Ohio's Medicaid home care landscape changed materially in January 2026 with the launch of Next Generation MyCare — the redesigned dual-eligible integrated program that replaced MyCare Ohio. For agencies, this means new plan contracts, new billing relationships, and new prior authorization workflows alongside the existing PASSPORT Waiver structure administered through 13 Area Agencies on Aging. Sandata handles EVV, and claims enforcement for home health services began in March 2025.
Ohio offers two primary Medicaid waiver programs for home-based care: the PASSPORT Waiver for adults age 60 and older, and the Ohio Home Care (OHC) Waiver for adults under 60 with complex medical needs. Both are 1915(c) waivers — services are provided as an alternative to nursing facility placement. Both require ODA or ODM provider certification before an agency can serve waiver participants.
Agencies serving dual-eligible (Medicare and Medicaid) participants now interact with Next Generation MyCare, Ohio's fully integrated program that replaced MyCare Ohio effective January 1, 2026. The managed care structure creates a separate billing and authorization pathway from fee-for-service waiver billing through MITS.
The PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) Waiver serves adults age 60 and older who need nursing home level of care but can remain safely in the community. There is no waitlist — PASSPORT is an entitlement for eligible individuals.
Administration is delegated by ODM and ODA to 13 Area Agencies on Aging across Ohio. The AAA in each participant's region conducts the assessment, issues service authorizations, and coordinates care. Agencies must be certified as PASSPORT providers through ODA. Referrals and authorizations come from the AAA, not directly from ODM.
Services include personal care, homemaker, home-delivered meals, transportation, and other HCBS. Specific service hours are determined by the individual's AAA-conducted assessment.
The Ohio Home Care Waiver serves adults under age 60 who have complex medical conditions requiring nursing home level of care. The waiver covers a broader range of medical services than PASSPORT, including private duty nursing, home-infused therapy, and specialized medical equipment.
ODM administers OHC Waiver directly. Provider certification requirements differ from PASSPORT — agencies planning to serve OHC Waiver participants should contact ODM's waiver program office directly for current certification requirements and any enrollment limitations in effect.
Understanding Ohio's AAA structure is essential for PASSPORT operations. The AAA in each participant's county is the entity that assesses eligibility, authorizes services, and manages the participant's case. For agencies, the AAA is the practical point of contact for authorization questions, care plan changes, and service disputes — not ODM directly.
Agencies operating in multiple counties work with multiple AAAs simultaneously. Authorization formats, care plan processes, and communication protocols vary somewhat between AAAs — agencies serving large geographic regions need to build working relationships with each relevant AAA contact.
Launched January 1, 2026 — rolling statewide April 1, 2026. Next Generation MyCare replaced the prior MyCare Ohio program and added Anthem as a new plan. The program launched in the 29 counties where MyCare Ohio previously operated and began expanding to all remaining Ohio counties on April 1, 2026. Three plans are available statewide to all members: Anthem Blue Cross and Blue Shield, CareSource, and Molina Healthcare of Ohio. A fourth plan, Buckeye Health Plan, remains available only to members who were already enrolled with Buckeye under the prior MyCare Ohio program — Buckeye is not available for new member enrollment or transfers from other plans. Former Aetna Better Health of Ohio and UnitedHealthcare Community Plan MyCare members were required to switch to one of the three statewide Next Generation plans. Agencies that held Aetna or UHC MyCare contracts need to establish new contracts with the Next Generation plans — those prior relationships did not carry forward.
Next Generation MyCare is Ohio's integrated care program for individuals enrolled in both Medicare and Medicaid. The program covers medical care, long-term care (including PASSPORT and OHC Waiver services), behavioral health, and care coordination in a single plan. For home care agencies, this creates an important billing decision point: participants in a waiver program who are also enrolled in Next Generation MyCare receive their waiver services through the MyCare Ohio waiver program within their MCO — bill the MCO, not MITS directly.
| Plan | Status in Next Gen MyCare | Statewide Availability |
|---|---|---|
| Anthem Blue Cross and Blue Shield | New to the program in 2026 | Yes — available statewide for all members |
| CareSource | Continued from MyCare Ohio | Yes — available statewide for all members |
| Molina Healthcare of Ohio | Continued from MyCare Ohio | Yes — available statewide for all members |
| Buckeye Health Plan | Continued from MyCare Ohio — existing members only | Not available for new enrollment or member transfers from other plans. Only members who were in Buckeye under the prior MyCare Ohio program may stay. |
Agencies must contract with each plan separately. Being contracted with one Next Generation MyCare plan does not grant participation in the others. Verify your contract status with each plan for your service counties before accepting referrals from Next Generation MyCare members enrolled in that plan.
Ohio uses Sandata as the statewide EVV system and aggregator. Ohio operates an open model — agencies may use Sandata directly (the mobile app is Sandata Mobile Connect, available at no cost through OH|ID) or an alternative EVV vendor as long as that vendor integrates with Sandata for state-level aggregation. The six federally required EVV data elements must be captured per visit.
EVV claims adjudication began March 1, 2025 for home health services. As of that date, ODM began denying Medicaid claims for covered home health service codes that lack a matching EVV visit record. This is hard-edit enforcement — no soft-edit review period for claims lacking EVV. Additional service categories have been phased in for enforcement through 2025 into 2026. Personal care services under PASSPORT and OHC Waiver are in scope. Verify current enforcement scope on ODM's EVV provider dashboard.
| Payer / Program | Billing System | Authorization Source | Critical Note |
|---|---|---|---|
| PASSPORT Waiver (FFS) | MITS (Ohio Medicaid IT System) | Area Agency on Aging | Authorization must come from the AAA before services begin. Claims without matching AAA authorization will deny. Billing uses procedure codes specific to PASSPORT services. |
| Ohio Home Care Waiver (FFS) | MITS | ODM directly | OHC Waiver service authorizations come from ODM, not an AAA. Separate billing codes from PASSPORT. Verify current procedure code requirements with ODM's OHC Waiver team. |
| Next Gen MyCare members — waiver services | Bill MCO directly | MCO care coordinator | PASSPORT and OHC Waiver participants who are also Next Gen MyCare enrollees access waiver services through the MCO waiver program. Bill the MCO, not MITS. Must be contracted with the specific plan. |
| Next Gen MyCare members — non-waiver | Bill MCO directly | MCO prior authorization | Each MCO has its own prior authorization format and timely filing window. Verify requirements with each contracted plan. |
| Medicaid-only (non-dual FFS) | MITS | ODM / AAA by program | Medicaid-only members not enrolled in managed care bill directly through MITS. Verify member's managed care enrollment status before billing pathway determination. |
The PASSPORT Waiver is administered through 13 Area Agencies on Aging across Ohio. The AAA in the participant's region assesses eligibility, authorizes service hours, and manages the care plan. For home care agencies, this means the authorization pathway runs through the AAA, not directly through ODM. Agencies need to establish working relationships with the AAA that covers their service counties — the AAA issues the authorization that must be in place before services begin and before MITS claims process. A claim without a matching AAA authorization will deny regardless of service delivery.
Next Generation MyCare replaced MyCare Ohio effective January 1, 2026. Three plans continued from the old program: CareSource, Molina, and Buckeye Health Plan (Buckeye only for its existing members — not available to new enrollees or transfers). Anthem Blue Cross and Blue Shield joined as a genuinely new plan. Aetna Better Health of Ohio and UnitedHealthcare Community Plan did not continue into Next Generation MyCare — their former members were required to switch to one of the three statewide plans. Agencies that held Aetna or UHC contracts under the old MyCare Ohio program need to establish new contracts with Anthem, CareSource, or Molina. The program also expanded geographically: it launched in the 29 prior MyCare Ohio counties and began rolling to all remaining Ohio counties on April 1, 2026. Agencies in previously non-MyCare counties now have new MCO contracting obligations for dual-eligible members.
Ohio began hard-edit EVV claims enforcement for home health services on March 1, 2025. Hard-edit means claims without a matching EVV record are denied at adjudication — there is no soft-edit grace period or secondary review for missing EVV. Personal care services under PASSPORT and OHC Waiver are also in scope. Agencies using Sandata or an integrated alternative vendor need to verify that their EVV records are successfully transmitting to Sandata as the state aggregator before billing cycles — a claim submitted before Sandata receives the corresponding EVV visit record will trigger the N56 error and be denied.
Ohio uses Sandata as the statewide EVV system and aggregator — not HHAeXchange. Ohio operates an open model, meaning agencies can use the state-provided Sandata Mobile Connect app at no cost, or an alternative EVV vendor as long as that vendor has completed interface testing with Sandata and can transmit EVV records to Sandata for state-level aggregation. The free Sandata app is accessible through an OH|ID login. For alternative vendor questions, contact the ODM Integrated Help Desk at 1-800-686-1516.
Ohio agencies managing PASSPORT operations through multiple AAAs, Next Generation MyCare contracts across four plans, FFS billing through MITS, and Sandata EVV compliance are managing at least five separate administrative relationships simultaneously. CareBravo delivers scheduling, EVV compliance, billing across both FFS MITS pathways and MCO-direct submission, and authorization tracking as completed operational work — so the office isn't manually reconciling PASSPORT AAA authorizations against MCO billing for dual-eligible participants on the same caseload.
Ohio agencies managing PASSPORT waiver services through 13 AAAs while building new Next Generation MyCare plan contracts and keeping Sandata EVV in hard-edit compliance are managing significant operational complexity. The CareDrain Diagnostic shows what current gaps are costing you monthly before you decide how to address them.