How to start a behavioral health clinic in Ohio

Ohio requires a OhioMHAS certification of community mental health and addiction services (certifiable services listed in OAC Chapter 5122-29); opioid treatment programs are licensed separately from Ohio Department of Mental Health and Addiction Services (OhioMHAS) — Office of Licensure and Certification to operate a behavioral health clinic. Fee: $1,000.

License required

Yes

License

OhioMHAS certification of community mental health and addiction services (certifiable services listed in OAC Chapter 5122-29); opioid treatment programs are licensed separately

Issuing agency

Ohio Department of Mental Health and Addiction Services (OhioMHAS) — Office of Licensure and Certification

Fee

$1,000

Fee details

Initial certification: $1,000 base application fee regardless of number of services, plus $200 for each service that has no national accreditation standard (as OhioMHAS determines). Adding services mid-term: $250 base plus $200 per non-accreditable service. Fees are non-refundable (OAC 5122-25-12, effective 2026-08-01).

Renewal

Renewal: $500 base plus $200 per service with no national accreditation standard.

Accreditation

Required: since 2023-10-03 new providers seeking initial certification must hold national accreditation for services that have national standards (H.B. 33 eliminated deemed status); existing providers must have it at renewal from 2025-10-01. Ohio is not among the federal CCBHC demonstration states named by Medicaid.gov.

Survey and inspection

OhioMHAS conducts on-site reviews for services without national accreditation standards and may review on site when it needs more information.

Regulation

Ohio Rev. Code 5119.36; OAC Chapter 5122-25 (certification procedures, fees at 5122-25-12); OAC Chapter 5122-29 (certifiable services)

1. Identify the certifiable services or supports from OAC Chapter 5122-29 you will provide
2. Obtain national accreditation (The Joint Commission, CARF, COA or another approved accreditor) for each service that has accreditation standards; new providers must hold it for initial certification
3. Submit the initial certification application in OhioMHAS's licensure and certification tracking system (each provider under a parent submits its own), including adverse-action history in other jurisdictions
4. Upload accreditation survey reports and pay the base fee plus any per-service fees
5. OhioMHAS reviews the application, with an on-site review for services that lack national accreditation standards
6. Renew certification by renewal application before the term ends

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.

Community/behavioral health agencies and mental health clinics — active organization NPIs (NPPES)

3,782 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Ohio Behavioral health 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 →