Understanding Self-Direction in Ohio: What It Is and How It Works 

Join our free webinar, “Learn about Self-Direction in Ohio: An Overview” on Wednesday, August 27, 2026, from 1:00 to 2:00 PM EST. We’ll cover how these programs work, who they’re for, and how to get started, with a live Q&A at the end to answer your questions.

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To understand self-direction, it helps to compare it to the way home care usually works. 

Normally, you’ll call a home care agency. The agency finds a worker and sends them to your house. You don’t usually get to pick who that person is. You take who’s available, on their schedule, doing things the way the agency trains them to. 

Self-direction works differently. Under this model, you become the employer. That means you get to: 

• Choose who provides your care 
• Set the days and times that work for your life 
• Decide how tasks get done in your home 
• Train your caregiver on your specific needs and routines 

For a lot of people, the best caregiver isn’t a stranger. It’s someone who already knows the person receiving care. Maybe it’s a family member who understands their routines. Maybe it’s a friend who knows how to calm them down on a hard day. Maybe it’s a neighbor who’s already been stopping by to help out. Self-direction makes it possible to pay that person for the care they’re likely already helping with, instead of relying on whoever an agency happens to send. 

And if you don’t already have someone in mind, that’s okay too. You can hold interviews and find the right caregiver on your own terms, the same way you’d hire for any other job. Self-direction gives you the choice to find someone who’s truly the right for you or your loved one. 

There are some basic requirements. The person you hire needs to meet the program’s standards for the specific services they’ll be providing, which includes background verification before they can be paid as a caregiver. Depending on the program, you may also be able to negotiate their pay within your approved budget. 

One thing worth knowing: spouses usually can’t be paid as a caregiver under Ohio’s self-direction programs. There’s a very narrow exception if your case manager determines that no other qualified caregiver is realistically available to you, but it still requires state approval. If you think this situation applies to you, your care manager can walk you through what that process looks like. 

It’s important to note that you don’t go through this process alone. A Financial Management Services (FMS) provider handles the part of being an employer that most people don’t want to deal with, like payroll and taxes. We’ll explain exactly how this works later in this blog.

Ohio’s self-direction programs serve a wide range of people. You don’t need a specific diagnosis to look into whether you qualify. In general, the person receiving care needs ongoing support to stay safely at home, and they need to be eligible for Medicaid. From there, eligibility depends more on the type of support someone needs than any single condition or age group. 

These programs fall under a category called Home and Community-based Services (HCBS), which simply means care that helps someone stay in their own home and community instead of a long-term care facility. 

Across Ohio’s three main self-direction programs, eligible individuals generally fall into these groups: 

• Adults with a physical disability, a mental or behavioral health need, or a condition that qualifies them for both Medicare and Medicaid (two separate programs that some people, often older adults or people with disabilities, qualify for at the same time) who require a Nursing Facility – Level of Care (NF-LOC) 
• Adults and individuals 18 and under who are chronically ill or have a physical disability and need help staying at home 
• Older adults who need support at home to avoid moving into a nursing home 

It’s worth noting that some people could technically fit into more than one category, and the right program often comes down to a person’s specific needs, age, and health status rather than a strict checklist. If that sounds overwhelming, you’re not expected to figure it out alone. A case manager or care coordinator can walk through your situation with you and help point you toward the program that fits best. 

And if none of these groups sound like your situation, don’t count yourself out. For example, Ohio has separate Medicaid programs for children and youth with behavioral health needs. We cover those later in this article.

You can take a short questionnaire to see if self-directed care could be a good fit for you or the person you’re caring for.

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Ohio offers self-direction through a few different Medicaid programs called waivers. A waiver is a special approval that lets the state pay for care at home instead of only in a hospital or long-term care facility. Ohio has three main waivers that offer self-direction: the Next Generation MyCare Waiver, the Ohio HomeCare Waiver, and the PASSPORT Waiver.  

MyCare serves adults 18 and older who need NF-LOC. That generally means someone struggles with several everyday tasks on their own, like personal care, communicating, learning new things, decision making, moving around, or living independently. This includes people with disabilities, people who qualify for both Medicare and Medicaid, and people with mental or behavioral health needs.  

MyCare is available to members enrolled in Anthem MyCare, Buckeye, CareSource, or Molina. This program is also expanding and is now available in 88 Ohio counties. 

Under MyCare, you can have budget authority, employer authority, or both. Budget authority means you decide how your approved funds are spent. Employer authority means you’re the one who hires, manages, and can terminate your caregiver. You manage all of this through a portal called MyAccount, where you can track your budget, review caregiver hours, and handle timesheets. 

Ohio HomeCare serves adults and individuals 18 and under who are chronically ill or have a physical disability. Like MyCare, this program gives you the choice of budget authority, employer authority, or both, and it also uses the MyAccount portal to manage your budget and caregiver timesheets. 

One thing that stands out about Ohio HomeCare is how much say you get over caregiver pay. Within your approved budget, you can actually negotiate the wage you pay your caregiver. That means you have a say not just in who provides your care, but also in how much they’re compensated.  

PASSPORT serves older adults who need help managing daily lifer at home. This usually means someone has trouble with several basic tasks on their own, such as taking care of themselves, communicating, making decisions, and moving around. PASSPORT is designed to give these individuals the support they need to stay in their own home rather than move into a nursing facility. 

Like the other two programs, PASSPORT gives you the ability to find, hire, manage, and terminate your own caregiver. Instead of MyAccount, PASSPORT uses a portal called BetterOnline™, where you review your budget, approve timesheets, and keep track of spending.  

Want to learn more about how these programs work? Join our free webinar, “Learn about Self-Direction in Ohio: An Overview” on Wednesday, August 27, 2026, from 1:00 to 2:00 PM EST. The webinar wraps up with a live Q&A, so you can get your specific questions answered.

Register Here

Each of Ohio’s three self-direction programs offers a set of services built around what the person receiving care actually needs. Before services are approved, a clinical assessment documents what someone cannot safely do on their own. From there, those needs are built into a person-centered care plan, which determines which services you’re approved to receive.  

These aren’t extra conveniences. They’re the kind of support that allows you or your loved one to continue living at home. That means staying in a place that feels comfortable and cared for by someone you know and trust. 

Services available across Ohio’s self-direction programs generally fall into a few categories: 

• Personal care, including help with bathing, dressing, eating, and other tasks, sometimes called attendant care or personal care aide services 
• Transportation and errands, like rides to medical appointments or help with grocery shopping, depending on your program 
• Nursing care, provided by a licensed nurse for people with ongoing medical needs, including infusion therapy in some cases 
• Home maintenance and chore support, like basic upkeep around the house 
• Alternative meals, for people who are unable to safely prepare their own food 

Depending on your care plan, you may also be approved for: 

• Home modifications, like ramps or grab bars, to make a home safer 
• Home medical equipment and supplies needed for a person’s care 
• Self-directed goods and services, which covers other approved items or supplies not available another way, up to a set yearly amount 

Not every service is available in every program, and the exact names and requirements can vary depending on which waiver you’re enrolled in. Your care manager can help you understand exactly what your assessment determined you’re eligible for. 

Remember budget authority and employer authority from earlier? Depending on your program, you may have one or both, and that combination shapes exactly how much control you have over your care.

Earlier, we mentioned that an FMS provider helps handle the employer side of self-direction. Here’s a closer look at what that actually means. 

When you choose self-direction, you take on real responsibilities as an employer. That includes paying your caregiver, withholding the right taxes, and keeping up with the paperwork that comes with having an employee. Most Medicaid-funded self-direction programs require you to work with an FMS provider to help manage all of this, which is a real relief for most participants. 

An FMS provider typically handles: 

• Payroll: Processing payment for your caregiver using money from your approved budget 
• Employment taxes: Includes federal, state, local, and unemployment tax requirements 
• Monthly budget management: Keeps your spending on track 
• Enrollment support: Helps you and your caregiver get set up and trained as needed 
• Customer service: You have someone to ask when questions come up 
• Service reports: Gives you a clear picture of the services you’ve received 

Working with an FMS provider is a required part of self-direction in Ohio. PPL serves as the FMS provider for Ohio’s self-direction waivers, supporting participants and caregivers through payroll, enrollment, and everyday questions along the way. This allows you to move forward with peace of mind knowing the details are handled.

All self-direction programs use a system called Electronic Visit Verification (EVV) to confirm when caregiver visits happened. PPL’s mobile app, Time4Care™, makes this easy for both you and your caregiver. It sends reminders when a timesheet needs attention, flags errors before they become a problem, and lets you approve hours right from your phone.

The three waivers covered so far aren’t the only Ohio Medicaid programs that offer participants choice and control over their care. If your situation doesn’t match MyCare, Ohio HomeCare, or PASSPORT, one of these programs might still be a fit. 

If you’re the parent or caregiver of a child or teen with complex behavioral health needs, OhioRISE may be worth looking into. It’s a specialized care program for youth ages 0 to 20 with significant mental or behavioral health needs, built around a care coordinator who works with the family to build a care plan.  

For families already connected to OhioRISE, respite services are also available, and this particular service is self-directed. Families can choose independent providers for behavioral health respite, giving a primary caregiver time to rest, run errands, or take a break, with PPL managing the payroll and paperwork behind the scenes. 

If you’re an adult managing a chronic illness, ODH offers financial assistance for related expenses, including health insurance premiums and Medicaid spend-down payments.  

If you need help covering the cost of a breast or cervical cancer screening, BCCP provides financial assistance for eligible individuals. 

Not sure which program fits your situation? A care manager or care coordinator can help point you in the right direction.

Getting started with self-direction in Ohio begins with a conversation. To be eligible for MyCare, Ohio HomeCare, or PASSPORT, you’ll need to be enrolled in Medicaid. If you’re not already enrolled, a care manager or care coordinator can help you understand what that process looks like alongside your waiver eligibility. 

From there, the process generally looks like this: 

• Confirm your Medicaid and waiver eligibility with a care manager or care coordinator 
• Let them know you’re interested in self-directing your care 
• Get connected with a Financial Management Services (FMS) provider like PPL to handle payroll and paperwork 
• Choose and hire your caregiver, whether that’s someone you already know or someone new 

Want to hear more about how this works before you decide? Join our free webinar, Learn about Self-Direction in Ohio: An Overview, on Wednesday, August 27, 2026 from 1:00 to 2:00 PM ET. The webinar wraps up with a live Q&A, so you can get your specific questions answered.

Register Here

PPL is the financial management services provider supporting Ohio’s self-direction waivers. Our job is to help take the weight of employer responsibilities off your shoulders, so payroll, taxes, and paperwork are handled, and you can put your energy into care instead. 

We’re the largest company of our kind in the country, supporting close to 700,000 participants and caregivers across 18 states. Every day, our work centers on the same idea: people deserve real choice in who cares for them, and the independence that comes with staying home, surrounded by people they trust. 

If you live outside Ohio, or if you’re just curious what self-direction looks like in other states, PPL supports programs in a number of places across the country.  

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