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The Ohio Department of Job and Family Services processes all applications for Ohio Home Care Providers. Use the information and links below to obtain the appropriate application and instructions for your specific provider type:
Provider Applications
To submit an application to enroll as a provider for the Ohio Home Care Waiver Program, please review the options below. Locate the service you would like to provide (click "fact sheet" to learn about each type), and then click "Application" to the right of the service to download the application. Once you have downloaded the application, please print, read, complete, and sign all of the documents.
After you have completed and signed the documents, please mail them to the address below.
A checklist has been provided to ensure you have included all the necessary documents. Incomplete applications cannot be accepted. In addition, online applications are not accepted. All applications are reviewed on a "first-come, first-serve" basis. Your Provider Application MUST be completed correctly to be processed by the Ohio Home Care Waiver Program. Failure to do so will result in your application being returned for corrections.
NOTE: Contact information and additional helpful documents are available under the table of provider types below.
Criminal Background Check Information
All Provider Applicants must complete a criminal background check conducted by the Ohio Bureau of
Criminal Identification and Investigation (BCI&I). Click the link below for more information, including a WebCheck listing of finger printing locations.
Background Check Info & Impact of Convictions
Authorization Agreement for State Medicaid Payments
EFT and OBM Information Form
Questions?
Call 614-466-6742
Mail Applications to:
Bureau of Long Term Care Services & Supports
ATTN: Application Coordinator
P.O. Box 182709, 5th Floor
Columbus, Ohio 43218-2709
Additional Forms & Info:
Home Choice Provider Applications
Frequently Asked Questions
Provider Orientation Contacts
CSTO-Other Equivalent Training Option-Forms
Ohio Home Care Program Rules
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