How to start an assisted living facility in Ohio

Ohio requires a Residential care facility license. Any assisted living facility that meets the residential care facility definition in R.C. 3721.01 is regulated as one. from Ohio Department of Health, Office of Health Assurance and Licensing to operate an assisted living facility. Fee: $320 for each 50 beds or part thereof (1–50 beds $320; 51–100 $640; up to $1,920 for 251–300), non-refundable. An optional expedited initial inspection costs extra. Processing time: Submit the application 60 to 180 days before the planned opening date.

License required

Yes

License

Residential care facility license. Any assisted living facility that meets the residential care facility definition in R.C. 3721.01 is regulated as one.

Issuing agency

Ohio Department of Health, Office of Health Assurance and Licensing

Fee

$320 for each 50 beds or part thereof (1–50 beds $320; 51–100 $640; up to $1,920 for 251–300), non-refundable. An optional expedited initial inspection costs extra.

Renewal

Every year · There is an annual renewal licensing and inspection fee of $320 per 50 persons (or part) of licensed capacity (R.C. 3721.02(E)).

Processing time

Submit the application 60 to 180 days before the planned opening date.

Survey and inspection

ODH inspects at least once every 15 months (up to every 30 months for facilities with clean records), and the fire marshal also inspects at least every 15 months.

Medicaid waiver coverage

HHS's 2015 compendium reported that Ohio's 1915(c) Assisted Living waiver and the MyCare Ohio demonstration cover assisted living services in licensed residential care facilities.

Regulation

R.C. 3721.01–.02; Ohio Adm. Code ch. 3701-16 and 3701-17

1. Submit the initial license application with the fee 60–180 days before opening
2. Attach a schematic drawing, certificate of occupancy, State Fire Marshal inspection report, heating system inspection letter and Notice of Readiness
3. Pass the ODH pre-licensure inspection

Program

Ohio Medicaid (Ohio Department of Medicaid, ODM)

Enrollment portal

Provider Network Management (PNM) module of the Ohio Medicaid Enterprise System (OMES)

Application fee

Organizational provider types pay a non-refundable fee of $750 per application in 2026 (42 CFR 455.460 and OAC 5160-1-17.8), paid online in PNM. Individual practitioners and practitioner groups do not pay it. The fee is waived if paid to Medicare or another state's Medicaid program within the past five years for new enrollments; ODM's revalidation FAQ uses a two-year window for revalidations. The application cannot be finished until the fee is paid or proof is uploaded.

Fingerprinting

ODM requires BCI&I criminal record checks for certain providers, notably Ohio Home Care Waiver non-agency providers, who have done annual checks. ODM is moving these providers to RAPBACK, the retained-applicant fingerprint database, which gives continuous criminal-history updates at no cost to the provider. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under OAC 5160-1-17.8, some providers get pre- and post-enrollment on-site screening visits. Public Consulting Group (PCG) does the visits for providers not already screened by another state or federal agency. The visits are unannounced, and not cooperating can affect enrollment. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

ODM revalidates under 42 CFR 455.414 (at least every 5 years). It sends a notice about 120 days before the deadline, one per provider number, and also posts it in PNM correspondence. Do not start revalidation until the notice arrives. Revalidating with Medicare does not replace Ohio revalidation. ODM may do an on-site visit as part of it.

Full Ohio Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (long-term care)

Agency

Ohio Department of Health (Director of Health)

Services covered

• long-term care facilities: licensed nursing homes and skilled nursing / long-term care beds (including county homes and hospital-registered long-term care beds)
• new long-term care facilities, increases in bed capacity, and relocation of beds between sites

Ohio certificate of need details →

State minimum wage

$11.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $11.40 on 2027-01-01 ($5.70 tipped) for employers above the gross-receipts threshold.

Rate pass-through

HB 33 (FY2024-25 budget) requires DODD waiver provider rate increases to be used to raise wages and workforce supports; the bill's specific $17/$18 per hour rate language was vetoed, but the funding remained.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

1,094 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,597,852 (as of Jun 1, 2026)

All Ohio Home care Medicaid rates, ranked →

• OH Assisted Living Waiver (1915(c))
• OH Home Care Waiver (1915(c))
• OH Individual Options (IO) Waiver (1915(c))
• OH Level One Waiver (1915(c))
• OH MyCare Ohio Waiver (1915(c))
• OH OhioRISE Waiver (1915(c))
• OH PASSPORT Waiver (1915(c))
• OH Self Empowered Life Funding (SELF) Waiver (1915(c))

Ohio waivers and waiting lists →