Home Care Agency Licensure in Ohio

New licensure regime. Ohio's 2021 budget bill (HB 110) created home health licensure under R.C. ch. 3740, implemented from 2023 — a major change in a state that historically had no home care license at all. Source ↗

Two license types. The Ohio Department of Health issues a Skilled Home Health Services license and a separate Nonmedical Home Health Services license covering home health aide services, personal care, medication self-administration assistance, homemaker services, and errands. Source ↗

Surety bond. Applicants that were not already providing direct care before the grandfathering cutoff must post a $20,000 surety bond for a nonmedical license; owner fingerprinting and criminal-records-check policies are required for all applicants. Source ↗

Surveys and renewal. ODH's Licensure and Certification Unit processes applications and renewals and conducts surveys/complaint investigations with plan-of-correction enforcement; ODH remains the CMS survey agency for Medicare-certified agencies. Source ↗

Beware stale guidance. Many older guides still describe Ohio as a no-license state — that is outdated; operating a home care agency without an ODH license is now prohibited. Source ↗

No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction. Source ↗

Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license. Source ↗

Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey. Source ↗

State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual. Source ↗