Ohio PASSPORT Waiver 2026: Eligibility, Services & Apply

In 2026, the Ohio PASSPORT waiver pays for in-home care for Ohioans age 60 and older who would otherwise need a nursing facility. To qualify, a person must be 60 or older, meet a nursing facility level of care, and meet Ohio's institutional Medicaid financial rules. PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) is the state's largest Medicaid Home and Community-Based Services (HCBS) waiver for older adults, and it covers personal care, homemaker help, adult day, meals, and other community supports. It is authorized under Ohio Administrative Code Chapter 5160-31 and run day to day by the Ohio Department of Aging (ODA) through Ohio's Area Agencies on Aging (AAAs) under an agreement with the Ohio Department of Medicaid (ODM).1

This guide is the operational deep-dive on PASSPORT, distinct from the Ohio HCBS waivers overview and the Ohio Medicaid application guide. It walks through:

• The four eligibility tests: age, residency, clinical (nursing facility level of care), and financial.
• The in-home assessment and how the level-of-care determination works.
• The full PASSPORT service package and the per-person monthly cost cap.
• How the service plan is built, the role of the AAA case manager, and how to appeal a denial or reduction.

Key Takeaways

• PASSPORT is the Ohio Medicaid waiver for older adults in the community. A participant must be age 60 or older at enrollment, meet an intermediate or skilled nursing facility level of care, and meet Ohio institutional Medicaid financial eligibility. Authority: OAC Chapter 5160-31.1
• Administered by ODA through Area Agencies on Aging. ODA delegates daily operations to its designees, which are the listed AAAs plus Catholic Social Services of the Miami Valley. The AAA handles intake, the in-home assessment, the service plan, and case management. Statewide intake: 1-866-243-5678.1
• Level of care is functional, not diagnostic. The assessment looks at activities of daily living, instrumental activities of daily living, cognition, behavioral health, medical complexity, and available informal support. No single diagnosis automatically qualifies or disqualifies.
• The service package covers 21 services. Personal care, homemaker, adult day, home-delivered meals, transportation, personal emergency response systems, home modifications, respite, waiver nursing, and consumer-directed options are among them. The mix is individualized in the service plan.1
• Each plan of care has a hard monthly cost cap of $14,700. Under OAC 5160-31-03, an individual's PASSPORT waiver services cannot exceed $14,700 per month, which is why the waiver typically does not fund 24-hour personal care in the home.1
• Consumer direction lets family members be paid. Through Consumer-Directed Personal Care Service and the Choices Home Care Attendant Service, a participant can hire a family member (other than a spouse, with a narrow conditional exception under OAC 5160-44-32) as a paid attendant. See /caregiver/ohio/consumer-direction.
• Appeals have a 90-day window. State Hearings on PASSPORT denials, reductions, or terminations must be filed within 90 days of the adverse notice. File at 1-866-635-3748.

Who PASSPORT Serves

PASSPORT serves older Ohioans who, without community-based services, would qualify for nursing facility placement: a person must be age 60 or older and meet an intermediate or skilled nursing facility level of care.1 Most participants are women, most are over age 75, and most have multiple chronic conditions with functional limitations in activities of daily living or instrumental activities of daily living. A substantial share have cognitive impairment or dementia. The common thread: the person could be on a Medicaid nursing facility bed but lives in the community instead, because PASSPORT funds the supports that make community living safe.

In practice, PASSPORT serves three rough situations:

1. The frail older adult who lives alone and needs help with personal care, meals, medication management, and household tasks to stay home safely. The trigger is often a hospitalization, a fall, a stroke, or a slow decline a family or physician notices.
2. The older adult who lives with family whose relatives provide the primary care but need paid supplements (respite, adult day, personal care) so the family caregiver can work, sleep, or recover. Here PASSPORT supplements informal care rather than replacing it.
3. The older adult with cognitive impairment whose family manages dementia care at home and needs adult day, respite, and oversight to maintain the home placement. For dementia-specific guidance, see /care-types/ohio/memory-care.

In all three, the trigger for applying is usually a transition: a hospital discharge, a post-rehab return, family caregiver burnout, or a clinical event that surfaces the gap between what informal care covers and what the older adult needs.

Ohio PASSPORT Waiver Eligibility in Detail

A PASSPORT applicant must clear four tests: age, residency, clinical level of care, and financial eligibility.

Age

The participant must be age 60 or older at the time of enrollment.1 Adults under 60 with disabilities are served by the Ohio Home Care Waiver (OHCW) under OAC Chapter 5160-46 instead of PASSPORT.

Residency

The participant must be an Ohio resident. PASSPORT has no minimum length-of-residency requirement beyond establishing Ohio as the state of legal residence, consistent with federal Medicaid residency rules at 42 CFR 435.403.

Setting

The participant must live in a community setting: their own home, an apartment, a family member's home, or another non-institutional arrangement. PASSPORT does not serve nursing facility residents (who receive institutional Medicaid) or residents of licensed Residential Care Facilities (who use the Assisted Living Waiver under OAC Chapter 5160-33). A nursing facility resident planning to return to the community can apply for PASSPORT in anticipation of discharge, and the AAA conducts the assessment during discharge planning. PASSPORT enrollment is also mutually exclusive: a participant cannot be simultaneously enrolled in the state-funded PASSPORT or assisted living components, another Medicaid HCBS program, the Residential State Supplement program, or PACE.1

Financial Eligibility

PASSPORT requires Ohio Medicaid financial eligibility at the institutional level, which means:

• Income at or below the Special Income Level, set at 300 percent of the SSI federal benefit rate, which is $2,982 per month for 2026. An applicant over that limit can use a Miller Trust (Qualified Income Trust) to establish eligibility. For the income limit and Miller Trust mechanics, see /medicaid/ohio/eligibility-income-limits.2
• Countable resources at or below $2,000 for a single applicant ($3,000 if both spouses apply). For a married couple with one spouse applying, the community-spouse resource allowance under federal spousal-impoverishment rules protects part of the couple's resources for the spouse at home.2
• No improper transfers in the 60-month lookback period. Gifts and transfers below fair market value trigger a transfer penalty.
• Home equity at or below $752,000 for 2026, the federal home-equity exclusion limit Ohio applies.2

For couples, the planning around the community-spouse resource allowance, the snapshot date, and the spousal resource assessment is the highest-leverage procedural work. See /medicaid/ohio/how-to-apply for the application guide.

Clinical Eligibility: Nursing Facility Level of Care

PASSPORT requires that the applicant meet an intermediate or skilled nursing facility level of care under OAC rule 5160-3-08, meaning that without waiver services they would qualify for nursing facility placement.1 Level of care is determined through an in-home comprehensive assessment administered by AAA assessors. The assessment looks at:

• Activities of daily living (ADLs): bathing, dressing, transferring, toileting, eating, and continence. The assessor records whether the applicant needs help with each and to what degree (independent, supervision, limited assistance, extensive assistance, or total dependence).
• Instrumental activities of daily living (IADLs): meal preparation, medication management, housekeeping, laundry, transportation, telephone use, shopping, and managing finances.
• Cognitive function: memory, decision-making, and the ability to understand and be understood.
• Behavioral health: behaviors that affect safety or care, mood symptoms, and sleep disruption.
• Medical complexity: chronic conditions, medications, recent hospitalizations, recent falls, skin integrity, nutrition, and pain.
• Informal support: the availability and capacity of family, friends, and neighbors to provide care.
• Environmental factors: home safety, accessibility, distance from medical care, and isolation.

Level-of-care determination in Ohio is functional and clinical, not diagnostic. A specific diagnosis such as dementia or Parkinson's disease does not automatically qualify; what qualifies is the functional impact of the conditions combined with available informal support.

This is why two people with the same diagnosis can have different outcomes. A person with mild-to-moderate dementia who lives alone with limited family involvement may meet the level of care because the cognitive impairment plus the lack of support creates real safety risk. Another person with similar dementia who lives with an attentive spouse may not, because the informal support compensates for the impairment. The assessment is designed to capture this variation.

The In-Home Assessment Process

The PASSPORT assessment is administered in person at the applicant's home by a registered nurse, licensed social worker, or other qualified professional employed by or contracted with the AAA.1 It moves through four stages, from the first phone call to the written level-of-care determination.

What to Do If You Disagree With the Assessment

If the family believes the assessment did not capture the applicant's functional limitations, they have options:

• Request a reassessment through the AAA with new clinical information or observations
• Submit physician documentation elaborating on functional limitations the assessment may have under-captured
• Request a second opinion from a different AAA assessor where available
• File a State Hearing appeal within 90 days of the adverse notice and present the case to a State Hearing Officer

For applicants with cognitive impairment, documented evidence of specific incidents (wandering, medication errors, kitchen safety failures, falls, missed meals) strengthens the case substantially.

The Person-Centered Service Plan

Once the level of care is established and the applicant is financially eligible, the AAA case manager and the applicant (or representative) develop the person-centered service plan, the operational core of PASSPORT participation. The plan draws from the 21 covered services defined in OAC Chapter 173-39 and is bounded by the individual cost cap.1

The service plan documents the participant's goals, identified needs in each functional domain, authorized services with specific hours or units, the providers chosen from the AAA's list, the budget measured against the cost cap, backup planning, and a reassessment schedule. Each service is authorized in specific units (hours per week, meals per month, days of adult day, modifications by item) based on assessed need and participant preference within the cap.

PASSPORT is built around participant choice. Within the authorized budget, the participant chooses the mix of services, the provider for each, the agency-employed or consumer-direction model for personal care, and the schedule. The plan is not static: the case manager reviews it at least annually, and the participant can request a revision any time needs change, whether from a hospitalization, the loss or addition of an informal caregiver, a move, a provider change, or a concern about service adequacy.

The PASSPORT Service Package

The full PASSPORT service package under OAC Chapter 5160-31 comprises 21 covered services, each defined in OAC Chapter 173-39.1 The most-used services include:

Personal Care Services

Personal care covers help with ADLs (bathing, dressing, transferring, toileting, eating, continence) and IADLs (meal preparation, medication reminders, light housekeeping, laundry). It is delivered either by agency-employed home care aides through participating Medicaid home care agencies, or by consumer-directed attendants, with the participant as the managing employer and Public Partnerships LLC as the fiscal management service. The hours authorized depend on assessed need, available informal support, and the cost cap.

Homemaker Services

Homemaker services cover housekeeping, laundry, shopping, meal preparation, and other instrumental tasks the participant cannot do alone. Homemaker is conceptually distinct from personal care: homemaker is about the home environment, personal care is about the person. In practice the same worker often provides both, with the agency billing the appropriate code for each task.

Adult Day Services

Adult day services provide structured group programming during the day at an adult day center, typically for older adults with significant supervision needs (often due to dementia) who live with a family caregiver who is away during the day. Services include socialization, supervision, meals, activities, transportation, and in some adult day health centers, limited skilled nursing.

Home-Delivered Meals

PASSPORT covers home-delivered meals for participants who cannot prepare meals safely, typically delivered five days a week with frozen weekend meals available. The meal program is often run by local senior nutrition providers under contract with the AAA.

Other Core Services

The package also includes non-medical transportation to medical appointments, adult day, and other authorized destinations; personal emergency response systems (a wearable help button with monitoring); home modifications such as ramps, grab bars, stair lifts, door widening, and bathroom changes, funded up to a per-participant limit and requiring AAA approval; respite care, in-home or out-of-home, to relieve the primary informal caregiver; home health aide services delivered through Medicaid-participating agencies (distinct from Medicare-certified home health and not requiring homebound status); waiver nursing; nutrition consultation; and social work or counseling. For respite specifics in Ohio, see /caregiver/ohio/respite-care.

Consumer-Direction Services

Within PASSPORT, the participant can choose consumer direction for personal care through the Choices Home Care Attendant Service or Consumer-Directed Personal Care Service, both under OAC Chapter 5160-44. The participant becomes the managing employer who hires, trains, schedules, and supervises the attendant, while Public Partnerships LLC handles payroll, taxes, and Medicaid billing. Family members other than spouses (subject to the conditional pathway at OAC 5160-44-32) can be paid this way. For the operational mechanics, see /caregiver/ohio/consumer-direction.

The Plan-of-Care Cost Cap

The cost cap is the single most important constraint on PASSPORT service planning. Under OAC 5160-31-03, an individual's PASSPORT waiver services cannot exceed $14,700 per month.1 This individual cap implements the federal cost-neutrality requirement at 42 USC 1396n(c)(2)(D), which obligates Ohio to show the federal Centers for Medicare and Medicaid Services (CMS) that serving PASSPORT participants in the community costs less, on average, than serving them in a nursing facility.

Practical implication: PASSPORT typically cannot fund 24-hour personal care in the home, because around-the-clock attendant hours at Medicaid rates would push a plan toward or past the cap. For participants needing 24-hour supervision, the realistic options are:

1. Combine PASSPORT with substantial family or informal caregiving (the most common pattern)
2. Combine PASSPORT with PACE if available in the county (PACE provides comprehensive integrated care for nursing-facility-eligible older adults but is not statewide in Ohio; note that PACE enrollment and PASSPORT enrollment are mutually exclusive)
3. Transition to assisted living under the Assisted Living Waiver if that setting fits
4. Transition to a nursing facility if community placement is no longer feasible
5. Use the MyCare Ohio Waiver if the participant is a full-dual eligible in a MyCare county, which can offer more flexibility in service mix through the integrated plan

For families discovering that PASSPORT cannot fund what they expected, the case manager is the best resource for understanding the cap and the trade-offs. Sometimes a service-plan revision (more adult day, less personal care, or the reverse) fits the cap better; sometimes the right answer is a setting transition.

The Role of the AAA Case Manager

The AAA case manager (some AAAs use "care manager" or "service coordinator") is the participant's primary contact for the duration of PASSPORT participation. Under OAC 173-39-01, the case manager is a registered or licensed person the AAA employs to plan, coordinate, monitor, evaluate, and authorize services for enrolled individuals.1 Responsibilities include:

• Coordinating the assessment and annual clinical reassessment
• Developing and revising the service plan
• Authorizing services and providers
• Monitoring service-delivery quality and investigating provider complaints
• Coordinating with the primary care physician, home health agency, hospital discharge planners, hospice, and family caregivers
• Responding to changes in clinical condition or living situation
• Connecting the participant to resources outside PASSPORT (legal aid, food assistance, senior centers, support groups)
• Advocating for the participant when needs exceed the cost cap

Case management is a high-volume role in Ohio's HCBS system, so most contact with the case manager is by phone or scheduled visit rather than on demand. Families should know their case manager's name and direct contact information and should reach out promptly when issues arise.

When the Participant and Family Disagree With the Case Manager

Disagreements between families and case managers are common in HCBS waiver case management, usually over the hours of personal care authorized, the choice of services within the cost cap, the choice or quality of providers, the frequency of reassessment, consumer-direction decisions, or transitioning to a higher level of care.

The first step is always a direct conversation with the case manager. If that does not resolve it, the participant can ask to speak with the case manager's supervisor at the AAA. Escalation paths include:

• The AAA executive director or director of long-term services
• The Ohio Department of Aging state office
• The Ohio Long-Term Care Ombudsman at 1-800-282-1206 (the ombudsman traditionally serves nursing facility and assisted living residents but can in some cases advocate for HCBS waiver participants)
• A State Hearing appeal (the formal administrative process)

For service reductions or terminations the participant believes are wrong, the State Hearing appeal at 1-866-635-3748 is the formal due-process pathway. The 90-day filing window applies. For terminations, filing within 15 days of the adverse notice preserves aid pending hearing (continued benefits at the prior level during the appeal).

How the Ohio PASSPORT Waiver Compares to Other Long-Term Care Options

PASSPORT is one option in Ohio's long-term services and supports menu. The table below lines up the adjacent programs by who they serve and what they cover.

Choosing the right pathway depends on age, clinical needs, finances, family capacity, and geography. The AAA case manager can advise on the trade-offs, and an Ohio elder law attorney is often helpful on the financial planning side.

How PASSPORT Relates to MyCare Ohio

For full-dual eligibles (Medicare plus Medicaid) in MyCare counties, the MyCare Ohio Waiver absorbs PASSPORT services under OAC 5160-58-04. The participant's PASSPORT services continue, but operationally, day-to-day case management runs through the MyCare plan's care coordinator (often alongside a contracted AAA case manager), service authorization flows through the plan, providers must be in the plan's network or have prior authorization, and medical and HCBS coverage are integrated under one plan.

As of 2026, Ohio is replacing the original MyCare Ohio demonstration with Next Generation MyCare, structured as Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs). ODM rolled out Next Generation MyCare in 29 counties on January 1, 2026, and is expanding it to the rest of Ohio from April through August 2026.3 Three plans are available statewide to new members: Anthem Blue Cross and Blue Shield, CareSource, and Molina Healthcare of Ohio. For dual eligibles outside MyCare counties, PASSPORT continues to be administered directly by the AAA.

How PASSPORT and Medicare Home Health Differ

Families often confuse PASSPORT with Medicare home health. They are different programs that can run at the same time for the same person.

A PASSPORT participant who has a qualifying skilled-need episode (post-hospital wound care, post-stroke therapy) can receive Medicare home health concurrently with PASSPORT. The PASSPORT home health aide hours are distinct from the Medicare home health aide hours. For more, see /care-types/ohio/home-care-vs-home-health.

What PASSPORT Does Not Cover

To set expectations clearly, PASSPORT does not pay for:

• Room and board (the participant pays from their own income, retaining a personal needs allowance)
• Custodial nursing facility care (that is institutional Medicaid)
• Assisted living facility room and board (the Assisted Living Waiver covers services, not housing)
• Medical services Medicare or Medicaid pays directly (billed under standard coverage, not the waiver)
• Acute hospital care, prescription drugs, or physician services (standard Medicaid or Medicare)
• 24-hour one-on-one personal care in most cases (the $14,700 monthly cost cap typically prevents it)1
• Family caregiver wages outside the consumer-direction structure (informal family caregiving is not paid unless the family member becomes a paid worker through consumer direction or structured family caregiving)

Operational Mistakes That Hurt PASSPORT Participants

Families regularly run into preventable problems on PASSPORT. The most common:

1. Underutilizing authorized services. A participant authorized for more personal care hours than the agency can staff often accepts the shortfall instead of pushing for the full authorization or requesting a service-plan change.
2. Not understanding the cost cap. Families ask for more hours and are told no without learning that the $14,700 monthly cap is the constraint, and that a service-mix reshuffle can sometimes free up budget.1
3. Failing to use consumer direction when family caregivers exist. Many families provide uncompensated care while not enrolling in consumer direction, which could pay the caregiver legally. See /caregiver/ohio/consumer-direction.
4. Missing the annual reassessment. The annual reassessment is the formal review point for the plan. Families who skip or under-prepare for it miss the chance to request needed changes.
5. Not communicating clinical changes promptly. When a participant's condition changes, the case manager needs to know to revise the plan. Delay delays the service adjustment.
6. Confusing PASSPORT with Medicare home health. They serve different needs and can coexist, but they are not the same program.
7. Not appealing adverse decisions. State Hearing appeals are free, do not require an attorney, and frequently favor participants who present clear evidence. Many adverse decisions go unappealed because the family does not know the right exists.

Next Steps for Ohio Families

For families considering PASSPORT, the path from first call to an active service plan runs through these steps:

For broader context on Ohio Medicaid and HCBS waivers, see /medicaid/ohio and /medicaid/ohio/hcbs-waivers.

Use these free contacts to apply, ask coverage questions, arrange consumer direction, appeal a decision, or reach crisis and legal help.

Learn More

Find personalized help navigating the Ohio PASSPORT 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.