PASSPORT and MyCare: How Ohio Medicaid Pays for Adult Day Services

Ohio pays for adult day services on two tracks, and as of August 1, 2026, every center in the state deals with both. The first track is PASSPORT, Ohio's 1915(c) waiver for seniors, administered by the Department of Aging through the Area Agencies on Aging. The second is MyCare Ohio, the managed care program for people on both Medicare and Medicaid — which finished its statewide rollout this August, putting every county's dual-eligible seniors into one of four health plans. Same service, same center, two different payers depending on which program the participant is in.

ElderSuite serves adult day care centers nationwide. This piece is Ohio-specific — and it covers the senior programs only. Ohio's separate "adult day support" service for people with developmental disabilities runs through DODD under different rules.

The PASSPORT track

PASSPORT — waiver number 0198.R07.00 on Medicaid.gov, approved through June 30, 2028 — covers adult day service for Ohioans 65 and older and adults 60 to 64 with physical disabilities who meet a nursing facility level of care. The Department of Aging administers it day to day, and OAC rule 173-39-02.1 defines the service: regularly scheduled care at an adult day center, with programming, meals, and — at the higher tier — health monitoring and therapy services.

The same rule defines the billing units, and they matter: a half day is under four hours, a full day is four to eight hours, and time beyond eight hours bills in 15-minute units up to a 12-hour daily maximum. Your attendance records are your units.

What Ohio pays

Adult day rates are statewide — OAC 5160-31-07 eliminated the old regional rate differences — and the current maximums sit in the rate appendix to OAC 5160-1-06.1:

• Adult day, enhanced: full day $80.94; half day $40.48; 15-min unit $2.54
• Adult day, intensive: full day $106.26; half day $53.11; 15-min unit $3.33
• Adult day transportation: $3.12 per mile; $28.61 round trip; $23.21 one-way

Those numbers are worth a second look if you haven't priced Ohio lately: effective January 1, 2024, the full-day rates jumped roughly 31 percent — enhanced went from $61.74 to $80.94, intensive from $81.05 to $106.26 — and the 2026 rule refresh carried them forward unchanged. Providers bill at or below the maximum and cannot balance-bill the participant.

The MyCare track — now statewide

Next Generation MyCare launched January 1, 2026 with four plans — Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource, and Molina Healthcare — serving more than 250,000 dual-eligible Ohioans. It began in the 29 legacy counties, added ten more on April 1, and per ODM's provider page completed the statewide rollout between April and August 1, 2026. One wrinkle: Buckeye is not accepting new members in 2026.

Adult day is a covered MyCare waiver service — OAC 5160-58-04, effective January 1, 2026, covers it by direct reference to the same 173-39-02.1 definition — and the rule is blunt about what that means for a center: you must be enrolled with Ohio Medicaid and contracted with the member's MyCare plan. If dual-eligible seniors are part of your census anywhere in Ohio, plan contracting is no longer optional.

Certification runs through your Area Agency on Aging

Ohio regulates Medicaid adult day through ODA provider certification rather than a facility license. Applications go through ODA's certification process — a pre-certification site visit by your Area Agency on Aging, a 60-day review window, and a $730 application fee for agency providers (2025). Once certified, expect scrutiny to continue: under OAC 173-39-04, adult day providers get structural compliance reviews every year — more often than many other provider types — and unannounced reviews are permitted. Correction plans are due within 10 business days of a violations letter, and records must be kept six years.

Billing: two destinations, one workflow

Where a claim goes depends on the track. PASSPORT claims are 837P files submitted to your regional PASSPORT Administrative Agency for processing and payment. MyCare claims go to the member's plan — and all four Next Generation MyCare plans, along with Ohio Medicaid itself, are available payers on the Availity clearinghouse, the same clearinghouse ElderSuite submits claims through. Ohio Medicaid's fee-for-service timely filing is 365 days from the date of service; MyCare plans set their own deadlines in the provider contract.

What every track shares is the documentation floor. OAC 173-39-02.1 requires, for every session: the individual's name, the date, arrival and departure times, how they got there, and a unique identifier attesting that the service was received. That is an attendance-tracking spec written into regulation — the units you bill are only as good as the times you recorded. For the full workflow from attendance record to electronic claim, see ElderSuite's Medicaid billing guide.

One piece of good news to close the compliance file: electronic visit verification does not apply to adult day. ODM's EVV service list (revised March 2026) names every EVV-subject service, and congregate adult day is not among them.

Where to check

• OAC 173-39-02.1 (service definition and units) and the 173-39 certification chapter
• The current PASSPORT rate appendix
• ODM's MyCare Ohio provider page
• ODA provider certification and your Area Agency on Aging