Ohio Home Care Waiver 2026: OHCW Eligibility & Services

The Ohio Home Care Waiver (OHCW) is the Medicaid waiver for Ohioans from birth through age 59 who need nursing-facility-level care at home. It is a federal section 1915(c) home and community-based services waiver administered by the Ohio Department of Medicaid (ODM) under Ohio Administrative Code Chapters 5160-44, 5160-45, and 5160-46.1 It is for people who, without the waiver, would need care in a hospital or nursing facility, so an adult under 60 at that level of need can use it to get long-term care at home instead. An enrollee is disenrolled no later than 120 calendar days after their 60th birthday and is offered the opportunity to transition to the PASSPORT waiver if all of that program's eligibility criteria are met.1

This guide is the operational deep-dive on OHCW, distinct from the Ohio HCBS waivers overview, the Ohio PASSPORT deep-dive, and the Ohio Medicaid application procedural guide. It covers eligibility in detail, how OHCW differs structurally from PASSPORT, the common entry points, the service package and the limits on it, consumer direction, the personal needs allowance and patient liability, the age-60 transition, and appeals.

Key Takeaways

• OHCW is the Ohio HCBS waiver for people from birth through age 59 who need a nursing-facility level of care. Authority: OAC Chapter 5160-46. It is administered by ODM under OAC Chapters 5160-44, 5160-45, and 5160-46, not by the Ohio Department of Aging (ODA).1
• Eligibility: birth through age 59, eligible for Ohio Medicaid (under OAC Chapters 5160:1-1 to 5160:1-6), and determined to have a nursing-facility-based level of care (intermediate or skilled) through the OAC Chapter 5160-45 comprehensive assessment.1 For institutional and HCBS-waiver Medicaid, the 2026 financial test is income at or below the Special Income Level of $2,982 per month (300 percent of the SSI federal benefit rate) and countable resources at or below $2,000 for a single applicant.2,3
• Developmental disabilities have their own waivers. Ohio runs separate Developmental Disabilities waivers, Individual Options, Level One, and Self-Empowered Life Funding (SELF).4 If the disability is developmental, ask the Ohio Department of Developmental Disabilities (DODD) or your County Board of Developmental Disabilities about those before settling on OHCW.
• The service package is set by OAC 5160-46-06 and includes personal care aide, home care attendant, waiver nursing, home-delivered meals, home modification, structured family caregiving, personal emergency response, respite, and supplemental adaptive devices and vehicle modification (each limited to $10,000 per calendar year, though ODM or its designee may approve adaptive-device spending above that limit when there is a documented need). That $10,000 is a ceiling, not a budget: ODM approves only items no other funding source covers, and only the lowest-cost option that meets the assessed need.1
• Self-direction is available: personal care aide service may be delivered by a non-agency aide rather than an agency employee. The rule limiting paid work by parents of minor children, spouses, and relatives with legal decision-making authority to the conditions in OAC 5160-44-32 is written for agency aides; whether those relatives can be paid outside an agency is not settled by those rules, so confirm with ODM first.1 See /caregiver/ohio/consumer-direction.
• The individual cost limit for waiver services is $14,700 per month. Community transition, home maintenance and chore, home modification, self-directed goods and services, supplemental adaptive and assistive devices, and vehicle modification are excluded from that limit, and ongoing costs may exceed it if ODM approves.1
• At age 60, the participant is disenrolled within 120 days and offered transition to PASSPORT if all of PASSPORT's eligibility criteria are met.1

In This Guide

• Who the Ohio Home Care Waiver Serves
• How OHCW Differs From PASSPORT
• Do You Qualify? Eligibility in Detail
• How People Enter OHCW
• What the Ohio Home Care Waiver Covers
• The Plan-of-Care Cost Limit
• How the Age-60 Transition to PASSPORT Works
• How OHCW Relates to MyCare Ohio
• How to Appeal a Denial
• Learn More

Who the Ohio Home Care Waiver Serves

The Ohio Home Care Waiver serves Ohioans from birth through age 59 with disabilities that produce a nursing-facility-based level of care need.1 Conditions that can bring someone to that level of need include:

• Progressive neurological conditions such as multiple sclerosis, ALS, Huntington's disease, and Parkinson's-plus syndromes.
• Spinal cord injury, traumatic brain injury (non-developmental), stroke, or major cardiac events that leave persistent functional limitations.
• Complex chronic medical conditions such as advanced kidney disease on dialysis, severe COPD, or severe rheumatologic disease producing functional dependence.
• Children and adolescents with qualifying disabilities, since the waiver covers participants from birth.

Participants may live with family, with informal caregivers, or alone with paid support. What they cannot do is live in a facility: the waiver requires a home or community setting rather than a hospital, nursing facility, residential care facility, or adult foster home.1

How OHCW Differs From PASSPORT

OHCW and PASSPORT serve different ages and run on different administrative tracks. The differences below are the ones that change where a family applies and who assesses the applicant.

PASSPORT's side of the table comes from OAC Chapter 5160-31, which ODA operates under an agreement with ODM.5

The administrative split is the practical difference. OHCW is an ODM-administered waiver: case management is provided by a case management contractor that ODM designates, which may be a contracted case management agency, a MyCare Ohio plan, or ODM itself.1 The rule does not name which entity holds that contract in any given region, so ask ODM or the Ohio Medicaid Consumer Hotline who your case management contractor is rather than assuming it is the local Area Agency on Aging that runs PASSPORT. Eligibility and level of care are determined by the OAC 5160-45-01(N) comprehensive assessment, an in-person evaluation of daily activities, natural supports, cognition, health, behavioral health, safety, and the home environment.1 Both waivers require an intermediate or skilled level of care; what differs is who administers the waiver and arranges the assessment.5

If the participant is working or in school, Opportunities for Ohioans with Disabilities (OOD), Ohio's vocational rehabilitation agency, may be worth contacting alongside OHCW.

Do You Qualify? Eligibility in Detail

Age

The participant must be from birth through age 59. An enrollee is disenrolled from OHCW no later than 120 calendar days after their 60th birthday and is offered the opportunity to transition to PASSPORT if all of that program's eligibility criteria are met.1

Nursing Facility Level of Care

The applicant must be determined to have a nursing-facility-based level of care, intermediate or skilled, using the OAC 5160-45-01(N) comprehensive assessment, which includes an in-person evaluation.1 In plain terms, that describes a person who, without the waiver, would need care in a hospital or nursing facility.1

To enroll and stay enrolled, the participant must meet one of two service-need tests: either need and agree to receive at least one waiver service each month that is not otherwise available from another source, or need continuous nursing services longer than four hours, plus at least one waiver service annually, plus monthly monitoring of health and welfare through a combination of telephone and in-person contacts with the case manager.1 The second test matters for participants whose care is dominated by skilled nursing rather than by a monthly waiver service.

Meeting every test does not by itself secure a place. Enrollment also needs an available OHCW slot within the limit CMS authorizes for the waiver year, and ODM gives priority for the eligibility assessment to six groups, including a person aged 21 to 59 who spent at least 14 consecutive days as a hospital inpatient immediately before applying and a person under 60 at imminent risk of institutionalization after the documented loss of a primary caregiver. A denial or disenrollment comes with a notice of hearing rights.1

Residency and Setting

The applicant must be able to live in a home or community setting that is not a hospital, nursing facility, ICF-IID, residential care facility, adult foster home, or other state-licensed group living arrangement, and their needs must be able to be met safely there. Someone in a nursing facility can still qualify if they are able to move out; a person under 60 living in a Medicaid-funded nursing facility is one of the priority groups.1

Financial Eligibility

OHCW uses the Ohio Medicaid institutional and HCBS financial framework. For 2026:

• Income at or below the Special Income Level of $2,982 per month (300 percent of the SSI federal benefit rate) for a single applicant.2 An applicant whose income exceeds that limit may establish a Qualified Income Trust, also called a Miller Trust, under OAC 5160:1-6-03.2 to bring countable income to or below it; any income not deposited into the trust still counts.3
• Countable resources at or below $2,000 for a single applicant ($3,000 if both spouses apply); spousal impoverishment rules protect a community spouse's share.2
• Watch the 60-month look-back. Under OAC 5160:1-6-06, giving away assets for less than fair market value in the 60 months before the baseline date is presumed improper and triggers a restricted Medicaid coverage period, a stretch when Medicaid will not pay for long-term care services. For a waiver applicant, the baseline date is the first date they have both applied for Medicaid and requested waiver enrollment. The rule ties that waiver provision to SIL-based eligibility, so ask the county about your case before assuming it applies.6
• Home equity at or below the 2026 federal limit of $752,000.2

If an applicant holds personal-injury settlement proceeds, how that money is moved matters. Ohio's transfer rule does not treat assets placed in a trust for the sole benefit of a disabled person under 65 as an improper transfer, provided the trust spends on an actuarially sound basis, so talk to an elder-law or special-needs attorney before moving settlement money.6 See /medicaid/ohio/eligibility-income-limits.

How People Enter OHCW

There are several ways in:

• Hospital discharge. After a stroke, spinal cord injury, or severe cardiac event, ask the hospital discharge planner or rehabilitation social worker about starting an OHCW referral as part of discharge planning. A person aged 21 to 59 with 14 consecutive inpatient days immediately before applying is a priority group for the assessment.1
• An SSI or SSDI claim. Ohio became a 1634 state on August 1, 2016,2 and in a 1634 state an approved Supplemental Security Income (SSI) award generally enrolls the recipient in Medicaid with no separate Medicaid application. That route depends on meeting certain citizenship or immigration status requirements; Social Security refers someone who may not meet them to the state, which is not a Medicaid denial.7 Medicaid alone does not put someone on OHCW, which has its own tests and enrollment.1
• Vocational rehabilitation. A participant working with Opportunities for Ohioans with Disabilities (OOD) on employment goals can ask about OHCW alongside that work.
• Family-initiated. Families caring for an adult son, daughter, sibling, or spouse with a disability can call the Ohio Medicaid Consumer Hotline at 1-800-324-8680, whose staff help complete an application.8

What the Ohio Home Care Waiver Covers

The Ohio Home Care Waiver service package is set by OAC 5160-46-06, which lists fifteen services.1 The named services include:

• Personal care aide service. It may be delivered by an agency aide or, under consumer-directed care, by a non-agency direct care worker.1
• Home care attendant service.
• Waiver nursing.
• Home-delivered meals.
• Home maintenance and chore service.
• Home modification.
• Community integration and community transition services.
• Structured family caregiving, a named OHCW service.1
• Adult day health center service.
• Personal emergency response systems (PERS).
• Out-of-home respite to relieve a primary informal caregiver. For deeper guidance on Ohio respite options, see /caregiver/ohio/respite-care.
• Supplemental transportation.
• Supplemental adaptive and assistive devices, limited to a combined total of $10,000 within a calendar year under OAC 5160-46-11. That limit is not absolute: the same rule lets ODM or its designee approve device services above it when there is a documented need. It is also a ceiling rather than a budget, since the service reaches only equipment and supplies no other funding source covers, every purchase is prior-approved, and ODM approves only the lowest-cost alternative that meets the assessed need.1
• Vehicle modification, with service authorization limited to $10,000 per calendar year under OAC 5160-46-09. The vehicle must be owned by the participant, by a relative who provides their primary long-term support, or by an unpaid non-relative who does; vehicles owned by businesses or provider agencies don't qualify, and modifications another funding source covers fall outside the service.1

When a needed device costs more than the $10,000 annual device limit, the first move is to document the need and ask the case management contractor to seek ODM approval above the limit, not to assume the item has to wait for next year.1 Vehicle modification is capped as a per-calendar-year authorization, so ask the case management contractor how a project above $10,000 would be handled before committing to one.1

Consumer Direction

Personal care aide service may be delivered by a non-agency personal care aide rather than an agency employee.1 For parents of minor children, spouses, and relatives appointed legal decision-making authority, the restriction sits in the rule for agency aides, OAC 5160-46-04(G)(4), which lets them serve as a direct care worker only in accordance with OAC 5160-44-32, and 5160-44-32 itself covers agency-delivered aide and nursing services. Whether and on what terms one of those relatives can be paid outside the agency route is not settled by those two rules, so confirm with ODM before a family relies on that income.1 For the operational mechanics, see /caregiver/ohio/consumer-direction.

Patient Liability and the Personal Needs Allowance

A participant with income contributes part of it toward the cost of care (patient liability), but the post-eligibility budget first preserves a personal needs allowance. For someone on OHCW, that allowance is the Special Individual Maintenance Needs Allowance (SIMNA), which OAC 5160:1-6-07.1 sets at 65 percent of the special income level. For 2026 ODM publishes the SIMNA as $1,939 per month, effective January 1, 2026, and if the participant has earned income, up to another $65 of that income is subtracted as well.9

Do not apply the $75 figure that circulates for Ohio nursing facility residents. That $75 is the institutional personal needs allowance under OAC 5160:1-6-07, and it governs post-eligibility budgeting for people living in a medical institution.10 The two allowances answer different questions: the institutional figure applies to someone living in a medical institution, while the SIMNA is the amount set aside for an OHCW participant's own maintenance needs while living in the community.9 The SIMNA is also only the first deduction. Ohio then subtracts, in order, any allowance for a community spouse or dependent family, health insurance premiums and cost-sharing, and medical expenses Medicaid doesn't cover, plus up to $15 a month (or an agency-approved amount) to run a qualified income trust; only what's left is patient liability. You get written notice of that amount and can request a hearing if you disagree with it.9 A participant who later moves onto the assisted living waiver gets a third figure, the Assisted Living Maintenance Needs Allowance, equal to the SSI federal benefit rate of $994 per month for 2026.9

The Plan-of-Care Cost Limit

Ohio sets an individual cost limit for OHCW waiver services of $14,700 per month, under OAC 5160-46-02(B)(9). Six services are excluded from that limit: community transition, home maintenance and chore, home modification, self-directed goods and services, supplemental adaptive and assistive devices, and vehicle modification. The limit is tested twice: at enrollment, the initial cost of waiver services in the person-centered services plan may not exceed it, and after that, the ongoing cost may not exceed it unless ODM approves.1

Two things follow when a family is building a plan. First, equipment, home modification, and vehicle modification do not count against the monthly limit, so spreading them across plan years does nothing to free up room under it; sequencing is a question about the separate $10,000 annual limits, not about the cost limit. Second, what does count is the recurring core of the plan, including personal care aide hours, waiver nursing, home-delivered meals, adult day health center service, and respite.1 The initial plan has to fit under $14,700 at enrollment, but an enrolled participant whose recurring care later prices out above it should ask the case management contractor to seek ODM approval to exceed the limit, rather than treating a trimmed plan as the last word.1

When community supports genuinely cannot meet a participant's needs within it, the alternatives are the assisted living waiver or nursing facility care.

How the Age-60 Transition to PASSPORT Works

When an OHCW participant turns 60, they are disenrolled from OHCW no later than 120 calendar days after the birthday and are offered the opportunity to transition to PASSPORT if all of PASSPORT's eligibility criteria are met.1 The transition is an offer contingent on qualifying for the receiving waiver, not an automatic rollover. Administration shifts from ODM to the Ohio Department of Aging, and PASSPORT's own criteria in OAC 5160-31-03 include an available PASSPORT slot and the same $14,700 monthly cost limit, so the participant still has to meet them to land there.5 Families should start tracking the timeline well before the 60th birthday, because the 120-day window is the period in which the transition has to be arranged.

If community supports cannot safely meet the participant's needs before 60, the next step depends on circumstances. A participant who moves to a Medicaid-participating licensed residential care facility uses the assisted living waiver under OAC Chapter 5160-33, which pays for the assisted-living service package but never for room and board;9 see /medicaid/ohio/assisted-living-waiver. A participant whose clinical needs exceed both community and assisted-living capacity uses nursing facility Medicaid; see /care-types/ohio/nursing-homes.

How OHCW Relates to MyCare Ohio

Ohio's integrated managed-care program for people who have both full Medicaid and Medicare is Next Generation MyCare. It is open to people age 21 or older who have full Medicaid plus Medicare Parts A, B, and D, and it replaced the prior MyCare Ohio demonstration as of January 1, 2026.4 An OHCW participant who does not have Medicare is not in MyCare. A participant 21 or older who gains Medicare through Social Security Disability Insurance or End-Stage Renal Disease and has full Medicaid is placed in the program rather than applying to it, and is automatically enrolled in a plan if they don't pick one, unless they are already in PACE, a Developmental Disabilities waiver, or an intermediate care facility, or have other insurance covering both hospital stays and doctor visits.4 On the SSDI route, premium-free Part A begins with the twenty-fifth month of SSDI entitlement, so plan on that timing rather than on the date the disability claim is approved. The main exception is ALS, where Medicare starts with the first month of disability benefits.11

In 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, though a current Buckeye member who wants to keep the plan doesn't need to do anything.4 ODM rolled out Next Generation MyCare in 29 counties on January 1, 2026 and in the rest of Ohio from April 1 to August 1, 2026, so it now runs statewide.4

How to Appeal a Denial

OHCW applicants and participants who are denied initial eligibility, denied a service plan request, terminated, or facing a service reduction have State Hearing appeal rights through the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings. Ohio allows 90 calendar days to request a hearing, starting the day after the notice of action is mailed, and that clock runs only if you received notice of your hearing rights for that action.12 Ninety days is the most federal rules allow under 42 CFR 431.221(d), not a floor you are guaranteed, so go by the deadline printed on your own notice of action.13 You can ask orally, in writing, or electronically: call or write your county agency, or mail the request form to ODJFS Bureau of State Hearings, PO Box 182825, Columbus, Ohio 43218-2825, or fax it to (614) 728-9574.12

Keeping services at the prior level during the appeal runs on a second, shorter clock. For a notice that reduces, stops, or restricts services, request the hearing within 15 days of receiving it. Continuation is conditional: Ohio's rule lists ten circumstances that end it, including a hearing finding that the sole issue is one of law rather than fact, and withdrawing the appeal. If you miss the 15 days but your request arrives within 10 calendar days after the action takes effect and you show good cause, such as a death in the immediate family or a sudden illness, benefits are reinstated back to the date they were cut; if services were cut with no prior notice, a request within 15 days of the notice's mailing date restores them. If you lose the hearing, you may have to repay benefits you were not eligible for. If services changed without written notice, or changed even though you asked for a hearing in time, call the Bureau at 1-866-635-3748 to ask whether benefits should continue; the same line lets you join a hearing by phone if you can't attend in person.12 Behind those Ohio rules sits 42 CFR 431.230: a hearing requested before the action's effective date keeps services in place until a decision, unless the hearing determines the sole issue is one of federal or state law or policy and the agency promptly tells you in writing that services will be cut pending the decision.14

For complex appeals (disability determination disputes, equipment authorization denials), Disability Rights Ohio works on disability-related Medicaid issues. The Ohio Legal Help network can direct a family to free local legal aid.

What OHCW Does Not Cover

OHCW does not pay for the following, which fall outside the OAC 5160-46-06 waiver service package:1

• Room and board in any setting, including assisted living; the participant lives in their own or a family member's home and no housing cost is covered.
• Custodial nursing facility care, which is institutional Medicaid.
• Acute medical care, prescription drugs, or physician services, which are standard Medicaid.
• Services Medicare covers for dual eligibles, where Medicare is primary.
• Vocational rehabilitation services available through OOD, which are funded separately.

Operational Mistakes Families Make

1. Confusing OHCW with PASSPORT, or with the Developmental Disabilities waivers. Birth through 59 is OHCW; PASSPORT enrolls people 60 or older.5 For a developmental disability, ask DODD or the County Board of Developmental Disabilities about Ohio's separate DD waivers too.
2. Missing the SSI Medicaid pathway. Ohio became a 1634 state on August 1, 2016,2 and in a 1634 state an SSI award generally enrolls the recipient in Medicaid with no separate Medicaid application, provided certain citizenship or immigration status requirements are met.7
3. Treating the $10,000 device limit as final. ODM or its designee can approve adaptive-device services above it on a documented need, so a family that stops at the figure may accept less equipment than the participant needs.1
4. Budgeting the wrong personal needs allowance. An OHCW participant living at home is budgeted with the $1,939 SIMNA as the personal needs allowance, not the $75 institutional figure.9
5. Not asking about self-direction. OHCW lets a participant use a non-agency personal care aide rather than an agency employee; spouses, parents of minor children, and relatives with legal decision-making authority face extra conditions, so confirm with ODM before counting on pay for a relative.1
6. Not planning for settlement proceeds. Moving a personal-injury settlement or inheritance the wrong way can trigger a restricted coverage period; a trust for the sole benefit of a disabled person under 65 is one of the transfers Ohio does not treat as improper, so get legal advice first.6
7. Not tracking the age-60 transition, which has to be arranged inside the 120-day window and depends on qualifying for PASSPORT.

Next Steps for Ohio Families

Learn More

Find personalized help navigating the Ohio Home Care Waiver 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.