small roster of two or three approved workers on MyAccount so a backup worker is already enrolled; use NFCSP respite hours or county-levy adult day for short gaps; use the agency-employed pathway as a backup for longer gaps. The case manager can help arrange agency-provided backup services in genuine emergencies.

Does consumer direction work for someone with dementia?

Yes, with an authorized representative. When the recipient cannot manage the responsibilities of being a managing employer due to dementia or other cognitive impairment, an authorized representative (typically an adult child or spouse) takes on the day-to-day managing-employer functions: approving timesheets in MyAccount, managing the worker roster, communicating with PPL and the case manager. The case manager helps set up the authorized-representative designation as part of the service plan. The Difficulty of Care exclusion still applies based on the worker's household-sharing with the recipient, not with the authorized representative.

How do I get started?

Contact the case manager for the recipient's waiver: AAA at 1-866-243-5678 for PASSPORT, Ohio Medicaid at 1-800-324-8680 for the Ohio Home Care Waiver, the MyCare plan care manager for MyCare Ohio Waiver, or the DODD Service and Support Administrator for DODD waivers. Tell the case manager you want to add consumer direction (C-HCAS, CD-PCS, SFC, or PD-HPC depending on the waiver and your circumstances) to the service plan. The case manager initiates the PPL enrollment process and sets up the authorization for hours.

Next Steps for Ohio Families

The decision to take on consumer direction is not just about getting paid; it is about taking on the operational responsibilities of being an employer. For families that have identified a specific paid caregiver and that have the bandwidth to manage timesheets, EVV, and the FMS relationship, consumer direction offers control, flexibility, and a tax-advantaged income stream through the Difficulty of Care exclusion. For families without a specific caregiver in mind, or without the bandwidth for the administrative work, the agency-employed pathway is usually a better fit.

Start by reading the companion piece at /caregiver/ohio/how-to-get-paid-family-caregiver, which walks through all six Ohio paid-caregiver pathways at a higher level, including the VA programs that often work better for veterans than Ohio Medicaid consumer direction. Then call the case manager for the recipient's waiver and ask the specific question: "Can we add consumer direction to the service plan?" The case manager will know whether the recipient's waiver supports it and will start the PPL enrollment process.

Key Ohio consumer-direction contacts, all free:

• Area Agency on Aging (PASSPORT intake, statewide): 1-866-243-5678
• Ohio Medicaid Consumer Hotline (OHCW intake): 1-800-324-8680
• MyCare Ohio plans: Anthem 1-844-912-1226, Buckeye 1-866-549-8289, CareSource 1-855-475-3163, Molina 1-855-665-4623
• DODD intake (county-by-county County Board of DD): dodd.ohio.gov for county-level contacts
• Public Partnerships LLC (PPL) Ohio worker services: see publicpartnerships.com for the current Ohio-program-specific contact line
• Alzheimer's Association 24/7 Helpline: 1-800-272-3900
• Ohio Long-Term Care Ombudsman: 1-800-282-1206

Compare home and community-based pathway eligibility at Ohio Medicaid and consumer-direction rate schedules at the participant's Area Agency on Aging.

Find personalized help setting up Ohio consumer direction at brevy.com.

This guide is for general informational purposes and is not a substitute for legal, tax, or financial advice. Ohio Medicaid rules, FMS contractors, and reimbursement rates change; verify with the cited statutes, rules, agencies, and PPL before acting.