Self-Direction and FMS in Ohio

All states: self-direction map

Ohio self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Ohio offer self-direction?

Ohio offers self-direction in six Medicaid waivers, run by three state agencies. The Ohio Department of Medicaid (ODM) runs the Ohio Home Care and MyCare waivers and calls the option self-direction. The Ohio Department of Aging (ODA) runs PASSPORT and calls it participant direction. The Ohio Department of Developmental Disabilities (DODD) runs the Individual Options, Level One and SELF waivers and calls it participant-direction. In all six the individual hires and manages the workers, and for at least some services also controls a budget.

• Ohio Home Care Waiver (self-direction): serves people aged 0 to 59 with physical disabilities who meet a nursing facility level of care. ODM runs it. Self-direction started on this waiver on October 1, 2024. The individual has employer authority and budget authority for personal care aide, home care attendant and waiver nursing services, and sets caregiver wages within the budget. Home modifications (up to $10,000 a calendar year) and self-directed goods and services (up to $2,500 per 365 days) carry budget authority only.
• MyCare Waiver (self-direction): serves adults 18 and older who are eligible for both Medicare and Medicaid and meet a hospital or nursing facility level of care, in MyCare counties. ODM runs it through the MyCare Ohio managed care plans. Self-directed services were expanded on November 15, 2024. The member has employer authority and budget authority for Choices home care attendant, home care attendant, personal care aide and waiver nursing. Budget authority only applies to alternative meals, home maintenance and chores, home medical equipment, home modifications and self-directed goods and services.
• PASSPORT Participant Direction: serves people 65 and older, and people 60 to 64 with physical disabilities. ODA runs it through the regional PASSPORT Administrative Agencies. There are two worker services. Under the Choices Home Care Attendant Service (C-HCAS) the individual has employer authority and sets the hourly wage with the case manager. Under the Consumer-Directed Personal Care Service (CD-PCS) the individual has employer authority only, and the rate is set by the state. Home care attendant and waiver nursing cannot be self-directed on PASSPORT.
• Individual Options (IO) Waiver: serves people with developmental disabilities who need many different services. DODD runs it, and county boards of developmental disabilities administer it locally. Participant direction is optional. The service is participant-directed homemaker/personal care (PD-HPC), and the person must live alone or with family to use it. The individual has employer authority and negotiates the pay rate with the worker inside the minimum and maximum set in the rule.
• Level One Waiver: serves people with developmental disabilities who do not need many paid support staff. DODD runs it through the county boards. Participant direction is optional and covers participant-directed homemaker/personal care and participant-directed goods and services, with employer authority and budget authority.
• Self-Empowered Life Funding (SELF) Waiver: serves adults and children with developmental disabilities who want to direct their own services. DODD runs it through the county boards. Participant direction is required: the person or a representative must direct at least one service. Employer authority covers participant-directed homemaker/personal care, self-directed transportation and support brokerage. Budget authority adds clinical/therapeutic intervention and participant-directed goods and services.

Employer authority means the individual recruits, hires, schedules and supervises the workers. Budget authority means the individual also decides how a set amount of money is spent, which can include the worker's wage. On the SELF waiver, Ohio Administrative Code rule 5123-9-40 (the version effective July 1, 2026) caps the waiver at $62,136 for an adult and $41,424 for a child per 12 month waiver eligibility span, and caps support brokerage at $8,000.

Who handles financial management services (FMS) in Ohio?

Two companies handle financial management services for Ohio self-direction, split by state agency. Public Partnerships Limited (PPL) is the FMS for the Ohio Home Care, MyCare and PASSPORT waivers. GT Independence is the FMS for the three DODD waivers. Ohio uses a fiscal/employer agent model, which means the FMS runs payroll and taxes while the individual stays the legal employer of the workers. Each agency contracts with one FMS, so participants do not pick among vendors.

A fiscal/employer agent is the organization that handles the paperwork side of being an employer. It enrolls the workers, processes their time, pays them and files the employer taxes on the individual's behalf. ODA's PASSPORT participant direction page says the individual is the employer of record and must use the state-contracted FMS provider for payroll, taxes, workers' compensation and unemployment premiums.

• Legal employer: the individual. On the ODM waivers, self-directed caregivers are the individual's employees. On the DODD waivers the worker must be a common law employee of the individual, with the state-contracted FMS acting as agent.
• The SELF waiver exception: SELF also allows co-employment. The individual can share the employer role with an agency with choice, which is an organization that serves as employer of record while the individual directs the day to day work. This option is not available on the IO or Level One waivers. We did not find a published list of organizations that act as an agency with choice. Ask the county board of developmental disabilities.
• PPL (ODM and ODA waivers): ODM's caregiver resources page names PPL as the FMS. Caregivers enroll with PPL, which handles payroll, employment taxes and budget tracking. On MyCare, caregivers are paid by PPL and not by ODM or the health plan. On the ODM waivers the FMS also runs criminal record checks, and a caregiver may be conditionally employed for up to 60 days while the check is pending.
• GT Independence (DODD waivers): DODD announced in May 2022 that GT Independence would replace Morning Sun as the FMS for participant-directed services on the SELF, IO and Level One waivers on July 1, 2022, after a competitive bid. DODD pays for FMS through its own contract, not from the person's waiver budget.

Wages work differently by agency. On the ODM waivers the individual sets caregiver wages using budget authority, and care coordinators authorize overtime when appropriate. On the DODD waivers staff cannot be paid less than minimum wage or more than the Medicaid maximum.

Who can be a paid caregiver under self-direction in Ohio?

Individuals can hire relatives, friends and neighbors, but Ohio limits pay for the closest family members. A spouse or the parent of a minor child can be paid only when no other willing and able provider is available and the care is extraordinary care, and then for no more than 40 hours a week. A representative who helps the individual self-direct cannot also be the paid worker.

The rule behind this is Ohio Administrative Code rule 5160-44-32. It says a spouse or the parent of a minor must either work for an agency or deliver a participant-directed service through the FMS, is limited to 40 hours a week, and cannot be paid for respite. A relative who holds legal decision-making authority for the individual, such as a guardian or a power of attorney, can be paid but is also limited to 40 hours a week.

• Ohio Home Care and MyCare: a parent, spouse or other relative may be a self-directed caregiver if the conditions in rule 5160-44-32 are met. A self-direction representative cannot be the caregiver. One MyCare plan handbook (CareSource) says a spouse or relative can be paid for a maximum of 40 hours a week.
• PASSPORT: the individual may hire family, friends or neighbors aged 18 or older who meet ODA certification. A spouse, or a relative with a legal representative designation, can be hired only if the requirements of rule 5160-44-32 are met.
• IO and Level One: DODD's FAQ says a parent or spouse who provides participant-directed homemaker/personal care must be a DODD certified independent provider enrolled with the FMS. The 40 hour limit applies to parents of minors and spouses and is counted per child, not per parent.
• SELF: the same rules apply, and a parent or spouse may instead work for an agency with choice.
• All DODD waivers: the representative who helps a person self-direct cannot be paid to provide waiver services to that person. Family members can be hired only if they are not designated to help with employer functions.

Does EVV apply to self-directed workers in Ohio?

Yes. Electronic visit verification (EVV) applies to self-directed workers in Ohio, and pay depends on it. On the ODM waivers, caregivers must record all time they expect to be paid for in the FMS timekeeping system, which includes EVV. Ohio also denies claims that have no matching EVV visit.

• Ohio Home Care and MyCare: rule 5160-45-03.2 requires caregivers to record their time in the FMS timekeeping system, which includes EVV.
• PASSPORT: for the Choices Home Care Attendant Service, EVV is done through the FMS, which acts as the State's alternate EVV vendor. That data goes to the state's Sandata Aggregator.
• DODD waivers: EVV is required for participant-directed homemaker/personal care. DODD's FAQ says that since July 1, 2024 a live-in caregiver may be exempted through ODM's process, using form ODM 10374.
• FMS vendors: an FMS contracted with ODM, ODA or DODD must hold Ohio alternate EVV vendor certification.

Ohio's published EVV dates show that claims without a matching EVV visit are denied, by date of service, for DODD waivers from October 1, 2025, for Ohio Home Care and PASSPORT from January 1, 2026, and for MyCare from March 1, 2026.

Two points could not be confirmed. We did not find a primary source that says whose EVV system DODD participant-directed workers use day to day. We also did not find a statement that the FMS system is the EVV method for PASSPORT Consumer-Directed Personal Care, since the ODA guide covers the Choices service only. For DODD waivers, ask the county board or the FMS. For PASSPORT, ask the PASSPORT Administrative Agency.

What is changing next for self-direction in Ohio?

Under Senate Bill 315, the Ohio Department of Medicaid anticipates rule changes in July 2027 that would require GPS capture at the start and end of each visit and narrow the live-in caregiver exemption. This is the timing ODM gave stakeholders, not a filed rule, so both the date and the details can change. Until a rule is final, the current EVV rules and the current live-in exemption process stand.

ODM's EVV stakeholder workgroup deck of September 28, 2026 also describes a GPS waiver. As presented, self-direction workers on nursing facility based waivers would not be eligible for that waiver unless the individual has a developmental disability. FMS organizations and families who rely on the live-in exemption should watch for the proposed rule text.

One current item affects hiring. ODM has a statewide moratorium on new provider enrollment for several home care provider types, including non-agency personal care aides and home care attendants. It began May 14, 2026 and runs until November 14, 2026 unless the federal government authorizes an extension. ODM says individuals can still hire new self-directed caregivers during the moratorium. The caregiver must be enrolled with PPL or already enrolled with Ohio Medicaid, and the care manager sends a referral to PPL. We did not find a statement on how the moratorium affects people who want to become ODA-certified participant-directed providers for PASSPORT. Ask the PASSPORT Administrative Agency.

Ohio self-direction sources

• Ohio Department of Medicaid: Self-Direction Services and Information
• Ohio Department of Medicaid: Self-direction resources for caregivers
• Ohio Administrative Code rule 5160-45-03.2 (self-direction on ODM waivers)
• Ohio Administrative Code rule 5160-44-32 (paid relatives and legally responsible family members)
• Ohio Department of Aging: PASSPORT participant direction
• Ohio Department of Developmental Disabilities: Self-directed services
• Ohio Department of Developmental Disabilities: FAQ revised March 24, 2025
• Ohio Department of Developmental Disabilities: FMS provider announcement (May 23, 2022)
• Ohio Department of Medicaid: EVV stakeholder workgroup deck (September 28, 2026)

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Ohio EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.