Ohio Medicaid HCBS Waivers (2026): PASSPORT, AL, OHCW, MyCare, IO, Level One, SELF

Ohio operates several distinct Medicaid Home and Community-Based Services (HCBS) waivers under the federal HCBS waiver authority (Section 1915(c) of the Social Security Act), plus a parallel managed-care overlay (MyCare Ohio) that absorbs some of those waivers for dual eligibles. The waivers split cleanly into two universes administered by two different state agencies. The aged-and-disabled universe is administered by the Ohio Department of Aging (ODA) and the Ohio Department of Medicaid (ODM); it includes PASSPORT (older adults in the community), the Assisted Living Waiver (older adults in licensed Residential Care Facilities), and the Ohio Home Care Waiver (younger adults with disabilities). The developmental disability universe is administered by the Ohio Department of Developmental Disabilities (DODD) and the County Boards of DD; it includes the Individual Options Waiver, the Level One Waiver, and the Self-Empowered Life Funding (SELF) Waiver. Sitting across both universes for dual eligibles is the MyCare Ohio Waiver, which absorbs PASSPORT and the Ohio Home Care Waiver into a single managed-care benefit for residents of MyCare counties.

This guide is the anchor overview. It explains which waiver fits which person, what each waiver covers, what each waiver excludes, what the eligibility rules are, how to apply, what waitlists exist, and how the waivers interact with each other, with nursing facility Medicaid, and with the broader Ohio Medicaid program. The companion pieces dive deeper into the individual waivers: see /medicaid/ohio/passport-waiver for PASSPORT, /medicaid/ohio/assisted-living-waiver for the Assisted Living Waiver, /medicaid/ohio/ohio-home-care-waiver for the Ohio Home Care Waiver, and /medicaid/ohio/mycare-ohio-waiver for the MyCare overlay. For the procedural pipeline on applying, see /medicaid/ohio/how-to-apply.

By Brevy Care Team · Last verified May 11, 2026

The Two Universes

Ohio's HCBS waiver landscape makes much more sense once families understand that there are two largely separate administrative pipelines. The aged-and-disabled pipeline is run by ODA and ODM, with the local Area Agency on Aging as the consumer-facing intake and case-management body. The developmental disability pipeline is run by DODD, with the County Board of Developmental Disabilities as the consumer-facing intake and case-management body. Many families learn this the hard way: the parent or guardian of an adult with an intellectual disability tries to apply for PASSPORT and is told they need to go to the County Board of DD; the family of an older adult with dementia tries to apply through the County Board of DD and is told they need to go to the AAA. Knowing which pipeline applies before the first phone call saves weeks.

The simplest rule:

• Was the person's qualifying disability present before age 22 and is it a developmental disability (intellectual disability, autism, cerebral palsy, traumatic brain injury before age 22, or similar)? Go to the County Board of Developmental Disabilities for DODD waivers (IO, Level One, SELF).
• Is the person an older adult (typically age 60+) needing personal care, homemaking, or other community supports because of frailty, chronic illness, or age-related disability? Go to the local AAA for PASSPORT or the AL Waiver.
• Is the person an adult age 0-59 with a non-developmental disability (multiple sclerosis, spinal cord injury, ALS, stroke-related disability, complex medical conditions) who needs community supports? Go to ODM and the AAA for the Ohio Home Care Waiver.

There are edge cases (people with both an intellectual disability and a separate age-related condition, people whose qualifying disability did not surface until adulthood), and these often need a phone call to both DODD and ODA to identify the correct pipeline. The County Board of DD and the AAA are accustomed to redirecting people; do not feel embarrassed about starting at the wrong door.

The Ohio HCBS Waivers at a Glance

PASSPORT: The Aged Community Waiver

PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) is Ohio's largest HCBS waiver and the most-used pathway for community-based long-term services for older adults. Authorized under Ohio's PASSPORT OAC chapter on codes.ohio.gov, PASSPORT is administered by the Ohio Department of Aging through Ohio's Area Agencies on Aging.

Who qualifies:

• An Ohio resident at or above the PASSPORT age threshold
• Meets the nursing facility level of care (NF LOC) as determined by the Adult Comprehensive Assessment Tool (ACAT)
• Meets Ohio Medicaid financial eligibility at the institutional level (income at or below the federal Special Income Limit, with Miller Trust available for over-income applicants; countable resources at or below the SSI-aligned LTC limit for an individual, or the spousal-impoverishment levels for married couples)
• Resides in a community setting (home, apartment, family member's home) rather than a nursing facility or licensed RCF

Services covered:

• Personal care attendant services (ADL/IADL support)
• Homemaker services
• Adult day services
• Home-delivered meals
• Transportation
• Personal emergency response system
• Environmental modifications (ramps, grab bars, accessibility upgrades)
• Respite care
• Home health aide services (Medicaid home health is parallel)
• Choices Home Care Attendant Service and Consumer-Directed Personal Care Service for participants choosing the consumer-direction model (see /caregiver/ohio/consumer-direction)

Intake: Call 1-866-243-5678 to reach the local AAA. The AAA conducts the ACAT clinical assessment, refers the financial application to CDJFS, develops the person-centered service plan, and assigns a case manager.

Why this matters: PASSPORT is the lowest-friction HCBS pathway for older adults and the most common entry point into the Ohio LTSS system. Most older adults exploring "Medicaid for in-home care" in Ohio are heading toward PASSPORT whether they realize it or not.

The Assisted Living Waiver

The Ohio Assisted Living Waiver serves adults who meet NF LOC and reside in (or are moving into) a Medicaid-participating licensed Residential Care Facility. The waiver is administered jointly by ODA and ODM through the local AAA.

Who qualifies:

• An adult Ohio resident at or above the AL Waiver's age threshold
• Meets NF LOC
• Meets Ohio Medicaid financial eligibility at the institutional level
• Resides in (or is moving into) a Medicaid-participating, licensed Residential Care Facility in Ohio

Services covered:

The AL Waiver covers a defined service package within the RCF: personal care, medication oversight, meals (some), housekeeping, social activities, and limited skilled-nursing oversight delivered within the assisted-living model. The waiver does not cover room and board, which the resident pays from their income subject to the assisted-living personal needs allowance (see /medicaid/ohio for the personal needs allowance).

Important constraint: The AL Waiver pays a defined per-diem rate to the RCF, which is significantly lower than the private-pay rate most Ohio RCFs charge. RCFs participate in the AL Waiver voluntarily, and the participating-facility list is shorter than the total list of licensed RCFs in Ohio. Before counting on the AL Waiver, families need to verify that a specific desired RCF participates and has an open Medicaid bed.

Intake: Through the local AAA at 1-866-243-5678, coordinated with the RCF's admissions team.

Why this matters: The AL Waiver is the bridge between private-pay assisted living and full Medicaid coverage. For families whose loved one needs more care than community-based PASSPORT can provide but is not yet ready for nursing facility level of care in practice (even if eligible on paper), the AL Waiver offers a middle path.

The Ohio Home Care Waiver (OHCW)

The Ohio Home Care Waiver serves adults under the older-adult threshold who have a qualifying disability, meet NF LOC, and reside in a community setting. OHCW is administered by ODM in partnership with the AAAs.

Who qualifies:

• An adult Ohio resident under the older-adult threshold with a qualifying disability
• Meets NF LOC
• Meets Ohio Medicaid financial eligibility at the institutional level
• Resides in a community setting

Services covered:

OHCW covers a service package similar to PASSPORT, scaled to the needs of younger adults with disabilities: personal care, home modifications, durable medical equipment beyond standard Medicaid coverage, respite, home-delivered meals where appropriate, and the consumer-direction service options (Choices Home Care Attendant Service, Consumer-Directed Personal Care Service).

Intake: Through the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or the local AAA, with ODM as the policy backstop. Some applicants are referred directly by hospital discharge planners, SSI/SSDI claim representatives, or vocational rehabilitation case managers.

Why this matters: OHCW fills the gap between pediatric Medicaid coverage and PASSPORT eligibility at age 60. For adults under 60 with serious disabilities, OHCW is often the only Medicaid pathway to community-based long-term supports.

The MyCare Ohio Waiver: The Managed-Care Overlay

The MyCare Ohio Waiver is structurally different from the other Ohio waivers. Rather than being a stand-alone HCBS waiver, MyCare is a combined federal authority that uses managed care to deliver an integrated Medicare-and-Medicaid benefit (a Fully Integrated Dual Eligible Special Needs Plan, or FIDE-SNP, for federal Medicare purposes) to full-dual eligibles in MyCare counties.

The most important rule about MyCare: it does not create new HCBS services. Under Ohio's MyCare OAC rules, MyCare continues the services that the participant was receiving under PASSPORT or OHCW before MyCare enrollment, delivered through the participant's MyCare FIDE-SNP plan rather than directly through ODA/ODM fee-for-service.

Who qualifies:

• Full-dual eligible (Medicare A, B, and full Medicaid)
• Resides in a MyCare county (the geographic footprint is expanding through the Next Gen MyCare initiative; verify current county list)
• Meets either PASSPORT or OHCW clinical eligibility (NF LOC, age-appropriate)
• Enrolled in a MyCare FIDE-SNP plan: Anthem, Buckeye, CareSource, or Molina

Services covered:

Continuation of PASSPORT or OHCW services as appropriate to the participant's age and disability profile, plus all standard Medicare and Medicaid services, plus the integrated care coordination that the FIDE-SNP model is designed to provide.

Intake: Most participants enter MyCare passively through the Next Gen MyCare auto-enrollment process, which moves full-dual eligibles into MyCare plans unless they opt out. Voluntary enrollment is also available through the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or directly through the MyCare plans:

• Anthem: 1-844-912-1226
• Buckeye: 1-866-549-8289
• CareSource: 1-855-475-3163
• Molina: 1-855-665-4623

Why this matters: For dual eligibles in MyCare counties, MyCare is the operational form of their HCBS coverage even though the underlying authority is PASSPORT or OHCW. Understanding that MyCare absorbs the prior waiver is essential for navigating service plans, appeals, and provider participation.

The DODD Waivers: Individual Options, Level One, SELF

The three DODD waivers serve the developmental disability population, administered through Ohio's 88 County Boards of Developmental Disabilities under the authority of the Ohio Department of Developmental Disabilities.

Individual Options (IO) Waiver

The IO Waiver is the comprehensive DODD waiver, offering the broadest service package and the highest expenditure ceiling. It supports individuals with developmental disabilities living in a wide range of settings, from family homes to individually-leased apartments to small group homes.

Service package: Homemaker/personal care, home and community-based residential supports, adult day services, respite, vocational habilitation, supported employment, transportation, environmental modifications, assistive technology, behavioral supports, nursing services, and the participant-direction service options.

Eligibility:

• Developmental disability as defined by DODD eligibility rules (typically manifests before age 22 and results in substantial functional limitations)
• Meets ICF/IID level of care
• Meets Ohio Medicaid institutional financial eligibility

Waitlist: IO has historically had significant waitlists in many counties. The Ohio DODD waitlist reform initiative has been working to align county-level waitlist practices statewide. Verify current waitlist status with the County Board of DD.

Level One Waiver

The Level One Waiver is the lower-intensity DODD waiver, designed for individuals with developmental disabilities living in the family home or their own home with relatively lower support needs.

Service package: Homemaker/personal care, adult day services, respite, transportation, environmental modifications (limited), assistive technology (limited), and supported employment, all at a smaller scale than the IO Waiver.

Eligibility:

• Developmental disability
• Meets ICF/IID level of care
• Meets Ohio Medicaid institutional financial eligibility
• Annual expenditure cap (verify current cap with County Board of DD or DODD)

SELF Waiver

The Self-Empowered Life Funding (SELF) Waiver is DODD's self-determination model. Like the consumer-direction services in OAC Chapter 5160-44, SELF emphasizes participant direction: the individual or representative manages a budget, hires support workers, and directs services.

Service package: Similar service categories to the IO Waiver but with budget authority vested in the participant or representative.

Eligibility: Developmental disability, meets ICF/IID LOC, meets financial eligibility, and demonstrates capacity (with supports as needed) to direct the service plan.

DODD Intake

All three DODD waivers are accessed through the County Board of Developmental Disabilities in the applicant's county of residence. The County Board:

• Determines DODD eligibility (developmental disability)
• Conducts the ICF/IID level-of-care assessment
• Develops the Individual Service Plan
• Assigns a Service and Support Administrator (SSA) as case manager
• Coordinates with CDJFS for the financial application

Find your County Board of DD at dodd.ohio.gov.

How HCBS Waivers Interact With Nursing Facility Medicaid

A nursing-facility-Medicaid resident transferring back to the community can enroll in PASSPORT (if age 60+), OHCW (if under 60 with a qualifying disability), or a DODD waiver (if developmentally disabled). The federal Money Follows the Person program supports these transitions financially, though Ohio's MFP program structure has evolved over time; verify current MFP status with ODM.

In the reverse direction, an HCBS waiver participant whose needs exceed the community waiver's scope can transition to nursing facility Medicaid. This often happens when:

• The participant's clinical condition deteriorates beyond what community-based services can safely support
• The plan-of-care cost would exceed waiver expenditure limits (each Ohio waiver has cost-effectiveness rules that limit individual plans of care to a percentage of the institutional alternative)
• The primary informal caregiver is no longer available
• A specific clinical need (24-hour skilled monitoring, behavioral safety, complex wound care) cannot be safely met in the home

The transition between HCBS and nursing facility under the same Medicaid eligibility is typically routine from a financial standpoint, though the patient liability calculation may change because the personal needs allowance differs between settings. See /care-types/ohio/nursing-homes for the nursing facility side.

How HCBS Waivers Interact With Medicare

Medicare covers limited long-term services and supports. Medicare home health (under 42 CFR Part 484) is short-term, intermittent, and requires homebound status plus a skilled need; it is not a substitute for an HCBS waiver. Medicare nursing facility coverage is short-term post-acute care, not long-term custodial care. Medicare Advantage plans may offer expanded supplemental benefits including some non-medical home care hours, but these are plan-specific and do not replace the HCBS waiver pathway.

For dual eligibles (Medicare + Medicaid), Medicare is primary for medical services and the HCBS waiver is the source of long-term community-based supports. In MyCare counties, both are integrated under the FIDE-SNP MyCare plan. For non-dual Medicare beneficiaries who later become Medicaid-eligible through spend-down or institutionalization, the HCBS waiver pathway is the bridge to community services. For more on the home care versus home health distinction, see /care-types/ohio/home-care-vs-home-health.

Application Pathway in Brief

The detailed application procedural guide is at /medicaid/ohio/how-to-apply. At a high level, the HCBS waiver application proceeds along two tracks that must converge:

1. Financial track: JFS 7216 application filed with the County Department of Job and Family Services in the applicant's county of residence. CDJFS reviews income, resources, and the 60-month lookback for transfers.
2. Clinical track: ACAT clinical assessment (aged-and-disabled waivers) or County Board of DD eligibility determination + ICF/IID LOC assessment (DODD waivers). For aged-and-disabled waivers, the AAA also develops the person-centered service plan and assigns the case manager.

Once both tracks are approved, the waiver enrollment is finalized, the service plan is implemented, and providers begin delivering services. For consumer-direction participants, the Public Partnerships LLC enrollment process for the FMS happens at the service-plan stage. See /caregiver/ohio/consumer-direction for the operational mechanics.

What Waivers Do Not Cover

Even the most generous Ohio HCBS waiver does not cover:

• 24-hour one-on-one care in the home (waivers cover up to defined personal care hours, but expenditure caps prevent full 24-hour staffing in most cases)
• Room and board in any setting (waivers cover services, not housing; AL Waiver participants pay room and board from their income)
• Long-term care insurance premiums
• Medical services that Medicaid covers separately (those are billed under standard Medicaid)
• Services Medicare should pay (Medicare is primary for dual eligibles on Medicare-covered services)
• Custodial nursing facility care (that is institutional Medicaid, not an HCBS waiver)

The federal limitation on HCBS waiver scope reflects the program's purpose: to deliver community-based services as an alternative to institutional placement, not to replace family caregiving or housing.

Cost-Effectiveness: Why Each Waiver Has a Plan-of-Care Cap

Every federal Section 1915(c) HCBS waiver, including Ohio's aged-and-disabled and DD waivers, must satisfy federal cost-neutrality. Under the federal HCBS waiver statute, CMS approves waivers on the basis that the average cost of serving the waiver population in the community will not exceed the cost of serving them in the institutional alternative. This cost-neutrality test is the federal gatekeeper that constrains waiver expansion.

Ohio implements cost-neutrality through individual plan-of-care expenditure ceilings. Each waiver has a cap on the value of services authorized in any individual's annual service plan, often expressed as a percentage of the institutional rate. When a participant's needs would exceed the plan-of-care cap, the case manager and the participant face a choice: prioritize within the cap, request an exception (granted in specific circumstances under waiver rules), or transition to nursing facility care.

This is why some families discover, after months of waiver participation, that their loved one's needs are growing beyond what the waiver can fund. The plan-of-care cap is structural, not arbitrary, and exists to satisfy CMS cost-neutrality. Understanding it before enrolling helps families plan realistically.

Frequently Asked Questions

Next Steps for Ohio Families

For families starting from scratch with an HCBS waiver application:

1. Identify the correct pipeline. Aged-and-disabled (PASSPORT, AL Waiver, OHCW) goes through the AAA. Developmental disability (IO, Level One, SELF) goes through the County Board of DD. MyCare absorbs PASSPORT or OHCW for dual eligibles in MyCare counties.
2. Call the intake number. 1-866-243-5678 for PASSPORT or AL Waiver. 1-800-324-8680 for OHCW or MyCare. County Board of DD for DODD waivers.
3. Begin the financial application in parallel through CDJFS at benefits.ohio.gov, in person at the CDJFS office, or with assistance from the AAA or County Board.
4. Gather supporting documentation early, especially bank statements and resource records covering the federal lookback window, because documentation gaps are the largest cause of application delay.
5. Prepare for the clinical assessment. For ACAT, the assessor will visit the home, observe ADLs and IADLs, review medications, and ask about cognitive function and informal supports. For ICF/IID LOC, the County Board assessor will conduct a developmental disability eligibility review and functional assessment.
6. Stay engaged during the published processing window. Respond promptly to verification requests, return calls from the case manager, and confirm contact information.
7. Plan the service mix. Once approved, work with the case manager to develop a service plan that balances personal care hours, homemaker support, respite, and any consumer-direction or family-paid components.

For deeper coverage of specific waivers and topics, see the companion guides at /medicaid/ohio/passport-waiver, /medicaid/ohio/assisted-living-waiver, /medicaid/ohio/ohio-home-care-waiver, /medicaid/ohio/mycare-ohio-waiver, and the Ohio Medicaid hub at /medicaid/ohio.

This guide is for general informational purposes and is not a substitute for legal, tax, or financial advice. Ohio Medicaid waiver rules, expenditure caps, waitlist status, and managed-care county footprints change; verify current information with ODM, ODA, DODD, the relevant AAA or County Board of DD, or an Ohio elder-law attorney before acting.

Find personalized help navigating Ohio Medicaid HCBS waivers at brevy.com.