HomeCareAtlas Team · Updated April 2026
Researched from primary state regulatory sources.
How to Start a Home Care Agency in Ohio
Starting a home care agency in Ohio costs roughly $40,000 - $80,000 and takes 30-90 Days. Here's every step, fee, and deadline — sourced directly from Ohio Department of Health (ODH).
Since July 2022, Ohio requires a Nonmedical Home Health Services (NMHHS) license from the Ohio Department of Health. This was a major change — before 2022, no license was needed for private-pay non-medical care. Almost all agencies providing personal care, homemaking, or companionship must now be licensed (note: "nonmedical home health services" is Ohio's official term — this is a non-medical license, completely separate from Medicare-certified home health agencies that provide skilled nursing). The process is relatively fast (30-90 days for complete applications) and the $250 fee is one of the lowest in the nation. New agencies that were not operating before September 2021 must also provide a $20,000 surety bond. For Medicaid participation, you must separately enroll as a PASSPORT provider through the Ohio Department of Aging.
To start a non-medical home care agency in Ohio, you need a Nonmedical Home Health Services (NMHHS) License from the Ohio Department of Health (ODH). The application fee is $250 ($250 application fee), the process takes approximately 30-90 days, and total startup costs range from $40,000 - $80,000. New agencies must provide a $20,000 surety bond, and BCI/FBI background checks are mandatory — this license requirement has only been in effect since July 2022.
- License Required
- Yes — Nonmedical Home Health Services (NMHHS) License
- Regulatory Body
- Ohio Department of Health (ODH)
- Application Fee
- $250 ($250 application fee)
- Timeline
- 30-90 Days (complete application to license)
- Total Startup Cost
- $40,000 - $80,000
- Key Requirement
- New agencies must provide a $20,000 surety bond, and BCI/FBI background checks are mandatory — this license requirement has only been in effect since July 2022.
- Last Verified
- April 2026 against Ohio Department of Health (ODH) regulations
$250 Application Fee
Complete Application to License
Residents Age 70+
Strong Opportunity
How Ohio compares to neighboring states
| State | License Fee | Timeline | Startup Cost |
|---|---|---|---|
| Ohio ← | $250 | 30-90 Days | $40,000 - $80,000 |
| Pennsylvania | $100 | 10-20 Weeks | $12,000 - $38,000 |
| Indiana | $250 | 60-90 Days | $30,000 - $60,000 |
| Michigan | $0 (no license) | 8-12 weeks | $12,000 - $39,000 |
| Kentucky | $500 | 60-90 Days | $30,000 - $60,000 |
Ohio Licensing Overview
The Ohio Department of Health (ODH) oversees all non-medical agencies.Since July 2022, Ohio requires a Nonmedical Home Health Services (NMHHS) license from the Ohio Department of Health. This was a major change — before 2022, no license was needed for private-pay non-medical care. Almost all agencies providing personal care, homemaking, or companionship must now be licensed (note: "nonmedical home health services" is Ohio's official term — this is a non-medical license, completely separate from Medicare-certified home health agencies that provide skilled nursing). The process is relatively fast (30-90 days for complete applications) and the $250 fee is one of the lowest in the nation. New agencies that were not operating before September 2021 must also provide a $20,000 surety bond. For Medicaid participation, you must separately enroll as a PASSPORT provider through the Ohio Department of Aging.
NMHHS License Required (Since July 2022)
Almost all nonmedical home care agencies providing personal care, homemaking, or companionship must hold a Nonmedical Home Health Services (NMHHS) license from ODH. This is separate from Medicare-certified home health — Ohio uses "home health" in the name, but this is a non-medical license.
$250 Fee + $20,000 Surety Bond (New Agencies)
The application fee is only $250 (non-refundable) — one of the lowest in the nation. New agencies not operating before September 2021 must provide a $20,000 surety bond.
BCI & FBI Background Checks
Fingerprint-based background checks through the Ohio Bureau of Criminal Investigation (BCI) required for owners. FBI fingerprint checks required for Medicaid providers. Ohio Nurse Aide Registry and OIG/SAM exclusion checks for all staff.
Training Structure Required
Ohio does not mandate a specific hour count for caregiver training. However, agencies must define training policies, ensure caregiver competency, and maintain documentation. ODH expects a structured training program — "no mandated hours" does not mean "no training requirements."
Estimated Startup Costs (2026)
Budget for $40,000 - $80,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| ODH license application fee | $250 | $250 |
| Surety bond ($20,000 — new agencies) | $200 | $600 |
| Business formation (LLC with Secretary of State) | $99 | $300 |
| General liability insurance ($1M/$3M) | $1,200 | $3,000 |
| Professional liability insurance ($1M) | $1,000 | $2,500 |
| Workers' comp insurance | $500 | $2,000 |
| Automobile liability (if transporting) | $500 | $1,500 |
| BCI background checks (initial staff) | $200 | $500 |
| Policies & procedures development | $1,500 | $4,000 |
| Office space & setup | $1,000 | $4,000 |
| Technology & software | $1,000 | $3,000 |
| Marketing & branding | $1,000 | $5,000 |
| Working capital (3-6 months) | $18,000 | $45,000 |
Ohio Nonmedical Home Health Services (NMHHS) Licensing Timeline
1-2 Weeks
Register your business
File your LLC with the Ohio Secretary of State ($99 filing fee). Get your EIN from the IRS, open a business bank account. Register with the Ohio Department of Taxation and the Ohio Bureau of Workers' Compensation.
1-2 Weeks
Secure insurance & surety bond
Get general liability ($1M/$3M), professional liability ($1M), workers' comp, and automobile liability (if transporting). New agencies not operating before September 2021 must obtain a $20,000 surety bond.
2-3 Weeks
Create policies & procedures
Develop policies covering caregiving standards, hiring practices, safety protocols, client rights, emergency procedures, infection control, privacy and data handling, quality assurance, and a structured caregiver training program. Even though Ohio does not mandate specific training hours, ODH expects documented training policies that ensure caregiver competency.
2-4 Weeks
Complete background checks & hire staff
Complete BCI fingerprint-based background checks for the owner. Establish a background check process for all staff. Check the Ohio Nurse Aide Registry and OIG/SAM exclusion databases. Hire caregivers and conduct training per your documented policies.
1-2 Weeks
Submit ODH license application
Submit the NMHHS License Application to the Ohio Department of Health with the $250 non-refundable fee, surety bond (if required), fingerprint impressions for owner, insurance certificates, and all required proofs and attestations. Do not skip any required items — incomplete applications trigger deficiency letters and significant delays.
4-12 Weeks
ODH review & license issuance
ODH reviews your complete application. Processing takes 30-90 days for complete applications. ODH may request additional documentation or conduct follow-up reviews during this period. Once approved, you are licensed and can begin serving clients. Contact ODH at (614) 466-7713 or liccert@odh.ohio.gov with questions.
New 2026 Legal Mandates
Nonmedical Home Health Services (NMHHS) License (Since July 2022)
July 2022 (ongoing) - Ohio now requires almost all nonmedical home care agencies providing personal care, homemaking, or companionship to hold a license from ODH. This was a major regulatory change effective July 2022. Agencies must apply with the $250 fee and meet all ODH requirements.
$20,000 Surety Bond (New Agencies)
Ongoing - Agencies that were not providing direct care before September 2021 must provide a $20,000 surety bond as part of the license application.
BCI & FBI Background Checks
Ongoing - Fingerprint-based background checks through the Ohio Bureau of Criminal Investigation (BCI) are required for owners ($25-$40 per person, results in 2-5 business days). FBI fingerprint checks are additionally required for Medicaid providers.
Ohio Nurse Aide Registry & Exclusion Checks
Ongoing - Check the Ohio Nurse Aide Registry for all aides before hiring. Also verify staff against the OIG Exclusion List and SAM (System for Award Management) database.
Workers' Compensation Required
Ongoing - Ohio requires workers' compensation insurance for all employees. Register with the Ohio Bureau of Workers' Compensation. Coverage must be in place before your first employee starts work.
Caregiver Training & Competency Documentation
Ongoing - Ohio does not mandate a specific training hour count for nonmedical home care. However, agencies must maintain a structured training program, ensure caregiver competency, and keep documentation in personnel files. CPR and first aid certification is strongly expected and often required by agencies and payers, though not always explicitly mandated at the state level for all nonmedical care.
Worker Classification Compliance
Ongoing - Properly classify caregivers as W-2 employees. Misclassifying workers as 1099 independent contractors is a significant compliance risk — it can trigger penalties from the IRS, Ohio Department of Taxation, and Bureau of Workers' Compensation. Most home care agencies must use W-2 employment.
HIPAA Compliance (When Applicable)
Ongoing - Agencies that handle protected health information (PHI) in connection with covered entities or do electronic billing must comply with HIPAA. Many private-pay-only agencies operate in a gray area — but best practice is to build HIPAA-compliant processes from day one, especially if you plan to take Medicaid clients later.
ODH Compliance Reviews
Ongoing - ODH may request additional documentation or conduct follow-up reviews after initial licensure. Maintain complete personnel files, training records, background check documentation, and client records at all times. Documentation failures are a common compliance gap.
Caregiver Mandates
Important Warning
Ohio does not mandate a specific training hour count, but agencies must still define training policies, ensure competency, and maintain documentation. "No mandated hours" does not mean "no structure." PASSPORT (Medicaid) requires additional competency training. Always check the Ohio Nurse Aide Registry and exclusion databases before hiring. Misclassifying caregivers as 1099 contractors instead of W-2 employees is a major compliance risk.
- BCI Criminal Background Check: All staff providing direct care must undergo BCI fingerprint-based background checks. FBI fingerprint check additionally required for Medicaid providers. $25-$40 per person.
- Ohio Nurse Aide Registry Check: Verify all aides against the Ohio Nurse Aide Registry before hiring. Check for any findings or restrictions.
- OIG/SAM Exclusion Check: Verify all staff against the OIG Exclusion List and SAM database before hiring and on an ongoing basis.
- Structured Training Program: Agencies must maintain a documented training program that ensures caregiver competency. While Ohio does not mandate a specific hour count, ODH expects training policies, competency verification, and documentation in personnel files.
- CPR & First Aid Certification: Strongly expected and often required by agencies and payers. While not always explicitly mandated at the state level for all nonmedical care, it is industry standard and should be part of your training program.
- PASSPORT Competency Training (for Medicaid): Staff serving PASSPORT Medicaid clients must complete specific competency training per program requirements. These requirements are separate from and in addition to base ODH license requirements.
- New Hire Reporting: Ohio New Hire Reporting required within 20 days. I-9 compliance required for all employees. Maintain complete personnel files.
Regional Billing Snapshots
*Regional rates vary by specialized care needs (Dementia, Parkinson's) and local competition.*
Regional Market Opportunities
Ohio has approximately 2.2 million adults aged 65+ (about 18% of the state population) spread across multiple major metros — each with distinct dynamics. Columbus is the fastest-growing major metro in the Midwest. Cleveland has the largest senior population. Low cost of living keeps operating costs manageable, though caregiver wages are trending upward ($14-$18/hr in most markets, higher in Columbus and Cleveland).
Columbus Metro
Fastest-growing major metro in the Midwest. Senior population growing rapidly alongside the general population boom. Most competitive Ohio market with the highest caregiver wage pressure.
Key: Get in now — Columbus is booming. Growth trajectory means increasing demand, but also increasing competition and higher wages. Plan for $15-$18+/hr caregiver pay.
Cleveland-Akron Metro
Largest senior population in Ohio. Strong healthcare infrastructure with Cleveland Clinic and University Hospitals. Established market with moderate competition.
Key: Build referral relationships with the major hospital systems. Cleveland Clinic and University Hospitals discharge planners are key referral sources.
Cincinnati-Dayton Metro
Significant senior concentration across both cities. Cross-border opportunities with Kentucky. Lower operating costs than Columbus or Cleveland.
Key: Good value market — lower rates but also lower competition and operating costs. Kentucky border creates cross-state referral opportunities.
Toledo Metro
Underserved market with lower operating costs. Michigan border creates cross-state opportunities. Fewer agencies competing for clients.
Key: Low-moderate competition with real demand. Good entry point for new agencies willing to serve a smaller metro.
Rural Ohio
Suburban and rural areas across the state with growing demand and fewer providers. Staffing and travel distance are real challenges that thin margins.
Key: Only expand to rural after your metro base is stable. Unmet need is real but caregiver recruitment is harder and travel costs eat into margins.
Cost of care in Ohio
What agencies charge clients vs. what caregivers earn in Ohio. The difference is the agency's gross margin per billable hour — before overhead like insurance, admin, marketing, and compliance costs.
$32
Avg. hourly rate charged to clients
$19.39
Avg. caregiver hourly wage
$12.61
Gross margin per hour
39%
Gross margin %
What this means for agency owners
In Ohio, agencies keep roughly $12.61 per billable hour after paying the caregiver. That's a 39% gross margin.
This is a typical margin for the industry. You will need to manage overhead carefully, but profitability is achievable with good operations.
Sources: Avg. hourly rate from CareYaya and CareScout 2025 surveys (averaged). Caregiver wage from Care.com. Gross margin is before overhead costs like insurance, admin, marketing, and compliance.
Ohio Medicaid Programs
PASSPORT (Pre-Admission Screening System Providing Options and Resources Today)
Ohio's primary Medicaid waiver for seniors 60+ who qualify for nursing home level of care. Covers personal care and homemaker services. Administered by regional Area Agencies on Aging (AAAs).
Agency Angle: To become a PASSPORT provider: obtain your ODH license first, get required insurance, apply to your regional Area Agency on Aging, complete the provider agreement, and credential your caregivers. Enrollment takes 4-12+ weeks depending on your region and application completeness — AAA backlogs vary significantly. Provides a steady client pipeline once enrolled.
MyCare Ohio
Managed care program serving dual-eligible (Medicare/Medicaid) individuals. Integrates care coordination through managed care organizations (MCOs).
Agency Angle: Contract with MCOs serving MyCare Ohio members for a steady referral source. Requires additional credentialing with each MCO — plan for extra enrollment time.
Ohio Home Care Waiver
Serves individuals under 60 with disabilities. Covers personal care and homemaker services with consumer-directed options.
Agency Angle: Broadens your client base beyond seniors. Consumer-directed options mean clients have more say in their care — be prepared for collaborative care planning.
Payer Mix Strategy
Most successful Ohio agencies blend private-pay and Medicaid revenue. Private-pay clients have higher margins and faster payment. Medicaid (PASSPORT, MyCare) provides volume and steady referrals but lower rates and slower reimbursement. Starting with private-pay clients while building Medicaid enrollment is a common approach.
Agency Angle: Build your private-pay base first for healthy cash flow, then add Medicaid programs for volume. Key referral sources: hospital discharge planners, AAAs, senior centers, physicians, and elder law attorneys.
Becoming a Provider
Essential 2026 Tech Stack for Owners
Ohio Licensing FAQ
Do I need a license to start a home care agency in Ohio?
Yes — since July 2022, Ohio requires a Nonmedical Home Health Services (NMHHS) license from the Ohio Department of Health for almost all agencies providing personal care, homemaking, or companionship. This was a major change — before 2022, no license was needed for private-pay non-medical care. Note: "nonmedical home health services" is Ohio's official term — this is a non-medical license, completely separate from Medicare-certified home health agencies.
How much does the license cost?
The application fee is $250 (non-refundable) — one of the lowest in the nation. New agencies not operating before September 2021 must also provide a $20,000 surety bond. Total startup costs range from $40,000 - $80,000 including insurance, working capital, and business setup.
How long does licensing take?
ODH processes complete applications in 30-90 days. The key is submitting a complete application — skipping required proofs or attestations triggers deficiency letters and significant delays. ODH may also request additional documentation or conduct follow-up reviews.
What is the $20,000 surety bond?
New agencies that were not providing direct care before September 2021 must provide a $20,000 surety bond as part of the license application. The annual premium is typically $200-$600 depending on credit.
What background checks are required?
BCI (Bureau of Criminal Investigation) fingerprint-based checks are required for owners ($25-$40, results in 2-5 days). FBI fingerprint checks are additionally required for Medicaid providers. Also check the Ohio Nurse Aide Registry and OIG/SAM exclusion databases for all staff.
What training do Ohio caregivers need?
Ohio does not mandate a specific training hour count for nonmedical home care. However, agencies must maintain a structured training program, ensure caregiver competency, and keep documentation in personnel files. PASSPORT (Medicaid) requires additional competency training. CPR and first aid are strongly expected industry standards.
How do I become a PASSPORT Medicaid provider?
Get your ODH license first (required prerequisite), obtain required insurance, apply to your regional Area Agency on Aging, complete the provider agreement, and credential your caregivers. The enrollment process takes 4-12+ weeks depending on your region and application completeness.
Do I need to comply with HIPAA?
It depends on how you handle client data. Agencies that handle protected health information (PHI) in connection with covered entities or do electronic billing must comply with HIPAA. Many private-pay-only agencies operate in a gray area. Best practice: build HIPAA-compliant processes from day one, especially if you plan to take Medicaid clients.
Can I hire caregivers as 1099 contractors?
In most cases, no. Home care agencies generally must classify caregivers as W-2 employees. Misclassifying workers as 1099 independent contractors is a significant compliance risk — it can trigger penalties from the IRS, Ohio Department of Taxation, and Bureau of Workers' Compensation. Consult an employment attorney if you are unsure about your model.
Can I operate from home?
Yes, many Ohio home care agencies start as home-based businesses. Check your local zoning requirements for home occupation permits.
Is Ohio a good market for home care?
Ohio has approximately 2.2 million adults aged 65+ (about 18% of the population). Columbus is the fastest-growing major metro in the Midwest. Cleveland has the largest senior population. Caregiver wages are trending $14-$18+/hr depending on market. Strong Medicaid programs (PASSPORT, MyCare Ohio) provide steady revenue streams alongside private-pay clients.
Starting in a Nearby State?
Licensing requirements vary a lot between states. Compare your options:
Pennsylvania
$100 fee · 10-20 Weeks
Indiana
$250 fee · 60-90 Days
Michigan
No state license required · 8-12 weeks
Kentucky
$500 fee · 60-90 Days
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This guide is for informational purposes only and does not constitute legal, regulatory, or business advice. Licensing requirements, fees, and regulations change frequently. Always verify current requirements with your state's licensing agency before making business decisions. HomeCareAtlas is not responsible for the accuracy or completeness of this information.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.