Ohio DODD Waiver Rule Changes Effective July 1st
If you’re a home care provider in Ohio serving individuals on Medicaid developmental disability waivers, a significant set of rule changes is coming. The Ohio Department of Developmental Disabilities (DODD) is updating the Individual Options (IO), Level One (L1), and Self-Empowered Life Funding (SELF) waivers on July 1, 2026 — and several of the changes will directly affect how you deliver services, document care, and prepare for oversight visits.
This post breaks down every change that matters to home care providers, in plain language.
What Are the Ohio DODD HCBS Waivers?
Ohio’s DODD administers three Medicaid home and community-based services (HCBS) waivers for individuals with developmental disabilities:
- Individual Options (IO) Waiver — a comprehensive waiver for individuals who need a broad range of supports
- Level One (L1) Waiver — lower-intensity supports for adults living with family or in their own home
- Self-Empowered Life Funding (SELF) Waiver — a self-direction model that gives participants more control over their services
Home care agencies in Ohio frequently provide services under one or more of these waivers, including personal care, remote support, and in-home assistance for individuals with intellectual and developmental disabilities (IDD).
What’s Changing on July 1, 2026?
1. SSAs Must Now Visit Your Clients’ Homes in Person
This is the biggest change for home care providers.
Previously, Service and Support Administrators (SSAs) — the case managers responsible for overseeing each waiver participant’s services — could fulfill their monitoring responsibilities through phone calls, documentation reviews, or a combination of methods.
Under the updated rules, SSAs will be required to conduct regular in-person visits at both home settings and day service settings. If there is any concern about a client’s health or safety, SSAs will also be required to make unscheduled visits.
What this means for your agency: Your in-home documentation, caregiver practices, and care environment will have more eyes on them — and potentially on short notice. Visit notes, incident records, and care plans need to be current, complete, and consistent with what’s actually happening in the home before July 1.
Source: IO, Level 1, and SELF waivers — Appendix D; OAC 5123-9-06
2. Individual Service Plans Must Include a 12-Month Outcome
Every client’s Individual Service Plan (ISP) will need to document at least one goal that spans a full 12 months. ISP revisions will also need to be completed within 30 days of any change.
Before this rule, the 12-month outcome requirement was not a hard standard, and revision timelines were more flexible.
What this means for your agency: Your services will need to connect back to a documented long-term outcome — not just daily task completion. If a client’s plan changes after July 1, the revised ISP must be finalized within 30 days. Start working with your clients’ SSAs now to make sure plans will be ready.
Source: IO, Level 1, and SELF waivers — Appendix D
3. Assessments Must Happen Face to Face
Level of care assessments and reassessments — which determine what services a client is eligible for — will need to be conducted in person starting July 1. Phone-based or virtual-only assessments will no longer satisfy the requirement.
What this means for your agency: This primarily affects SSAs and county boards, but it will impact your clients’ authorization timelines. New enrollments and annual renewals may take longer to process as SSAs schedule and complete in-person visits. Plan ahead if you have clients approaching reassessment dates.
Source: IO, Level 1, and SELF waivers — Appendix B
4. HCBS Compliance in Non-Residential Settings Will Become a Tracked Metric
DODD is adding a new performance measure to the Level One and SELF waivers that will formally track whether non-residential settings — including adult day programs and community service locations — are complying with federal HCBS settings rules.
This is less a new requirement and more a formalization of oversight. DODD will be grading itself (and providers) on HCBS compliance in community settings, which means data collection and compliance reviews in those environments are likely to increase.
What this means for your agency: If your clients attend adult day programs or receive services in non-residential community settings, confirm now that those settings are meeting HCBS standards. Non-compliance in a setting where your clients receive services can affect their care plans and create disruptions to your service delivery.
Source: Level 1 and SELF waivers — Appendix C
5. Home Modification Cost Limit Raised to $15,000 — With New Process Requirements
The Environmental Accessibility Adaptations (EAA) service — which covers home modifications like ramps, grab bars, widened doorways, and safety adaptations — will see its cost limit increase from $10,000 to $15,000. This update applies to the IO and Level One waivers, and Environmental Accessibility Adaptations will be added as a new service under the SELF waiver.
However, the higher limit comes with tighter process requirements:
- A professional needs assessment is required before work begins
- Contractor bids must be submitted and documented
- All modifications must comply with local building codes
- Independent providers cannot subcontract adaptation work
- Approved repairs to existing adaptations are now explicitly covered
What this means for your agency: If your clients need home modifications, there will be more funding available — but the process to access it is more structured. Make sure requests are well-documented and that any contractors involved understand the new requirements.
Source: IO, Level 1, and SELF waivers — Appendix C and I; OAC 5123-9-23 and 5123-9-44
6. Medication Administration Rules Will Be Formally Written Into the Level One Waiver
The Level One waiver will include explicit language governing medication administration, aligned with Ohio Administrative Code rule 5123-6-06. Previously, this guidance existed in state rules but was not formally incorporated into the waiver document itself.
What this means for your agency: If you provide in-home services or remote support under the Level One waiver, your medication administration policies will need to align with OAC 5123-6-06. Review your current policies and procedures now to confirm they meet the rule’s requirements before July 1.
Source: Level 1 waiver — Appendix G; OAC 5123-6-06
7. Vehicle Modification Rules Are Getting Clearer
The vehicle modifications service will receive clarifying updates across all three waivers:
- Raised doors will be explicitly listed as an approved modification
- Moving equipment between vehicles will be a covered service
- Invoice documentation requirements will be clearly defined
What this means for your agency: If you assist clients in accessing vehicle modifications, the process will be less ambiguous after July 1. The clearer documentation requirements should also reduce billing disputes and claim denials related to this service.
Source: IO, Level 1, and SELF waivers — Appendix C; OAC 5123-9-44
What Should Home Care Agencies Do Before July 1?
You have one week. Here is what to prioritize:
Audit your documentation. With in-person SSA monitoring coming, your visit notes, incident reports, and care plans need to be complete and accurate. If documentation has been lagging, get it current now.
Review your ISPs for 12-month outcomes. Work with your clients’ SSAs to confirm that every active service plan will include at least one goal spanning a full year. Flag any plans approaching annual renewal that may need to be updated.
Check your medication administration policies. If you serve Level One waiver clients, review your policies against OAC 5123-6-06 and address any gaps before the rules take effect.
Communicate with your clients’ SSAs. The in-person assessment requirement will create scheduling pressure. Get ahead of upcoming reassessments so authorization delays do not disrupt service delivery.
Verify the HCBS compliance of any settings your clients use. If clients receive adult day or community services in non-residential settings, confirm those settings are meeting federal HCBS standards.
Stay on Top of Ohio Medicaid Changes
Regulatory changes like these happen regularly, and missing a deadline or failing to update your practices can put your clients’ authorizations — and your agency’s billing — at risk.
GEOH works with home care agencies across Ohio to manage billing, stay current on Medicaid rule changes, and keep operations running without the chaos. If you want to talk through how these updates affect your agency specifically, we’re here.
Schedule a free consultation with our Ohio billing team.
Source: Ohio Department of Developmental Disabilities — Effective Dates for New Rules and July 2026 Waiver Amendments. This post is for informational purposes only and does not constitute legal or compliance advice. Consult directly with DODD or a qualified compliance professional before making operational changes.