Ohio has one of the largest aging populations in the country, with approximately 2.2 million residents aged 65 and older. The state is hurtling toward a demographic turning point, with projections indicating significant strain on healthcare systems by 2040 as the ratio of working-age adults to seniors continues to decline. State leaders have identified workforce shortages and social isolation as top challenges, conditions that were exacerbated by COVID-19.

This demographic reality creates both tremendous demand and significant operational challenges for home health agencies. Ohio implemented comprehensive home health licensure requirements in 2022, transforming a previously unregulated market into one with clear compliance standards. The state's $3.4 billion Medicaid rate increase in 2024 signals commitment to strengthening the provider network, while stringent EVV enforcement beginning in 2025 requires careful attention to documentation. This guide covers everything agencies need to know about providing home health services in Ohio, from ODH licensing requirements to Medicaid reimbursement and strategies for building a sustainable caregiver workforce.

Ohio Home Health Agency Licensing Requirements

Prior to July 1, 2022, agencies providing skilled home health care, non-medical home health, and personal care services were unlicensed in Ohio. Beginning on July 1, 2022, all agencies that offer home health care (skilled or nonmedical) require a license issued by the Ohio Department of Health (ODH), as do non-agency providers of nonmedical home health care. This law is codified at O.R.C. Section 3740.01 et seq. and comes from Ohio House Bill 110.

Going deeper on the certification, licensure, and enrollment package. Ohio's framework is a three-track system: federal Medicare certification under 42 CFR Part 484 surveyed by the ODH Bureau of Long Term Care Quality, the ORC 3740 / OAC 3701-60 state license, and Medicaid HCBS provider enrollment under OAC 5160-12 and the waiver-specific rules. For a section-by-section walkthrough of how the three tracks interact, the documents an ODH BLTCQ surveyor expects, the CMS-855A and PNM steps every Ohio applicant has to run, the Personal Care Aide vs Home Health Aide distinction, and the most common survey findings, see our Ohio ODH home health agency certification and survey process guide.

Licensing authority. The Ohio Department of Health is responsible for issuing licenses and overseeing home health services through Chapter 3701-60 of the Ohio Administrative Code. ODH has released several new rules and revised existing rules to implement the state's licensure requirements. The department distinguishes between skilled home health agencies and non-medical home health agencies.

License types. Ohio offers two types of home care licenses: the Skilled Home Health Services license and the Non-Medical Home Health Services license. Agencies providing skilled nursing, physical therapy, occupational therapy, and speech-language pathology require a Skilled Home Health Services license. Agencies providing personal care services, homemaking services, bathing, dressing, meal preparation, and respite care require a Non-Medical Home Health Services license.

Skilled home health requirements. Agencies providing skilled home health services must demonstrate one of the following: proper evidence of certification for participation in the Medicare program, evidence of accreditation by a national accreditation organization approved by CMS, evidence of certification by the Department of Aging to provide such services, or evidence of past provision of direct care. In the absence of evidence showing prior provision of care, a surety bond in the amount of $50,000 is required.

Non-medical home health requirements. For agencies providing non-medical home health services, the requirements include fingerprinting for the primary owner, providing ODH with a copy of the criminal records check policy, a description of services offered, and a copy of policies and procedures as they relate to the services offered.

Surety bond requirements. All new agencies and individual licenses are required to purchase a surety bond. Skilled medical home health services require a $50,000 bond, while non-medical home health services require a $20,000 bond. If the agency or individual was licensed and providing services prior to September 30, 2021, a surety bond does not have to be purchased.

Application fees and processing. Ohio requires a $250 application fee for a license. There is no certificate of need requirement. ODH recommends allowing 90 days for non-medical license processing.

Penalties for non-compliance. Once H.B. 110 took effect, anyone operating a home care agency or providing non-agency home care without a license is subject to criminal prosecution. Agencies should ensure they have obtained proper licensure before providing services.

Home Health Aide Certification Requirements

Home Health Aides in Ohio must complete training that aligns with both federal requirements and state-specific standards. The state follows a federally aligned curriculum while maintaining specific requirements for different agency types.

Training hours. HHAs must complete a minimum of 75 hours of initial training, consisting of 59 hours of didactic instruction and 16 hours of clinical experience. This requirement applies to HHAs working with State-Licensed Agencies (Medicaid, HCBS: PASSPORT) as well as CMS Certified agencies. Training must be completed before providing services independently.

Training curriculum. The HHA training curriculum covers personal care techniques, home safety, infection control, communication, emergency response procedures, body mechanics, nutrition basics, and documentation requirements. Programs must be approved by the Ohio Department of Health to ensure compliance with state standards.

Program structure. The Ohio Council for Home Care & Hospice offers a comprehensive HHA Training Program designed to meet both CMS and PASSPORT requirements. This program includes 44.1 hours of online coursework through the RCTC platform, followed by a 16-hour live training session conducted over two consecutive 8-hour days. Participants must attend fully and pass a written competency exam.

Eligibility requirements. For Medicare- or Medicaid-certified agencies, candidates must be at least 18 years old and have a high school diploma or GED. All candidates must pass a BCI/FBI criminal background check. Physical exam, 2-step TB test, and proof of immunizations (like Hepatitis B) are required for clinical training and employment.

Competency evaluation. After completing training, candidates must pass competency evaluations including written examinations and skills demonstrations. Each evaluation must be conducted by a state-approved evaluator to ensure candidates have the skills to provide safe, effective care.

Continuing education. Home health aides must complete 12 hours of continuing education every 12 months to maintain their skills and knowledge. Aides must renew their home health aide certificate every two years to maintain their certification.

Program costs. Training programs range from $400 to $1,000 depending on the institution. Completion typically takes 2-3 weeks, though it may take longer if training is coupled with another program.

Salary expectations. The average salary for home health aides in Ohio is approximately $31,929 per year or $15.35 per hour according to recent data. Indeed reports an average of $16.26 per hour with an additional $3,969 in overtime annually. In major metropolitan areas like Columbus and Cincinnati, average wages reach approximately $18 per hour or $37,000-$38,000 annually. Certified home health aides earn slightly more at an average of $16.79 per hour.

State Tested Nursing Assistant (STNA) Requirements

Ohio refers to Certified Nursing Assistants as State Tested Nursing Assistants (STNAs). While Ohio does not require HHAs to hold STNA certification, many employers prefer candidates with these credentials. STNAs in Ohio are regulated by the Ohio Department of Health and may work in long-term care facilities, hospitals, and home health agencies.

Training requirements. Ohio requires completion of a state-approved CNA training program with at least 75 hours, including 16 hours of clinical practice. Training consists of at least 59 hours of classroom experience and skills training and at least 16 hours of supervised resident care in a nursing home. CNA programs must receive approval from the Ohio Department of Health.

Age and education requirements. Applicants must be at least 16 years old. A high school diploma or GED is required to ensure candidates have the basic literacy and numeracy skills critical for understanding medical terminology and following care protocols.

Training curriculum. The 75-clock hour STNA Training Program covers body mechanics, nutrition, anatomy and physiology, human disease processes, infection control, communication skills, and resident rights. Students master personal care skills including how to help patients bathe, eat, and groom themselves.

Competency examination. STNAs in Ohio must pass the National Nurse Aide Assessment Program (NNAAP) to earn certification. The exam consists of two parts: a written (or oral) exam and a hands-on skills assessment. The Ohio STNA state exam is distributed by D & S Diversified Technologies, which provides information to help candidates succeed.

Registry management. The Ohio Nurse Aide Registry is located at 246 N. High Street, Columbus, OH 43215. Phone: 800-582-5908 (in-state) or 614-752-9500 (out-of-state). The registry tracks certification status and any findings that would prevent employment.

Certification renewal. STNAs must renew every 24 months to remain active. Renewal requires documentation of at least 7.5 consecutive hours or 8 hours in 48 hours of supervised, paid nursing work within the previous 24 months, verified by the HEA 7713 form.

Program costs. CNA/STNA training costs in Ohio range from free (at some facilities that train their own staff) to $2,000 at private programs. Many programs accept financial aid and payment plans. Some nursing homes offer free training to prospective employees.

Medicaid Reimbursement in Ohio

Ohio's Medicaid program, administered by the Ohio Department of Medicaid (ODM), provides coverage for eligible residents through both fee-for-service and managed care arrangements. The state made historic investments in provider reimbursement beginning in 2024.

2024 rate increases. Ohio Department of Medicaid rolled out substantial reimbursement rate increases effective January 1, 2024. The rate increases are historic in nature, totaling approximately $3.4 billion per year across a network of more than 200,000 active providers. State plan private duty nursing and home health providers are among those benefiting from the rate increases.

Specific rate changes. Beginning January 1, 2024, the majority of codes in the Ohio Medicaid fee schedule for non-institutional providers increased by 5% or more. Specifically, there was approximately a 5% increase for physicians, APRNs, PAs, clinics, skilled therapy providers, ambulatory surgical centers, laboratories, dialysis providers, X-ray providers, and DME providers.

2025 fee schedule updates. A state plan amendment (OH-25-0001) was approved on May 15, 2025, accounting for new, amended, and deleted HCPCS codes on the ODM fee schedules, with an effective date of January 1, 2025. This ensures current procedure codes are properly reimbursed.

Managed care considerations. Most Medicaid patients are covered by Medicaid Managed Care Organizations (MCOs). Providers need to review their contracts with these companies to determine if rates are linked to the fee-for-service Medicaid fee schedule. Individual MCO websites provide specific provider manuals with detailed reimbursement guidance.

Accessing fee schedules. All current Medicaid fee schedules are available via the Fee Schedule & Rates page on the ODM website or via the Provider Network Management homepage. Providers do not need to be logged into PNM to access the Fee Schedule tab.

HCBS waiver programs. Ohio offers several Home and Community-Based Services waiver programs including PASSPORT, Ohio Home Care, MyCare Ohio, Individual Options (IO) Waiver, and SELF Waiver. Each program has specific eligibility requirements and service definitions.

Contact information. For additional assistance, providers can contact the ODM Integrated Helpdesk at 800-686-1516 or [email protected].

Medicare Home Health Coverage

With Ohio's large elderly population and high rates of chronic illness, Medicare remains a crucial payer for home health services. Medicare certification allows agencies to serve beneficiaries and diversify their payer mix beyond Medicaid.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound (leaving home requires considerable effort due to illness or injury), need skilled nursing care on an intermittent basis or require physical therapy, speech-language pathology services, or continued occupational therapy, have a physician certify the need for home health care and establish a plan of care, and receive services from a Medicare-certified home health agency.

2025 rate updates. CMS's Calendar Year 2025 Home Health Prospective Payment System Final Rule set the 30-day standard payment rate at $2,057.35, up 0.9% from the CY2024 rate of $2,038.13 for agencies that submit required quality data. Medicare payments to home health agencies in 2025 are estimated to increase in aggregate by 0.5%, or $85 million, compared to 2024.

PDGM adjustments. The CY 2025 rule finalized a permanent prospective adjustment of -1.975% to account for the impact of implementing the Patient-Driven Groupings Model (PDGM). The 2.7% market basket update is offset by productivity adjustments and PDGM budget neutrality requirements.

Plan of care requirements. Medicare requires a plan of care signed by a physician that specifies the services needed, frequency, and duration. The plan must be reviewed at least every 60 days.

Payer diversification. Medicare certification offers agencies an important pathway to serve more patients and improve financial sustainability, providing better reimbursement than many Medicaid programs.

Electronic Visit Verification (EVV) Requirements

The 21st Century Cures Act directs state Medicaid programs to require providers of personal care services and home health services to use an electronic visit verification system. Ohio began its phased rollout in 2018 and has significantly ramped up enforcement in 2025.

Current enforcement timeline. Since March 1, 2025, ODM has begun denying Medicaid claims that do not have a matching EVV visit record. For claims with a date of service on or after June 1, 2025, claims submitted for Home Health Services without a valid, matching EVV visit record on file with Sandata will be denied. For claims with a date of service on or after August 1, 2025, claims submitted for Private Duty Nursing, Nurse Assessment, and Consult Services without valid matching EVV records will be denied. Full implementation is expected by the end of the first quarter of 2026.

Services covered. Providers must utilize EVV for the following services reimbursed through fee-for-service: home health nursing, home health aide, private duty nursing, registered nurse assessments, and Ohio Home Care waiver nursing, personal care aide, and home care attendant services. This includes services under the Ohio Home Care Waiver, PASSPORT Waiver, MyCare Ohio, Individual Options (IO) Waiver, and SELF Waiver.

System requirements. Agencies must obtain signed consent before collecting GPS location data during clock-in/clock-out. Each visit must specify whether it took place at Home or in the Community. The system may reject manual entries without these tags. Ohio's secure identity management platform, OHID, with multi-factor authentication, manages access to all EVV-related portals.

Vendor options. Agencies can use an EVV vendor other than Sandata as long as the vendor integrates with Ohio's official EVV aggregator, Sandata. If an agency already has an electronic visit verification system in place, it is acceptable as long as the vendor is approved by ODM and meets mandate requirements.

Exemptions. When services are billed in certain scenarios, claims are not subject to EVV validation, including telehealth services billed with Place of Service Code 02. ODM allows exemptions for caregivers living with the patient through the EVV Exemption Portal.

Contact information. For EVV questions, contact the Ohio Department of Medicaid at [email protected].

Labor Laws and Wage Requirements

Ohio has its own minimum wage law that exceeds the federal minimum, and the state follows federal FLSA guidelines for overtime. Understanding these requirements is essential for compliance and competitive compensation.

Minimum wage. Effective January 1, 2025, Ohio's minimum wage is $10.70 per hour for non-tipped employees. This rate applies to employers with gross receipts greater than $394,000. Employers with gross receipts less than $394,000 may pay the federal minimum wage of $7.25 per hour. Ohio's minimum wage is adjusted annually based on the Consumer Price Index to reflect changes in the cost of living.

Tipped employees. Tipped employees are required to be paid a minimum wage of $5.35 per hour, plus tips that must equal or exceed the state minimum wage when combined.

Youth minimum wage. Ohio's minimum wage for 16-year-olds is the full state rate of $10.70 per hour. Employers may pay the federal minimum wage of $7.25 per hour to employees under the age of 16, regardless of the employer's gross receipts.

Overtime requirements. In Ohio, non-exempt employees are entitled to overtime pay at 1.5 times their regular hourly rate for every hour worked beyond 40 hours per week, aligning with federal FLSA guidelines.

Salary threshold for exemption. Following the 2024 federal court ruling, the overtime-exempt salary threshold for 2025 is $684 per week ($35,568 annually). Employees earning less than this threshold are entitled to overtime regardless of job duties. For highly compensated employees, the threshold remains at $107,432 per year.

Exemptions from overtime. Executive, administrative, professional, and outside sales positions may be exempt from overtime requirements. Specific roles like live-in caregivers may have exemptions, but most home health aides working scheduled shifts are entitled to overtime pay when exceeding 40 hours per week.

Enforcement. The Ohio Department of Job and Family Services (ODJFS) oversees enforcement of wage and overtime laws. The statute of limitations for unpaid overtime claims is two years. Employers found in willful violation of minimum wage laws may face up to 60 days in jail and civil penalties up to $1,000 per violation.

Ohio's Workforce Challenges

Ohio faces significant home health workforce challenges driven by its large aging population, healthcare professional shortages, and competition from other industries for entry-level workers.

Aging population. Ohio already has roughly 2.2 million residents age 65 and older, one of the largest senior populations in the country. The state is hurtling toward a demographic turning point by 2040 as the ratio of working-age adults to seniors continues to decline. Projections suggest the current ratio of four workers per senior will drop to only 2.9 workers per senior within the next five years.

Workforce shortage severity. The state is struggling to recruit and retain a workforce willing to do physically and emotionally demanding elder care jobs. Workforce shortages and social isolation have been identified as top challenges by Ohio's aging advocacy organizations, conditions exacerbated by COVID-19.

National context. The demand for home care workers is soaring nationally, with a projected 4.6 million unfulfilled jobs by 2032. The non-medical home care industry faces a significant workforce crisis characterized by caregiver shortages impeding the delivery of vital daily support to seniors, people with disabilities, and those in recovery.

Competitive wages. Ohio's HHA wages are moderate compared to the national average, with state averages around $15.35-$16.26 per hour. Major metro areas like Columbus and Cincinnati offer approximately $18 per hour. However, Ohio ranks 50th out of 50 states for private home health aide salaries according to some measures, indicating significant recruitment challenges.

Cost pressures. The price of care is rising faster than general inflation. Federal data shows that while the Consumer Price Index increased around 3% annually, the cost of nursing homes and adult day services jumped more than 4%. Medicaid reimbursement has not kept pace with the real cost of care, leaving facilities to absorb higher labor, food, and housing expenses or shift costs onto families.

Budget protections. State leaders point to provider-rate protections in the 2026 budget for aging services as a critical step. Avoiding cuts helps stabilize the strained network of nursing facilities, home health agencies, and community-based providers.

ARPA funding transition. Through the American Rescue Plan Act, states were able to use temporary federal flexibility and enhanced funding until March 31, 2025, to stabilize direct care workforces. With ARPA funds expiring, states like Ohio require alternative funding sources to sustain ongoing workforce efforts.

Strategies for Ohio Agencies

Given Ohio's specific market dynamics characterized by a large aging population, comprehensive licensing requirements, and workforce shortages, agencies must adopt targeted strategies to recruit and retain caregivers.

Pay competitively. With Ohio's minimum wage at $10.70 per hour and average HHA wages around $15.35-$16.26 per hour, paying at the higher end of the wage spectrum is essential for recruitment. Metro areas like Columbus and Cincinnati see average wages near $18 per hour. Consider offering $17-19 per hour to attract quality candidates in competitive markets.

Leverage the 2024 rate increases. Ohio's historic $3.4 billion Medicaid rate increase effective January 2024 provides opportunity to improve caregiver compensation. Review your MCO contracts to ensure you're receiving the increased rates and consider passing some of the increase to caregivers to improve recruitment and retention.

Emphasize career pathways. Create clear pathways from HHA to STNA and beyond. Ohio's training requirements (75 hours for both HHA and STNA with different competency evaluations) create opportunities for advancement. Partner with community colleges and nursing programs to offer tuition assistance tied to employment commitments.

Address benefits gaps. Many Ohio caregivers lack basic benefits. Even modest offerings such as paid time off, health insurance contributions, or retirement matching can significantly differentiate your agency. Same-day pay options can address financial stress among workers.

Focus on retention. Every retained caregiver saves significant replacement costs estimated at $2,500-5,000 per turnover. Invest in thorough onboarding, consistent scheduling, supervisor support, and recognition programs. Exit interviews can identify fixable issues driving turnover.

Ensure EVV compliance. With Ohio's strict EVV enforcement beginning in 2025 and claims being denied without matching EVV records, ensure your agency is properly set up with Sandata or an approved alternative vendor. Train staff thoroughly on proper clock-in/clock-out procedures including GPS consent and location tagging.

Maintain licensure compliance. Ohio's 2022 licensing requirements transformed the market. Ensure your surety bonds are current ($50,000 for skilled, $20,000 for non-medical), background check policies are documented, and all required certifications are maintained. Non-compliance carries criminal prosecution risk.

Pursue Medicare certification. Diversifying beyond Medicaid to include Medicare patients can improve your agency's financial sustainability. Medicare's 2025 rates provide better reimbursement than many state Medicaid programs, allowing agencies to potentially offer more competitive wages.

Build rural strategies. Ohio spans urban, suburban, and rural regions with varying healthcare access. Consider travel time reimbursement, mileage payments above the IRS rate, and local community recruiting rather than expecting workers to commute from distant areas.

Partner with Area Agencies on Aging. Ohio's Area Agencies on Aging network can connect agencies with referral sources and community resources. Building relationships with these organizations strengthens your presence in local markets and can provide access to PASSPORT and other waiver program referrals.

Key Resources and Contacts

Agencies operating in Ohio should maintain relationships with these key regulatory and support organizations:

Ohio Department of Health - Home Health Agency Licensing
Home health agency licensing under O.R.C. 3740
Chapter 3701-60 Ohio Administrative Code
Website: odh.ohio.gov

Ohio Nurse Aide Registry
STNA certification and registry
Address: 246 N. High Street, Columbus, OH 43215
Phone: 800-582-5908 (in-state) or 614-752-9500 (out-of-state)

Ohio Department of Medicaid
Medicaid provider enrollment and fee schedules
Integrated Helpdesk: 800-686-1516
Email: [email protected]
Fee Schedules: medicaid.ohio.gov (Provider Network Management portal)
Website: medicaid.ohio.gov

Ohio EVV Program (Sandata)
Electronic Visit Verification requirements
Email: [email protected]
Access via OHID secure identity platform

Ohio Council for Home Care & Hospice
HHA Training Programs and industry resources
Website: ochch.org

Ohio Department of Job and Family Services
Wage and hour enforcement, labor market information
Website: jfs.ohio.gov

U.S. Department of Labor - Wage and Hour Division
Federal wage and hour questions
Website: dol.gov/agencies/whd

The Bottom Line

Ohio presents significant opportunity for home health agencies serving one of the nation's largest aging populations. The state's 2.2 million seniors and demographic trajectory toward 2040 ensure sustained demand for home health services. The historic $3.4 billion Medicaid rate increase in 2024 signals state commitment to strengthening the provider network.

However, navigating Ohio requires careful attention to compliance. The state's 2022 licensing requirements brought comprehensive regulation to a previously unlicensed market, with criminal penalties for non-compliance. EVV enforcement ramped up significantly in 2025, with claims denied without matching visit records. Agencies must ensure proper licensure, surety bonds, and EVV system integration.

Workforce challenges remain significant. Ohio struggles to recruit caregivers for demanding elder care roles, and wages must compete with retail and other entry-level industries. While state averages of $15-16 per hour exceed minimum wage, agencies in competitive metro markets may need to offer $17-19 per hour to attract quality candidates.

Success in Ohio requires understanding the ODH licensing framework, maximizing the 2024 rate increases through MCO contract reviews, ensuring EVV compliance before claim denials impact cash flow, and investing in competitive compensation and career development pathways. Agencies that navigate these requirements while building supportive workplace cultures will be best positioned to serve Ohio's growing senior population and build sustainable businesses in the Buckeye State.