Ohio PASSPORT Waiver (2026): Eligibility, ACAT, Services, and Case Management

PASSPORT, formally Pre-Admission Screening System Providing Options and Resources Today, is Ohio's largest and most-used Medicaid Home and Community-Based Services (HCBS) waiver for older adults. Authorized under Ohio Administrative Code Chapter 5160-31 and administered by the Ohio Department of Aging (ODA) in partnership with the Ohio Department of Medicaid (ODM), PASSPORT provides community-based long-term services and supports to Ohioans age 60 and older who meet the nursing facility level of care (NF LOC) standard but choose to remain in their homes or other community settings. Operationally, PASSPORT is run on the ground by Ohio's 12 Area Agencies on Aging (AAAs), which conduct clinical assessments, develop person-centered service plans, assign case managers, and authorize services through participating providers.

This guide is the operational deep-dive on PASSPORT, distinct from the Ohio HCBS waivers overview and the Ohio Medicaid application procedural guide. It covers the eligibility tests in detail (clinical, financial, age, residency); the Adult Comprehensive Assessment Tool (ACAT) and how the NF LOC determination actually works; the full PASSPORT service package and what each service includes; how the person-centered service plan is developed, monitored, and revised; the role of the AAA case manager (often called a Care Manager or Case Manager depending on AAA terminology); the plan-of-care expenditure cap and how it constrains service hours; the consumer-direction options that allow family members to be paid; how PASSPORT relates to MyCare Ohio for dual eligibles; what to do when the case manager and family disagree about the service plan; and the operational realities that determine whether PASSPORT actually meets a family's needs or falls short.

By Brevy Care Team · Last verified May 11, 2026

Who PASSPORT Serves

PASSPORT serves older Ohioans who, without community-based services, would need nursing facility placement. Most PASSPORT participants are women, most are over age 75, and most have multiple chronic conditions and some form of functional limitation in either ADLs or IADLs. A substantial subset have cognitive impairment or dementia. The common thread is that the participant could be in a nursing facility on a Medicaid bed but is in the community instead because PASSPORT funds the supports that make community living safe and feasible.

In practice, PASSPORT serves three rough archetypes:

1. The frail older adult who lives alone and needs help with personal care, meal preparation, medication management, and household tasks to remain at home safely. Often the trigger is a hospitalization, a fall, a stroke, or a slow decline that the family or physician notices.
2. The older adult who lives with family and whose family provides primary caregiving, but who needs supplementary paid services (respite, adult day, personal care) to allow the family caregiver to work, sleep, or recover. PASSPORT here is supplementing informal care rather than replacing it.
3. The older adult with cognitive impairment whose family is managing dementia care at home and needs adult day services, respite, and oversight to maintain the home placement. For deeper dementia-specific guidance, see /care-types/ohio/memory-care.

In all three archetypes, the trigger for application is usually the same: a transition (hospital discharge, post-rehab, family caregiver burnout, a clinical event) that surfaces the gap between what informal care can cover and what the older adult needs.

Eligibility in Detail

Age

The participant must be age 60 or older on the date of application. Younger adults with disabilities are served by the Ohio Home Care Waiver (OHCW) under OAC Chapter 5160-46 rather than PASSPORT.

Residency

The participant must be a resident of Ohio. PASSPORT does not have a minimum length-of-residency requirement beyond establishing Ohio as the state of legal residence (this aligns with federal Medicaid residency rules under 42 CFR 435.403).

Setting

The participant must reside in a community setting (own home, apartment, family member's home, or other non-institutional living arrangement). PASSPORT does not serve residents of nursing facilities (those receive institutional Medicaid) or licensed Residential Care Facilities (those use the Assisted Living Waiver under OAC Chapter 5160-33). A nursing facility resident transitioning back to the community can apply for PASSPORT in anticipation of discharge; the AAA will conduct the ACAT during the discharge planning process.

Financial Eligibility

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

• Income at or below 300 percent of the federal SSI standard (the Special Income Limit, also called the "300 percent of SSI" limit). Applicants over the limit can use a Miller Trust (Qualifying Income Trust) to establish eligibility. For details on the income limit and Miller Trust, see /medicaid/ohio/eligibility-income-limits.
• Countable resources at or below $2,000 for an individual applicant. For married couples with one spouse applying, the community-spouse resource allowance (CSRA) under federal spousal-impoverishment rules protects a portion of the couple's resources for the community spouse.
• No improper transfers in the 60-month lookback period. Gifts, transfers below fair market value, and other divestments trigger the transfer-penalty calculation.
• Home equity below the federal limit (currently in the high six figures with annual COLA; verify current limit with CDJFS or an Ohio elder law attorney).

For couples, the planning around CSRA, the snapshot date, and the Spousal Resource Assessment (filed at institutionalization or HCBS waiver enrollment) is the highest-leverage procedural work. See /medicaid/ohio/how-to-apply for the application procedural guide.

Clinical Eligibility: Nursing Facility Level of Care

PASSPORT requires that the applicant meet the nursing facility level of care standard, meaning that without waiver services they would qualify for nursing facility placement. NF LOC is determined through the Adult Comprehensive Assessment Tool (ACAT), administered by AAA assessors. The ACAT looks at:

• Activities of Daily Living (ADLs): bathing, dressing, transferring (moving in and out of bed or chair), toileting, eating, continence. The ACAT asks whether the applicant needs assistance with each ADL and to what extent (independent, supervision, limited assistance, extensive assistance, total dependence).
• Instrumental Activities of Daily Living (IADLs): meal preparation, medication management, housekeeping, laundry, transportation, telephone use, shopping, managing finances. The ACAT asks the same kind of dependence question for each IADL.
• Cognitive function: memory, decision-making, ability to make oneself understood, ability to understand others. The ACAT may include a brief cognitive screening or rely on the assessor's clinical observation.
• Behavioral health: behaviors that affect safety or care delivery, mood symptoms, sleep disruption.
• Medical complexity: chronic conditions, medications, recent hospitalizations, recent falls, skin integrity, nutrition, hydration, pain.
• Informal support: the availability and capacity of family members, friends, neighbors, and other informal supports to provide care.
• Environmental factors: safety of the home, accessibility, distance from medical care, isolation.

The ACAT produces a score and a clinical narrative. The combination determines whether the applicant meets NF LOC. NF LOC 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 conditions in combination with the available informal support.

This is why two people with the same diagnosis can have very different ACAT outcomes. One person with mild-to-moderate dementia who lives alone and has limited family involvement may meet NF LOC because the cognitive impairment combined with lack of informal support creates significant safety risk. Another person with similar dementia who lives with an attentive spouse may not meet NF LOC because the informal support compensates for the functional impairment. The ACAT is designed to capture this real-world variation.

The Adult Comprehensive Assessment Tool (ACAT) Process

The ACAT is administered in person at the applicant's home. The assessor is a registered nurse, licensed social worker, or other qualified professional employed by or contracted with the AAA.

Step 1: Initial Phone Screening

When a family or referring entity (hospital discharge planner, physician, hospice agency, family member) calls the AAA at 1-866-243-5678, the AAA intake worker conducts a phone screening covering basic demographic information, broad clinical and functional needs, and the reason for the call. The screening is not the ACAT; it is a triage to determine whether to schedule an in-home assessment.

Step 2: Scheduling

If the phone screening suggests the applicant may meet PASSPORT eligibility, the AAA schedules an in-home ACAT. The timeline to scheduling varies by AAA workload, but most applicants can expect a scheduled assessment within 2-4 weeks. For hospital-discharge applicants on a short timeline, the AAA can expedite assessment to coordinate with the discharge.

Step 3: The In-Home Assessment

The ACAT visit typically lasts 90 minutes to 2 hours. The assessor:

• Observes the home environment for safety, accessibility, and adequacy of basic supplies
• Interviews the applicant directly, asking about each ADL, IADL, cognitive function, and behavioral health domain
• Observes the applicant's mobility, balance, transfers, and other physical functions during the visit
• Interviews family members or informal caregivers if present, asking about the kind and frequency of help they provide
• Reviews medications, recent medical encounters, and any clinical documents available
• Documents informal-support gaps and clinical risks

The applicant has the right to have a family member or representative present during the assessment. For applicants with cognitive impairment, family presence is essential because the applicant may not accurately describe their own functional level.

Step 4: Determination

The AAA assessor compiles the ACAT score and clinical narrative and submits it for NF LOC determination. The determination is communicated to the applicant in writing. If the applicant does not meet NF LOC, the notice will state the basis and provide State Hearing appeal rights. If the applicant meets NF LOC, the AAA proceeds to service-plan development.

What to Do If You Disagree With the ACAT

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

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

For applicants with cognitive impairment, well-documented evidence of the functional impact of the impairment, including specific incidents (wandering, medication errors, kitchen safety failures, falls, missed meals), helps the case substantially.

The Person-Centered Service Plan

Once NF LOC is established and the applicant is financially eligible, the AAA case manager and the applicant (or representative) develop the Person-Centered Service Plan, which is the operational core of PASSPORT participation.

What the Service Plan Contains

The service plan documents:

• The participant's goals in their own words (or representative's) for community living
• Identified strengths and informal supports that contribute to community living
• Identified needs in each functional domain
• Authorized services matched to identified needs, with specific hours per week or units per month
• Authorized providers for each service (chosen by participant from the AAA's list of participating providers)
• The plan-of-care budget showing total authorized expenditures against the waiver expenditure cap
• Backup planning in case the primary provider is unavailable
• Review schedule for reassessment and plan revision

How Services Are Authorized

Each service is authorized in specific units (hours per week, meals per month, days of adult day services per week, modifications by item) based on the identified need and the applicant's preferences within the constraints of the plan-of-care cap. For example, a participant may be authorized 25 hours per week of personal care, five days per week of home-delivered meals, three days per week of adult day services, environmental modifications totaling $X for a wheelchair ramp and grab bars, monthly PERS, and respite up to Y hours per quarter.

Participant Choice

PASSPORT is built around participant choice. The participant chooses:

• The mix of services within the authorized budget (more personal care vs. more adult day, for example, within the cap)
• The provider for each service from the AAA's list of participating providers
• The agency-employed model or the consumer-direction model for personal-care services
• The schedule and timing of services within authorized hours
• Whether to revise the plan when circumstances change

Service-Plan Revisions

The service plan is not static. The case manager reviews the plan at least annually (often more frequently). The participant can request revision at any time when needs change. Common triggers for revision include:

• Hospitalization or change in clinical condition
• Loss or addition of informal caregiver
• Move to a new home
• Change in participant goals or preferences
• Provider change or termination
• Concerns raised by participant, family, or provider about service adequacy

The PASSPORT Service Package

The full PASSPORT service package under OAC Chapter 5160-31 and the related Ohio Department of Aging service definitions in OAC Chapter 173-39 includes:

Personal Care Services

PCA services cover assistance with ADLs (bathing, dressing, transferring, toileting, eating, continence) and IADLs (meal preparation, medication reminders, light housekeeping, laundry). PCA services are delivered by:

• Agency-employed Home Care Aides through participating Medicaid home care agencies
• Consumer-directed attendants through C-HCAS or CD-PCS, with the participant as managing employer and Public Partnerships LLC as Fiscal Management Service

The hours of PCA service authorized depend on the assessed need, the available informal support, and the plan-of-care cap. Some participants receive 5-10 hours per week; others receive 30-40 hours per week or more.

Homemaker Services

Homemaker services cover housekeeping, laundry, shopping, meal preparation, and other instrumental tasks that the participant cannot do for themselves. Homemaker is conceptually distinct from PCA: homemaker is about the home environment; PCA 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 services center, typically serving older adults with significant supervision needs (often due to dementia) who live with a family caregiver who is at work or otherwise unavailable during the day. Services include socialization, supervision, meals, activities, transportation to and from the center, and (in some adult day health centers) limited skilled nursing or therapeutic services.

Home-Delivered Meals

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

Transportation

Non-emergency transportation to medical appointments, adult day services, and other authorized destinations. Often coordinated through county transportation programs, Ohio mobility management organizations, or contracted transportation providers.

Personal Emergency Response System (PERS)

A wearable button device that allows the participant to summon help in an emergency. Monthly monitoring fees are covered by PASSPORT.

Environmental Modifications

One-time or limited-time modifications to the home environment to support safety and accessibility:

• Wheelchair ramps
• Grab bars in bathroom and bedroom
• Stair lifts (in specific circumstances)
• Door widening for wheelchair access
• Bathroom modifications (roll-in shower, raised toilet, accessible sink)
• Other modifications justified by the assessment

Environmental modifications are funded up to a defined per-participant cap and require AAA approval before purchase or installation.

Respite Care

Short-term care provided to relieve the primary informal caregiver. Respite can be in-home (a paid worker comes to the home) or out-of-home (the participant goes to a respite facility, adult day program, or similar setting). PASSPORT respite authorization is typically expressed in hours per quarter or per year. For deeper guidance on respite options in Ohio, see /caregiver/ohio/respite-care.

Home Health Aide Services

PASSPORT can authorize home health aide services delivered through Medicaid-participating home care agencies. This is distinct from Medicare-certified home health (covered under /care-types/ohio/home-care-vs-home-health); PASSPORT home health aide is Medicaid-paid and does not require homebound status or skilled need.

Consumer-Direction Services

Within PASSPORT, the participant can choose consumer direction for personal care:

• Choices Home Care Attendant Service (C-HCAS) under OAC Chapter 5160-44: participant hires, trains, schedules, and supervises an attendant; PPL handles payroll, taxes, and Medicaid billing
• Consumer-Directed Personal Care Service (CD-PCS) under OAC Chapter 5160-44: parallel consumer-direction option

For the operational mechanics, see /caregiver/ohio/consumer-direction. Family members (other than spouses, subject to the OAC 5160-44-32 conditional pathway) can be paid through consumer direction.

Other Services

Depending on the specific plan-of-care and the AAA's contracting capacity, additional services may include nutrition counseling, social work services, durable medical equipment beyond standard Medicaid coverage, and assistive technology.

The Plan-of-Care Expenditure Cap

The plan-of-care cap is the single most important constraint on PASSPORT service planning. Under federal cost-neutrality at 42 USC 1396n(c)(2)(D), Ohio's PASSPORT waiver must demonstrate to CMS that the average cost of serving PASSPORT participants in the community is less than the average cost of serving them in a nursing facility. Ohio implements this through individual plan-of-care caps, often expressed as a percentage of the institutional nursing facility rate.

Practical implication: PASSPORT cannot typically fund 24-hour personal care in the home, because 24-hour PCA at typical Medicaid rates would exceed the institutional alternative. 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; not statewide in Ohio)
3. Transition to assisted living under the AL Waiver if appropriate setting
4. Transition to nursing facility if community placement is no longer feasible
5. Use MyCare Ohio Waiver if the participant is a full-dual eligible in a MyCare county, which can offer somewhat more flexibility in service mix through the FIDE-SNP plan

For families discovering that PASSPORT cannot fund what they thought it would, the case manager is the best resource for understanding the cap and the available trade-offs. Sometimes a service plan revision (more adult day, less PCA, or vice versa) can better fit the cap; sometimes the right answer is a setting transition.

The Role of the AAA Case Manager

The AAA case manager (terminology varies; some AAAs use "Care Manager" or "Service Coordinator") is the participant's primary point of contact for the duration of PASSPORT participation. Responsibilities include:

• Conducting the ACAT and clinical reassessment (typically annually)
• Developing and revising the service plan
• Authorizing services and providers
• Monitoring service delivery quality
• Investigating complaints about providers
• Coordinating with other providers (primary care physician, home health agency, hospital discharge planners, hospice, 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 plan-of-care cap

Case manager caseloads vary by AAA but typically range from 60 to 120 participants per case manager. This is a high caseload by national HCBS waiver standards and shapes the practical reality of case management: most contact with the case manager is by phone or scheduled visit, not 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 the participant or family and the case manager are common in HCBS waiver case management. Common areas of disagreement include:

• The hours of PCA service authorized
• The choice of services within the plan-of-care cap
• The choice or quality of providers
• The frequency of reassessment
• Decisions about consumer-direction enrollment
• Decisions about transitioning to a higher level of care

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

• AAA executive director or director of long-term services
• Ohio Department of Aging state office
• 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)
• State Hearing appeal (formal administrative process)

For service-plan reductions or terminations that 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 the State Hearing within 15 days of the adverse notice preserves aid pending hearing (continued benefits at the prior level during the appeal).

How PASSPORT Relates to MyCare Ohio

For full-dual eligibles (Medicare + 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 is handled by the MyCare plan's care coordinator, often in collaboration with a contracted AAA case manager
• Service authorization flows through the MyCare plan
• Providers must be in the MyCare plan's network (or have prior authorization for out-of-network)
• Integrated medical and HCBS coverage under one plan ID card

The MyCare plans (Anthem, Buckeye, CareSource, Molina) operate as Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) for federal Medicare purposes. The Next Gen MyCare expansion is broadening the geographic footprint through 2026 and 2027. For dual eligibles outside MyCare counties, PASSPORT continues to be administered directly by the AAA under standard fee-for-service Medicaid.

How PASSPORT Relates to Other LTSS Options

PASSPORT is one option in Ohio's long-term services and supports menu. Adjacent options include:

• Nursing facility Medicaid: institutional placement when community living is no longer feasible (see /care-types/ohio/nursing-homes)
• Assisted Living Waiver: for participants ready to move to a licensed Residential Care Facility (see /medicaid/ohio/assisted-living-waiver)
• Ohio Home Care Waiver: for adults under 60 with disabilities (see /medicaid/ohio/ohio-home-care-waiver)
• Medicaid home health: Medicaid-paid skilled and aide services for participants without HCBS waiver enrollment, under OAC Chapter 5160-12
• PACE (Program of All-Inclusive Care for the Elderly): comprehensive integrated care; not statewide in Ohio
• Private-pay home care: when PASSPORT services do not meet the full need and the family can supplement
• Hospice: for end-of-life care, runs under Medicare (or Medicaid hospice for non-Medicare participants); can coexist with PASSPORT in some configurations

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

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 the personal needs allowance)
• Custodial nursing facility care (that is institutional Medicaid)
• Assisted living facility room and board (the AL Waiver covers services, not housing)
• Medical services Medicare or Medicaid pays directly (those are billed under standard coverage, not the PASSPORT waiver)
• Acute hospital care, prescription drugs, or physician services (those are standard Medicaid or Medicare)
• 24-hour one-on-one personal care in most cases (the plan-of-care cap typically prevents)
• Family caregiver wages outside the consumer-direction structure (informal family caregiving is not paid by PASSPORT unless the family member becomes a paid worker through C-HCAS, CD-PCS, or SFC)

Operational Mistakes That Hurt PASSPORT Participants

The Brevy newsroom regularly encounters PASSPORT participants and families who experience preventable problems. The most common operational failures:

1. Underutilizing authorized services. Some participants are authorized 30 hours per week of PCA but actually receive 20 because the agency cannot staff the additional hours. Families often accept this rather than push for full authorized service or request a service-plan change.
2. Not understanding the plan-of-care cap. Families ask for more hours and are told no, without understanding that the cap is the constraint. Sometimes a service-mix reshuffle can free up budget for more PCA at the expense of less of something else.
3. Failing to use consumer direction when family caregivers exist. Many families do uncompensated caregiving while not enrolling in C-HCAS or CD-PCS, which could pay the caregiver legally and substantially. See /caregiver/ohio/consumer-direction.
4. Missing the annual reassessment. The annual reassessment is the formal review point for the service plan. Families who skip or under-prepare for it miss the opportunity to request needed changes.
5. Not communicating clinical changes promptly. When the participant's condition changes (new diagnosis, hospitalization, new behaviors), the case manager needs to know to revise the plan. Delayed communication delays service adjustment.
6. Confusing PASSPORT with Medicare home health. They are not the same. PASSPORT is Medicaid HCBS for personal care, homemaker, and community supports. Medicare home health is short-term skilled care. Both can coexist for the same person, but they serve different needs.
7. Not appealing adverse decisions. State Hearing appeals are free, do not require an attorney, and frequently result in favorable outcomes for participants who present clear evidence. Many adverse decisions go unappealed because the family does not know the right exists.

Frequently Asked Questions

Next Steps for Ohio Families

For families considering PASSPORT:

1. Call 1-866-243-5678 to reach the local AAA and request a screening
2. Schedule the in-home ACAT and prepare by gathering medical documentation, listing current medications, and identifying functional limitations the assessor should see
3. Begin the financial application in parallel through CDJFS or with AAA assistance; gather 60 months of bank statements and resource documentation
4. Consider consumer direction if a family member would be willing and able to be the paid personal care attendant
5. For couples, file the Spousal Resource Assessment at the moment of institutionalization or PASSPORT enrollment to lock the CSRA snapshot
6. Engage actively with the service-plan development to ensure the authorized service mix matches actual needs
7. Stay in touch with the case manager as circumstances change, and request service-plan revisions promptly when needed

For broader context on Ohio Medicaid and HCBS waivers, see /medicaid/ohio and /medicaid/ohio/hcbs-waivers. For the application procedural guide, see /medicaid/ohio/how-to-apply.

This guide is for general informational purposes and is not a substitute for legal, tax, or financial advice. Ohio PASSPORT rules, AAA processes, expenditure caps, and managed-care interactions change; verify current information with the local AAA, ODA, ODM, or an Ohio elder law attorney before acting.

Find personalized help navigating PASSPORT at brevy.com.