Ohio Medicaid HCBS Waivers 2026: PASSPORT, AL, OHCW & More

Ohio Medicaid HCBS waivers pay for nursing-home-level care delivered at home or in the community instead of in an institution. If your parent qualifies for a nursing facility but wants to stay home, a Medicaid Home and Community-Based Services (HCBS) waiver is the program that pays for it. Ohio runs several under the federal HCBS waiver authority (Section 1915(c) of the Social Security Act), plus a managed-care overlay, Next Generation MyCare, that absorbs some of those waivers for people on both Medicare and Medicaid.

The waivers split into two universes run by two agencies. The aged-and-disabled universe is run by the Ohio Department of Aging (ODA) and the Ohio Department of Medicaid (ODM): it holds PASSPORT (older adults at home), the Assisted Living Waiver (older adults in licensed Residential Care Facilities), and the Ohio Home Care Waiver (adults under 60 with disabilities). The developmental disability universe is run by the Ohio Department of Developmental Disabilities (DODD) and the County Boards of DD: it holds the Individual Options Waiver, the Level One Waiver, and the Self-Empowered Life Funding (SELF) Waiver. Sitting across both for dual eligibles is the MyCare Ohio Waiver, which folds PASSPORT and the Ohio Home Care Waiver into a single managed-care benefit.

This guide is the anchor overview: which waiver fits which person, what each covers and excludes, the eligibility figures, how to apply, and how the waivers interact. The companion pieces go deeper on each: PASSPORT, the Assisted Living Waiver, the Ohio Home Care Waiver, and the MyCare overlay. For the application process, see how to apply for Ohio Medicaid.

Key Takeaways

• This guide covers seven Ohio HCBS waiver programs: PASSPORT, the Assisted Living Waiver, the Ohio Home Care Waiver, the MyCare Ohio Waiver, and the three DODD waivers (IO, Level One, SELF). The aged-and-disabled side is run by ODA and ODM; the developmental disability side is run by DODD through County Boards of DD.
• PASSPORT serves community-residing Ohioans age 60 or older who meet nursing facility level of care (NF LOC), with an individual cost limit of $14,700 per month for waiver services.1
• The Assisted Living Waiver pays for the assisted-living service package in a Medicaid-participating licensed Residential Care Facility, but never room and board, which is capped at $944 per month in 2026.2
• The Ohio Home Care Waiver (OHCW) serves Ohioans from birth through age 59 who have a disability and meet NF LOC; enrollees are disenrolled no later than 120 calendar days after their 60th birthday and are offered a transition to PASSPORT if they meet all of its eligibility criteria.3
• The MyCare Ohio Waiver folds PASSPORT and OHCW into the Next Generation MyCare FIDE-SNP plan for full-dual eligibles age 21 and older; ODM launched it in 29 counties on January 1, 2026 and rolled it out to the rest of Ohio from April 1 to August 1, 2026.4
• The DODD waivers are the Individual Options Waiver (comprehensive supports), the Level One Waiver (lower-intensity supports), and the SELF Waiver (self-direction). All three serve the developmental disability population and use an ICF/IID level-of-care standard; confirm the current criteria and service list with your County Board of DD or on DODD's own waiver pages.
• Every HCBS waiver requires financial and clinical eligibility. Financially: monthly income at or below the Special Income Level of $2,982 in 2026 (with a Miller Trust if over income) and countable resources at or below $2,000 for a single applicant.5 Clinically: NF LOC for the aged-and-disabled waivers, ICF/IID LOC for the DODD waivers.

The Two Universes

Ohio's HCBS waivers run through two separate administrative pipelines. The aged-and-disabled pipeline is run by ODA and ODM, with the local Area Agency on Aging (AAA) as the intake and case-management body. The developmental disability pipeline is run by DODD, with the County Board of Developmental Disabilities filling that role. Families often learn this the hard way, applying for PASSPORT when they need the County Board, or the reverse. Knowing which pipeline applies before the first call saves weeks.

The simplest rule, by who qualifies for which:

• Developmental disability present before age 22 (intellectual disability, autism, cerebral palsy, traumatic brain injury before 22, or similar): go to the County Board of Developmental Disabilities for the DODD waivers (IO, Level One, SELF), which use an ICF/IID level-of-care standard rather than the nursing facility standard.
• Older adult age 60 or older needing personal care, homemaking, or community supports because of frailty, chronic illness, or age-related disability: go to the local AAA for PASSPORT or the Assisted Living Waiver.1
• Adult from birth through age 59 with a non-developmental disability (multiple sclerosis, spinal cord injury, ALS, stroke-related disability, complex medical conditions) needing community supports: go to ODM for the Ohio Home Care Waiver.3

Edge cases (someone with both an intellectual disability and a separate age-related condition, or a disability that surfaced in adulthood) often need a call to both DODD and ODA. Both agencies redirect people routinely, so starting at the wrong door costs only a phone call.

The Ohio Medicaid Waivers at a Glance

PASSPORT: The Aged Community Waiver

PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) is Ohio's most-used HCBS pathway for community-based long-term care for older adults. It is a Section 1915(c) waiver created under Ohio Revised Code 173.52 and governed by Ohio Administrative Code Chapter 5160-31. It is run by the Ohio Department of Aging through Ohio's Area Agencies on Aging.1

The waiver also has a set capacity. CMS's record for Ohio's current PASSPORT waiver (control number 0198.R07.00) lists it as approved 06/07/2023 and effective 07/01/2023 through 06/30/2028. Ohio's March 2026 amendment application, its request to CMS with a proposed effective date of March 1, 2026, puts the maximum number of unduplicated participants at 39,807 for each of waiver years 1 through 5. That's capacity counted across a whole waiver year, not the number of Ohioans enrolled today, and Ohio can change it by amendment. Part of it is reserved rather than open, including slots for people moving over from the Ohio Home Care Waiver.1

Who qualifies:

• An Ohio resident age 60 or older at enrollment1
• Meets nursing facility level of care (intermediate or skilled, under OAC 5160-3-08), assessed by the AAA
• Meets Ohio Medicaid financial eligibility at the institutional level: monthly income at or below the Special Income Level of $2,982 in 2026, with a Miller Trust for over-income applicants, and countable resources at or below $2,000 for a single applicant ($3,000 if both spouses apply); spousal-impoverishment rules protect a community spouse5
• An individual cost limit for waiver services not exceeding $14,700 per month at enrollment; the ongoing plan can go over it only if ODA approves1
• An open PASSPORT slot within the CMS-authorized limit for the waiver year1
• Lives in a community setting (home, apartment, family member's home), not a nursing facility or RCF

Services covered: the PASSPORT benefit package under OAC 5160-31-05 is limited to exactly 21 services, and nothing outside that list: adult day, alternative meals, choices home care attendant, community integration, community transition, enhanced community living, homemaker, home care attendant, home delivered meals, home maintenance and chore, home medical equipment and supplies, home modification, non-medical transportation, nutrition consultation, out-of-home respite, personal care, personal emergency response system, social work or counseling, structured family caregiving, vehicle modifications, and waiver nursing. Two bounds families routinely miss: the respite PASSPORT covers is out-of-home respite, and the transportation it covers is non-medical transportation. Home health aide service is not on the list; that is a separate Ohio Medicaid home health benefit, not a waiver service. Choices home care attendant and home care attendant are the self-direction route (see Ohio consumer direction).1

Intake: Call 1-866-243-5678 to reach the Area Agency on Aging serving your community.6 The AAA performs the clinical assessment, refers the financial application to the County Department of Job and Family Services (CDJFS), builds the service plan, and assigns a case manager. PASSPORT is the most common entry point into Ohio's long-term services system for older adults.

The Assisted Living Waiver

The Ohio Assisted Living Waiver is a Section 1915(c) waiver under OAC Chapter 5160-33. It pays a Medicaid-participating, licensed Residential Care Facility for the assisted-living service package, but never for room and board.2

Who qualifies:

• An adult Ohio resident who meets the waiver's enrollment criteria in OAC 5160-33-03 (your AAA confirms them)
• Meets nursing facility level of care
• Meets Ohio Medicaid institutional financial eligibility: income at or below the $2,982 Special Income Level and resources at or below $2,000 for a single applicant5
• Lives in (or is moving into) a Medicaid-participating, licensed Residential Care Facility in Ohio

What it covers: personal care, medication oversight, some meals, housekeeping, social activities, and limited skilled-nursing oversight within the assisted-living model. Room and board is excluded. Under OAC 5160-33-03, a participating RCF cannot charge more than the SSI federal benefit rate ($994 in 2026) minus $50, which is $944 per month in 2026; the resident pays that from income.2

The key constraint: the waiver pays a defined per-diem to the RCF, well below most private-pay rates, and facilities participate voluntarily. The participating-facility list is shorter than the full list of licensed RCFs in Ohio, so confirm a specific RCF participates and has an open Medicaid bed before counting on this waiver.

Intake: through the local AAA at 1-866-243-5678,6 coordinated with the RCF's admissions team. This waiver is the bridge between private-pay assisted living and full Medicaid coverage for someone who needs more support than PASSPORT provides at home.

The Ohio Home Care Waiver (OHCW)

The Ohio Home Care Waiver is a Section 1915(c) waiver run by ODM under OAC Chapters 5160-44, 5160-45, and 5160-46. It serves Ohioans from birth through age 59 who meet nursing facility level of care and live in the community. Enrollees are disenrolled no later than 120 calendar days after their 60th birthday and offered a transition to PASSPORT if they meet all of its eligibility criteria.3

Who qualifies:

• An Ohio resident from birth through age 59 with a qualifying disability3
• Meets nursing facility level of care (intermediate or skilled), determined by a comprehensive assessment under OAC Chapter 5160-45, not the PASSPORT instrument3
• Meets Ohio Medicaid institutional financial eligibility: income at or below $2,982 per month and resources at or below $2,000 for a single applicant5
• Lives in a community setting, not a hospital, nursing facility, residential care facility, adult foster home, or other licensed group living arrangement3
• An open OHCW slot within the CMS-authorized limit for the waiver year, so meeting every clinical and financial test doesn't by itself guarantee enrollment3

What it covers: fifteen services under OAC 5160-46-06: personal care aide, home care attendant, waiver nursing, home-delivered meals, home maintenance and chores, home modification, community integration, community transition, personal emergency response systems, out-of-home respite, structured family caregiving, adult day health center, supplemental transportation, supplemental adaptive and assistive devices, and vehicle modification. The individual cost limit is $14,700 per month for waiver services, though community transition, home maintenance and chore, home modification, self-directed goods and services, supplemental adaptive and assistive devices, and vehicle modification sit outside that limit. Supplemental adaptive and assistive devices are limited to $10,000 per calendar year per individual (OAC 5160-46-11), which ODM can exceed for a documented need; it's a prior-approved ceiling for equipment no other source pays for, not a budget, and ODM approves only the lowest-cost option that meets the need. Vehicle modification is limited to $10,000 per calendar year (OAC 5160-46-09), and only for a vehicle owned by the individual or by a person who provides the individual's primary long-term support. Personal care aide service can be self-directed through a non-agency worker rather than an agency employee.3

Intake: start with the Ohio Medicaid Consumer Hotline at 1-800-324-8680, ODM's contact point for help with an application or other questions.7 Eligibility turns on an in-person comprehensive assessment, and case management is provided by an ODM-designated contractor, a MyCare Ohio plan, or ODM itself.3 Many applicants are referred by hospital discharge planners, SSI/SSDI representatives, or vocational rehabilitation. 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 others. MyCare uses managed care to deliver an integrated Medicare-and-Medicaid benefit through a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP), defined in OAC 5160-58-01 and 42 CFR 422.2 as a single entity holding both a Medicare Advantage contract with CMS and a Medicaid managed care contract with the state.4 In practice that means a participant's long-term services are delivered through the MyCare plan rather than through ODA/ODM fee-for-service; confirm with your plan and case manager exactly which waiver services carry over, since that is set by the plan's contract and your service plan rather than by a published statewide list.

Who qualifies:

• A full-dual eligible age 21 or older with full Medicaid and Medicare Parts A, B, and D4
• Is not already enrolled in PACE, a Developmental Disabilities waiver (Individual Options, SELF, or Level One), or an Intermediate Care Facility, and has no other health insurance that covers both inpatient hospital stays and doctor visits4
• Lives in Ohio. Next Generation MyCare launched in 29 counties on January 1, 2026 and rolled out to the rest of the state from April 1 to August 1, 2026; ODM now reports it implemented across Ohio4
• Meets PASSPORT or OHCW clinical eligibility (NF LOC)
• Enrolled in a MyCare FIDE-SNP plan. For plan year 2026, three plans are available statewide to new members: Anthem Blue Cross and Blue Shield, CareSource, and Molina Healthcare of Ohio. Buckeye Health Plan is not an option for new members in 2026, and Aetna Better Health of Ohio and UnitedHealthcare Community Plan stopped being MyCare Ohio plans on December 31, 20254

What it covers: continuation of PASSPORT or OHCW services, plus all standard Medicare and Medicaid services, plus the integrated care coordination the FIDE-SNP model provides.

Intake: Next Generation MyCare isn't something you apply to. ODM says eligible people are in the program once it's available in their county, and anyone who didn't pick a plan is automatically enrolled in one for their Medicaid benefits. A Medicaid-only member can switch plans within 90 days of joining, or later for just cause; a member who gets both Medicare and Medicaid through the plan can change plans at any time through Medicare.4 For help with an application or other questions, call the Ohio Medicaid Consumer Hotline at 1-800-324-8680.7 For full-dual eligibles, MyCare is the operational form of HCBS coverage even though the underlying authority remains PASSPORT or OHCW, which matters for service plans, appeals, and provider participation.

The DODD Waivers: Individual Options, Level One, SELF

Three DODD waivers serve the developmental disability population through Ohio's County Boards of Developmental Disabilities under the Ohio Department of Developmental Disabilities. All three require ICF/IID level of care and Ohio Medicaid institutional financial eligibility (income at or below $2,982 per month and resources at or below $2,000 for a single applicant).5

Individual Options (IO) Waiver

The IO Waiver is DODD's comprehensive waiver, with the broadest service package and the highest expenditure ceiling. It supports people with developmental disabilities in settings from family homes to leased apartments to small group homes, and it has historically carried multi-year waitlists in many counties. Your County Board of DD reports your current waitlist position and the waiver's current service package; DODD publishes both on its Individual Options Waiver page.

Level One Waiver

The Level One Waiver is DODD's lower-intensity waiver, for people with developmental disabilities living in the family home or their own home with relatively lower support needs. It funds a narrower set of supports than the IO Waiver and operates under an annual expenditure cap; DODD publishes the current service list and cap on its Level One Waiver page.

SELF Waiver

The Self-Empowered Life Funding (SELF) Waiver is DODD's self-direction model. The individual or an authorized representative manages a budget, hires support workers, and directs services, which means it also asks for demonstrated capacity, with supports as needed, to direct the service plan. Current service categories and budget rules are on DODD's SELF Waiver page.

DODD Intake

All three DODD waivers are accessed through the County Board of Developmental Disabilities in the applicant's county. The County Board determines DODD eligibility, conducts the ICF/IID level-of-care assessment, develops the Individual Service Plan, assigns a Service and Support Administrator (SSA) as case manager, and coordinates with CDJFS for the financial application. Find your County Board at dodd.ohio.gov.

How HCBS Waivers Interact With Nursing Facility Medicaid

A nursing-facility-Medicaid resident moving back to the community can enroll in PASSPORT (age 60+), OHCW (under 60 with a qualifying disability), or a DODD waiver. Ohio's Money Follows the Person program, HOME Choice, supports these transitions.

In the reverse direction, a waiver participant whose needs exceed the community waiver's scope can move to nursing facility Medicaid. This commonly happens when:

• The clinical condition deteriorates past what community services can safely support
• The plan-of-care cost would exceed the waiver's expenditure limit (PASSPORT's is $14,700 per month)1
• The primary informal caregiver is no longer available
• A specific need (24-hour skilled monitoring, behavioral safety, complex wound care) cannot be safely met at home

The transition under the same Medicaid eligibility is routine financially, though the patient-liability calculation changes because the personal needs allowance differs by setting. See 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 does not 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 some non-medical home care hours, but those are plan-specific and do not replace the waiver pathway.

For dual eligibles (Medicare plus Medicaid), Medicare is primary for medical services and the HCBS waiver is the source of long-term community-based supports. Since Next Generation MyCare finished rolling out statewide in 2026, both are integrated under its FIDE-SNP plans for full-dual eligibles age 21 and older.4 For more on the home care versus home health distinction, see Ohio home care vs. home health.

Application Pathway in Brief

The detailed procedural guide is at how to apply for Ohio Medicaid. The HCBS waiver application runs along two tracks that must converge:

1. Financial track: the LTC Medicaid application (ODM 07400 plus the LTC supplement) filed with the County Department of Job and Family Services or through benefits.ohio.gov. CDJFS reviews income, resources, and the 60-month lookback for asset transfers under OAC 5160:1-6-06.8
2. Clinical track: the level-of-care assessment for aged-and-disabled waivers, or the County Board of DD eligibility determination plus ICF/IID assessment for DODD waivers. For aged-and-disabled waivers, the AAA also builds the service plan and assigns the case manager.

Once both tracks are approved, enrollment is finalized and services begin. Consumer-direction participants complete the Public Partnerships LLC enrollment for fiscal management at the service-plan stage.

What Ohio Medicaid 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 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; Assisted Living Waiver residents pay capped room and board of $944 per month in 2026 from their income.2
• Long-term care insurance premiums.
• Medical services 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.

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

Every Section 1915(c) HCBS waiver must satisfy federal cost-neutrality: CMS approves a waiver only if the average cost of serving its population in the community does not exceed the cost of serving them in the institutional alternative. This is the federal gatekeeper that constrains waiver expansion.

Ohio implements cost-neutrality through individual plan-of-care expenditure ceilings. PASSPORT sets an individual cost limit of $14,700 per month for waiver services,1 and the Ohio Home Care Waiver sets the same $14,700 monthly limit, with several capital and one-time services sitting outside it.3 When a participant's needs would exceed the cap, the choice is to prioritize within the cap, request an exception where the waiver's rules allow one, or transition to nursing facility care. The cap is structural, not arbitrary, and understanding it before enrolling reduces the shock of a later transition.

Next Steps for Ohio Families

For families starting an HCBS waiver application:

For deeper coverage, see the companion guides on PASSPORT, the Assisted Living Waiver, the Ohio Home Care Waiver, the MyCare Ohio Waiver, and the Ohio Medicaid hub.

Key Ohio HCBS waiver intake and information contacts, all free:

Learn More

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

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.