Adult Day Care Regulations in Ohio

Who regulates adult day care in Ohio

Ohio sets adult day standards through certification and Medicaid rules for centers serving publicly funded participants.

• The Ohio Department of Aging certifies adult day service (ADS) providers under Ohio Administrative Code (OAC) 173-39-02.1. Its designees, the area agencies on aging and Catholic Social Services of the Miami Valley, review applicants and monitor providers.
• The Ohio Department of Medicaid (ODM) administers the Ohio Home Care Waiver adult day health center service (OAC 5160-46-12) and the MyCare Ohio waiver.
• The Ohio Department of Developmental Disabilities (DODD) certifies adult day support providers under OAC 5123-2-08 and OAC 5123-9-17.

Types of adult day programs in Ohio

The Department of Aging certifies two ADS levels. Enhanced ADS includes supervision of all activities of daily living (ADLs), hands-on help with at least one ADL other than bathing, medication assistance and intermittent health monitoring. Intensive ADS adds hands-on help with at least two ADLs including bathing, skilled and rehabilitative nursing, social work and restorative services.

The Ohio Home Care Waiver covers adult day health center services for adults 18 and older. DODD's adult day support serves people on the Individual Options, Level One and SELF waivers, in person or virtually. Older Americans Act programs also recognize a basic ADS level under OAC 173-3-06.1.

How to get certified in Ohio

Only an agency provider can be certified to provide ADS. The Department of Aging and OAC 173-39-03 describe these steps:

1. Complete background checks, create an OH|ID account and write policies covering admission criteria and person-centered care plans.
2. Start in ODM's Provider Network Management (PNM) module, then finish in the department's Provider Certification Wizard, uploading documents and paying any fee.
3. The local area agency on aging visits your site and makes a recommendation, generally within 60 days of a complete application.
4. The department decides, and its designee signs an agreement with you setting your per-unit rate.

DODD certification is a separate application, and an initial one lasts three years. From May 14 to November 14, 2026, ODM has paused new Medicaid enrollment for home health, hospice and related provider types, including type 45 (Waivered Services Organization). The notice does not mention adult day, so confirm with ODM.

Key requirements

The ADS rule, updated effective October 1, 2026, requires certified centers to have:

• At least two staff present when more than one participant attends, one certified in CPR, and a ratio of at least one staff member to six participants at all times.
• An RN or LPN available for nursing services that need those skills, and an activity director.
• At least 60 square feet per participant served (excluding hallways, offices, restrooms and storage), one toilet per 10 participants and a wheelchair-accessible toilet.
• Compliance with Ohio fire and building code provisions for adult day care centers and an annual fire inspection.
• An initial assessment by the end of the second day of attendance, a health assessment and activity plan within 30 days, a plan of treatment every 90 days when needed, and a care conference every six months.
• At least eight hours of staff in-service training each calendar year.

Ohio Home Care Waiver centers must keep a one-to-six ratio of paid direct care staff, pass fire marshal inspections and run emergency drills at least quarterly.

Medicaid funding for adult day in Ohio

• PASSPORT serves people 60 and older who meet a nursing facility level of care. The Department of Aging operates it for ODM, and PASSPORT Administrative Agencies provide case management.
• MyCare Ohio waiver. Next Generation MyCare, for people 21 and older with full Medicaid and Medicare, reached the whole state by August 1, 2026. MyCare members who were on the Ohio Home Care, Assisted Living or PASSPORT waiver are now on the MyCare Ohio Waiver, which covers adult day health services (OAC 5160-58-04). People who are not eligible for MyCare, such as those without Medicare, stay on their original waiver. Providers must enroll with ODM and the MyCare Ohio plan to be paid.
• Ohio Home Care Waiver serves people from birth through age 59 with a nursing facility level of care.
• DODD waivers cover adult day support. A DODD-certified provider may contract with a Department of Aging-certified center to deliver it.

Billing basics

PASSPORT pays attendance in half-day units (under four hours), day units (four to eight hours) and 15-minute units past eight hours, up to 12 hours. Transportation is paid separately and does not count as attendance. Rate limits are in the appendix to OAC 5160-1-06.1.

For the Ohio Home Care Waiver, OAC 5160-46-06 lists code S5101 (per half day) and S5102 (per day), with claims submitted to ODM. Confirm each unit's hours in OAC 5160-46-12 or with ODM. DODD providers bill through eMBS for services authorized in DODD's PAWS system, using the service codes in Appendix A to OAC 5123-9-17.

Record arrival and departure times. Adult day is not among the services subject to electronic visit verification (EVV) in OAC 5160-32-01.

Other ways centers are paid

Area agencies on aging can fund adult day with Older Americans Act dollars, and those provider agreements must meet OAC 173-3-06.1.

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• Ohio Department of Aging: Certification for Providers
• OAC 173-39-02.1: Adult day service
• OAC 5160-46-12: Adult day health center service
• OAC 5123-9-17: Adult day support
• PASSPORT Waiver
• Next Generation MyCare
• DODD Waiver Billing
• Adult Day Ohio

Frequently asked questions

Do I need a license to open an adult day center in Ohio?

Ohio's adult day rules are certification rules for publicly funded programs. To serve PASSPORT participants, your center must be certified under OAC 173-39-02.1. If you will serve only private-pay participants, ask the Department of Aging and local building and fire officials which requirements apply.

Does Ohio Medicaid pay for adult day care?

Yes. PASSPORT, MyCare Ohio and the Ohio Home Care Waiver cover adult day health services, and DODD waivers cover adult day support.

Who inspects adult day centers in Ohio?

The Department of Aging or its designee conducts a structural compliance review of certified ADS providers by the first certification anniversary and then yearly, under OAC 173-39-04.

Is electronic visit verification required for adult day in Ohio?

No. Adult day is not on Ohio's EVV list, but you must still record arrival and departure times.