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Ohio - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Ohio Department of Medicaid (ODM), alongside the Department of Aging (ODA) and the Department of Developmental Disabilities (DODD), funds Out-of-Home and In-Home Respite Care Services through programs such as the Ohio Home Care Waiver, PASSPORT, and Individual Options. Providers enroll under specific classifications, such as DODD Provider Type 45 (Waivered Services Organization), to deliver short-term relief care that allows an unpaid primary caregiver to step away without the waiver participant losing supervision or support.

Effective May 14, 2026, through November 14, 2026, ODM enforces a strict federal moratorium (CMS-6101-N and 42 CFR 455.470) on all new Medicaid enrollment applications for Waiver Individuals and Organizations, blocking new respite providers from entering the network during this period. Outside of this freeze, applicants must navigate a decentralized certification process where the operating agency (ODA, DODD, or ODM's designee PCG) dictates the specific pre-certification reviews, background check routing, and HCBS settings compliance steps required before Medicaid billing privileges are granted.

1. Service Definition and Scope

In Ohio, Respite Care Services provide short-term, temporary relief to unpaid primary caregivers of individuals enrolled in Medicaid home and community-based services (HCBS) waivers. The service ensures the individual's health and safety needs are met while the primary caregiver is absent or needs rest.

The service is bifurcated into in-home respite (delivered in the individual's primary residence) and out-of-home respite (delivered in a certified facility or provider-controlled setting). Out-of-home settings must strictly adhere to federal HCBS settings requirements to ensure they do not isolate participants or operate as institutions.

2. Regulatory and Oversight Agencies

Ohio utilizes a multi-agency structure to oversee HCBS waivers. The Ohio Department of Medicaid (ODM) is the single state Medicaid agency, but day-to-day certification and oversight of respite providers are delegated to ODA, DODD, or ODM's contracted designees depending on the specific waiver program.

Providers must interact with the specific agency that operates the waiver they intend to bill. For example, PASSPORT providers work with ODA and local PASSPORT Administrative Agencies (PAAs), while Individual Options providers work with DODD.

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio imposes severe structural preconditions on new waiver providers. The most absolute block is the federal moratorium implemented by ODM, which halts all new applications for Waiver Organizations and Individuals for a designated six-month period in 2026.

Even when the moratorium is lifted, providers face geographic and setting-based gates. ODA requires applicants to consult with local PASSPORT Administrative Agencies to assess market saturation, and any provider-owned out-of-home respite setting presumed to have institutional qualities must survive a Heightened Scrutiny review by ODA and CMS before an application is accepted.

4. Licensure and Certification Requirements

Ohio does not issue a generic "Respite License." Instead, agencies and independent providers must obtain waiver-specific certification. For ODA waivers, this is governed by Ohio Admin. Code 173-39-03, which dictates the application and pre-certification review process.

DODD certifies its own network of providers under Provider Type 45 (Waivered Services Organization). All certifying agencies require a non-refundable application fee for agency-based providers and mandate a pre-certification review to verify compliance with service rules.

5. Medicaid Provider Enrollment

After obtaining the necessary waiver certification from ODA or DODD, or concurrently for ODM-administered waivers, providers must enroll in the Ohio Medicaid program. This process requires establishing an OH|ID and routing the application through the correct portal based on the target waiver.

Providers targeting the Ohio Home Care Waiver apply through Public Consulting Group (PCG), while DODD and ODA providers use their respective agency portals before final Medicaid enrollment is authorized.

6. Staffing, Training and Background Checks

Direct care staff providing respite must pass rigorous background checks and meet baseline training standards. Initial provider enrollments require Bureau of Criminal Identification & Investigation (BCI&I) reports to be sent directly to ODM.

ODM is currently transitioning to a new background check system that will eliminate the need for non-agency Ohio Home Care Waiver providers to conduct annual criminal records checks, streamlining ongoing compliance.

7. Documentation, Policies and Records

Providers must develop and maintain comprehensive policies and procedures as part of Step 5 of the ODA certification process. These policies must align with person-centered planning rules and HCBS settings requirements.

For out-of-home respite, documentation must explicitly prove that the setting optimizes individual autonomy. This includes maintaining legally enforceable agreements (tenant protections) and ensuring privacy in sleeping units.

8. Billing, Rates and Claims

Respite services are billed to Ohio Medicaid using standard healthcare transactions, which federally mandate the inclusion of the provider's NPI. Rates are established by ODM and the respective operating agencies (ODA/DODD) and are published in their waiver fee schedules.

Providers must ensure that claims accurately reflect the modality of respite provided (in-home vs. out-of-home) and adhere to any daily or annual limits established in the participant's person-centered service plan.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining an NPI and an OH|ID, followed by submitting a complete application to the appropriate waiver operating agency. ODA, for example, requires applications to be fully completed within 90 days of initiation.

Once a complete application is received, ODA initiates a pre-certification review within 30 days. Final determination is based on the review of application materials and the recommendation of the agency's regional designee.

10. Common Denials and Survey Findings

Applications are frequently denied due to timing and structural blocks, most notably applying during the active ODM moratorium on Waiver Organizations. Administrative dismissals also occur if an applicant fails to submit all required supporting records within the 90-day application window.

During pre-certification or post-certification surveys, out-of-home respite providers are commonly cited for failing HCBS settings requirements, such as lacking lockable doors, regimenting daily activities, or failing to provide legally enforceable tenant agreements.

11. Key Contacts and Resources

Prospective providers must direct their inquiries to the specific agency managing the waiver they wish to serve. ODM handles overarching Medicaid enrollment and background check routing, while PCG, ODA, and DODD manage the front-end certification portals.

Providers should utilize the official state portals for the most current rule updates, fee schedules, and training resources.

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