Ohio home care programs

Home health: the medical benefit

In Ohio, skilled home health is Medicaid Home Health Services (OAC 5160-12-01). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Ohio Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Ohio the agency route is PASSPORT Medicaid waiver. No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. PASSPORT Medicaid waiver lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Ohio's consumer-directed option is Choices Home Care Attendant Service (C-HCAS) and participant-directed personal care. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Choices Home Care Attendant Service (C-HCAS) and participant-directed personal care allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Ohio offers structured family caregiving through Structured Family Caregiving (SFC). A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways Ohio pays for care at home

Waiver in-home services: Homemaker/Personal Care (HPC) and Participant-Directed HPC (PD-HPC), MyCare Ohio Waiver (Next Generation MyCare), and Ohio Home Care Waiver (OHCW). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Medicaid Home Health Services (OAC 5160-12-01)).
• Needs daily help and wants an agency to supply and manage the aide: PASSPORT Medicaid waiver.
• Wants to choose the aide, including a relative where allowed: Choices Home Care Attendant Service (C-HCAS) and participant-directed personal care.
• Lives with a family member who provides care most of the day: Structured Family Caregiving (SFC).
• Meets nursing-home level of care and needs more than personal care: Homemaker/Personal Care (HPC) and Participant-Directed HPC (PD-HPC), MyCare Ohio Waiver (Next Generation MyCare), and Ohio Home Care Waiver (OHCW).