HomeCareAtlas Team · Updated November 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).
Ohio now licenses non-medical home care. House Bill 110 created ORC Chapter 3740, effective September 30, 2021. The license rule started one year later (ORC 3740.02). Now any agency or person that gives nonmedical home health services must hold an ODH license. Before this, no license was needed for private-pay non-medical care. "Nonmedical home health services" is Ohio's legal term. It includes personal care: hands-on help with daily tasks like bathing and dressing, help taking medicine, respite, errands, and homemaking that goes with that care (ORC 3740.01). It is a separate license from the skilled home health license. The fee is $250 (ORC 3740.03) and is not refundable (OAC 3701-60-03). The rule says to pay by cashier's check or postal money order to "Treasurer, State of Ohio" (OAC 3701-60-03). The license lasts 3 years (ORC 3740.05). New agencies that were not giving these services on or just before September 30, 2021 must post a $20,000 surety bond. The primary owner must send ODH fingerprint impressions with the application. For Medicaid, you must also become an ODA-certified PASSPORT provider.
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 fee (license lasts 3 years)), the process takes approximately 30-90 days, and total startup costs range from $40,000 - $80,000. You need an ODH Nonmedical Home Health Services license ($250, good for 3 years). New agencies must post a $20,000 surety bond, and every direct care hire needs a BCI fingerprint check.
- License Required
- Yes — Nonmedical Home Health Services (NMHHS) License
- Regulatory Body
- Ohio Department of Health (ODH)
- Application Fee
- $250 ($250 fee (license lasts 3 years))
- Timeline
- 30-90 Days (typical estimate (odh sets no fixed timeframe))
- Total Startup Cost
- $40,000 - $80,000
- Key Requirement
- You need an ODH Nonmedical Home Health Services license ($250, good for 3 years). New agencies must post a $20,000 surety bond, and every direct care hire needs a BCI fingerprint check.
- Last Verified
- November 2026 against Ohio Department of Health (ODH) regulations
Typical Estimate (ODH Sets No Fixed Timeframe)
This is our best guess. Check with the Ohio Department of Health (ODH).
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 (our estimate) |
| Kentucky | $500 | 60-90 Days | $30,000 - $60,000 |
Ohio Licensing Overview
The Ohio Department of Health (ODH) oversees all non-medical agencies.Ohio now licenses non-medical home care. House Bill 110 created ORC Chapter 3740, effective September 30, 2021. The license rule started one year later (ORC 3740.02). Now any agency or person that gives nonmedical home health services must hold an ODH license. Before this, no license was needed for private-pay non-medical care. "Nonmedical home health services" is Ohio's legal term. It includes personal care: hands-on help with daily tasks like bathing and dressing, help taking medicine, respite, errands, and homemaking that goes with that care (ORC 3740.01). It is a separate license from the skilled home health license. The fee is $250 (ORC 3740.03) and is not refundable (OAC 3701-60-03). The rule says to pay by cashier's check or postal money order to "Treasurer, State of Ohio" (OAC 3701-60-03). The license lasts 3 years (ORC 3740.05). New agencies that were not giving these services on or just before September 30, 2021 must post a $20,000 surety bond. The primary owner must send ODH fingerprint impressions with the application. For Medicaid, you must also become an ODA-certified PASSPORT provider.
Nonmedical Home Health Services License Required
Under ORC Chapter 3740, an agency that gives personal care must hold a Nonmedical Home Health Services license from ODH. Personal care includes hands-on help with daily tasks, help taking medicine, and respite (ORC 3740.01). It does not matter who pays. A skilled home health license also covers these services. Ohio uses "home health" in the name, but this is a non-medical license.
$250 Fee, 3-Year License, $20,000 Bond (New Agencies)
The fee is $250 (ORC 3740.03) and is not refunded (OAC 3701-60-03). Pay by cashier's check or postal money order (OAC 3701-60-03). The license lasts 3 years. New agencies must post a $20,000 surety bond from a company licensed in Ohio. This applies if you were not giving these services on or just before September 30, 2021.
Owner Fingerprints + BCI Checks for Direct Care Staff
The primary owner sends ODH fingerprint impressions with the application (ORC 3740.03). Every direct care hire needs a BCI fingerprint check (OAC 3701-60-06). Add an FBI check if the person has not lived in Ohio for the past 5 years. First, you must search six databases (ORC 3740.11(D)). They are the federal SAM list, the OIG exclusion list, the Ohio DD employee registry, the sex offender database, the state inmate database, and the Ohio Nurse Aide Registry.
No State Training Hours
ORC 3740 and the ODH rules (OAC 3701-60) set no caregiver training hours. But you still need to train your staff well. Write a training plan and keep records. Medicaid programs like PASSPORT set their own training rules.
Estimated Startup Costs (2026)
Budget for $40,000 - $80,000 to ensure 3-6 months of runway.
| Category | Low Est. | High Est. |
|---|---|---|
| ODH license fee ($250, good for 3 years) | $250 | $250 |
| Surety bond ($20,000 — new agencies; premium is our estimate) | $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 |
We map every cost and file your Ohio license for you.
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, professional liability, workers' comp, and auto liability (if you drive clients). Workers' comp comes from the Ohio Bureau of Workers' Compensation. New agencies must get a $20,000 surety bond (ORC 3740.03). This applies if you were not giving these services on or just before September 30, 2021.
2-3 Weeks
Create policies & procedures
Write policies for care, hiring, safety, client rights, emergencies, infection control, privacy, and quality. You must include a criminal records check policy with your application (ORC 3740.03). Ohio sets no training hours, but a written training plan is smart.
2-4 Weeks
Complete background checks & hire staff
Get fingerprint impressions for the primary owner. Follow ODH's instructions for how. Write a criminal records check policy. For each direct care hire, first check the six required databases. Then run a BCI fingerprint check (add FBI if not an Ohio resident for 5 years). You may hire someone on a conditional basis if you request the check within 5 business days (ORC 3740.11(G)). Train them per your policies.
1-2 Weeks
Submit ODH license application
Get the application from ODH and follow its current filing steps. Include the $250 fee (cashier's check or postal money order to "Treasurer, State of Ohio," per OAC 3701-60-03). Add the surety bond (if required), the owner's fingerprint impressions, your criminal records check policy, and copies of your Secretary of State filings. If ODH asks for more, you have 14 days to answer (OAC 3701-60-03).
4-12 Weeks
ODH review & license issuance
ODH reviews your application. ODH does not post a processing time. Our estimate is 30-90 days for a complete application. Do not serve clients until you have your license (ORC 3740.02). Contact ODH through its website with questions.
We can do all of them for you in Ohio.
New 2026 Legal Mandates
Nonmedical Home Health Services License (ORC Chapter 3740, OAC 3701-60)
September 30, 2022 (one year after ORC 3740.02 took effect) - House Bill 110 created ORC Chapter 3740 (effective September 30, 2021). Starting one year later, any agency or person that gives nonmedical home health services must hold an ODH license (ORC 3740.02). The fee is $250 and the license lasts 3 years.
$20,000 Surety Bond (New Agencies)
Ongoing - Under ORC 3740.03, new agencies must post a $20,000 surety bond with their license application. The bond must come from a company licensed in Ohio. You are exempt if you were giving these services on or just before September 30, 2021 (OAC 3701-60-03).
Criminal Records Checks (OAC 3701-60-05 and 3701-60-06)
Ongoing - The primary owner gives ODH fingerprint impressions. Every direct care applicant needs a BCI fingerprint check. Add an FBI check if the person has not lived in Ohio for 5 years. Repeat the check every 5 years (OAC 3701-60-06). You may hire someone conditionally if you request the check within 5 business days of their start (ORC 3740.11(G)).
Database Reviews Before Each Hire (OAC 3701-60-05)
Ongoing - Before the criminal records check, search six databases (ORC 3740.11(D)). They are the federal SAM list, the OIG exclusion list, the Ohio DD employee registry, the sex offender database, the state inmate database, and the Ohio Nurse Aide Registry. You may not hire anyone with disqualifying results for direct care.
Workers' Compensation Required
Ongoing - Ohio employers must have workers' compensation coverage. In Ohio, you get it from the state fund, the Ohio Bureau of Workers' Compensation (BWC). Set it up before your first employee starts work.
Caregiver Training & Competency Documentation
Ongoing - ORC 3740 and OAC 3701-60 set no training hours and no CPR rule for nonmedical home care. Medicaid programs like PASSPORT set their own rules. Still, train your staff and keep records in their files. Many agencies also have aides take CPR and first aid.
Worker Classification Compliance
Ongoing - Tax and labor law decide if a worker is an employee. If you set aides' schedules and tell them how to work, they are likely employees. Paying them on a 1099 by mistake can bring IRS and state tax and workers' comp bills. Most agencies use W-2 employees. Ask an employment lawyer if you are not sure.
HIPAA Compliance (When Applicable)
Ongoing - HIPAA covers a health care provider that sends health information electronically for billing and other standard transactions (45 CFR 160.103). That includes most agencies that bill Medicaid. A private-pay-only agency may not be covered. But it is smart to follow HIPAA from day one if you plan to take Medicaid later.
Records and Change Notices
Ongoing - Keep full staff files, training records, background check records, and client records. Keep a record of each criminal records check (OAC 3701-60-10). Tell ODH in writing within 10 days of any change to your application information (OAC 3701-60-03).
Our Ohio licensing team tracks the law so you do not have to.
Caregiver Mandates
Important Warning
Ohio sets no training hours for the nonmedical license. But train your staff and keep records. PASSPORT (Medicaid) providers must meet ODA training rules too. Always check the six required databases before hiring. Paying aides on a 1099 when they are really employees is a big risk.
- BCI Criminal Records Check: Every direct care applicant needs a BCI fingerprint check (OAC 3701-60-06). Add an FBI check if they have not lived in Ohio for the past 5 years. Repeat every 5 years. You pay the BCI fee. Ask your fingerprint site for current prices.
- 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: Check direct care hires against the OIG exclusion list and the SAM database before hiring (ORC 3740.11(D)). Also check the DD registry, sex offender database, and state inmate database.
- Your Own Training Plan: Ohio sets no training hours for the nonmedical license. Write your own training plan. Check that each aide can do the tasks you assign. Keep the records in their file.
- CPR & First Aid Certification: Not required for the ODH nonmedical license. Many agencies still have aides take it. Some payers may ask for it.
- PASSPORT Training Rules (for Medicaid): ODA-certified providers must meet ODA's own staff training rules (OAC Chapter 173-39). These are on top of the ODH license rules.
- 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.*
We launch Ohio home care agencies start to finish.
Regional Market Opportunities
Ohio has about 2.40 million adults 65 and older (about 20% of the state, Census 2025 estimate). They live across several big metros. Columbus is growing fast. Cleveland has many seniors. Costs are lower than on the coasts. The billing rates below are our estimates, not official numbers. For aide pay, check BLS wage data for your area.
Columbus Metro
A fast-growing metro. The senior population is growing too. Competition for aides can be strong.
Key: Growth means more demand, but also more competition and higher pay. Check local aide wages before you set prices.
Cleveland-Akron Metro
Many seniors. Big health systems like Cleveland Clinic and University Hospitals. An established market.
Key: Build referral relationships with the major hospital systems. Cleveland Clinic and University Hospitals discharge planners are key referral sources.
Cincinnati-Dayton Metro
Many seniors across both cities. Kentucky is right across the river.
Key: Serving Kentucky clients means following Kentucky rules too. Check them before you cross the river.
Toledo Metro
A smaller metro with lower costs. Michigan is next door.
Key: A smaller metro can be a good place to start. Check how many agencies already serve it.
Rural Ohio
Small towns and rural areas across the state. Hiring and long drives are real challenges.
Key: Grow into rural areas after your base is steady. Hiring is harder and driving costs add up.
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)
A Medicaid waiver for people 60 or older who need nursing home level care (OAC 5160-31-03). It helps them get care at home, like personal care and homemaker help. The Ohio Department of Aging (ODA) runs it, with local Area Agencies on Aging.
Agency Angle: Get your ODH license first. Then apply to become an ODA-certified provider (OAC Chapter 173-39). Ask your local Area Agency on Aging how to start. Our estimate is 4-12+ weeks, and it varies by region. Once you are in, it can bring steady clients.
MyCare Ohio
Health plans for adults who have both Medicare and Medicaid. Ohio has been changing this program. Check with the Ohio Department of Medicaid for the current plans and areas.
Agency Angle: Contract with the plans that serve MyCare members. Each plan has its own sign-up process. Plan for extra time.
Ohio Home Care Waiver
A Medicaid waiver for people age 59 and younger (OAC 5160-46-02). It is run by the Ohio Department of Medicaid. It helps people stay at home.
Agency Angle: It lets you serve people younger than PASSPORT clients. Ask the Ohio Department of Medicaid how to become a provider.
Payer Mix Strategy
Many Ohio agencies mix private-pay and Medicaid clients. Private pay often has higher margins and faster payment. Medicaid can bring volume, but rates are set by the state. Many start with private pay while they sign up for Medicaid.
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
Tiles outlined in teal are areas HomeCareAtlas covers in our platform.
Ohio Licensing FAQ
Do I need a license to start a home care agency in Ohio?
Yes. Since 2022, Ohio requires a Nonmedical Home Health Services license from the Ohio Department of Health under ORC Chapter 3740. It is for any agency that gives personal care, like help with bathing, dressing, medicine, or respite. Before this, no license was needed for private-pay non-medical care. "Nonmedical home health services" is Ohio's legal term. It is a non-medical license, separate from the skilled home health license.
How much does the license cost?
The fee is $250 and is not refunded. The license lasts 3 years. New agencies must also post a $20,000 surety bond. Our estimate for total startup costs is $40,000 - $80,000. That includes insurance, working capital, and business setup.
How long does licensing take?
ODH does not publish a set timeframe. Our estimate is 30-90 days for a complete application. Missing items cause delays. If ODH asks for more, you have 14 days to answer (OAC 3701-60-03).
What is the $20,000 surety bond?
Under ORC 3740.03, new agencies must post a $20,000 surety bond with the license application. It must come from a company licensed in Ohio. You are exempt only if you were giving these services on or just before September 30, 2021. Our estimate for the yearly premium is $200-$600, based on credit.
What background checks are required?
The primary owner sends ODH fingerprint impressions. Every direct care hire needs a BCI fingerprint check. Add an FBI check if they have not lived in Ohio for the past 5 years. Before the check, search six databases (ORC 3740.11(D); OAC 3701-60-05). They are SAM, the OIG exclusion list, the DD employee registry, the sex offender database, the state inmate database, and the Ohio Nurse Aide Registry.
What training do Ohio caregivers need?
Ohio sets no training hours for the nonmedical license (ORC 3740; OAC 3701-60). It has no CPR rule for it either. PASSPORT (Medicaid) providers must meet ODA training rules. Still, train every aide and keep records. Many agencies add CPR and first aid.
How do I become a PASSPORT Medicaid provider?
Get your ODH license first. Then apply to become an ODA-certified provider (OAC Chapter 173-39). Ask your local Area Agency on Aging how to start. Our estimate is 4-12+ weeks, based on your region and how complete your application is.
Do I need to comply with HIPAA?
It depends. HIPAA covers a health care provider that sends health information electronically for billing and other standard transactions (45 CFR 160.103). Most agencies that bill Medicaid are covered. A private-pay-only agency may not be. Still, it is smart to follow HIPAA from day one.
Can I hire caregivers as 1099 contractors?
Usually not. Tax and labor law decide if a worker is an employee. If you set the schedule and tell aides how to work, they are likely employees. Getting it wrong can bring IRS and state tax and workers' comp bills. Ask an employment lawyer if you are not sure.
Can I operate from home?
Maybe. We did not find an ODH rule that bans a home office for the nonmedical license. ODA-certified Medicaid providers must keep a business site (OAC 173-39-02). Check local zoning too.
Is Ohio a good market for home care?
Ohio has about 2.40 million adults 65 and older (about 20%, Census 2025 estimate). That is the 6th most in the U.S. Columbus is growing fast. Cleveland has many seniors. Medicaid programs like PASSPORT can add clients alongside private pay.
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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Home care agencies in Ohio
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- Home care agencies in Columbus
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Where our numbers come from
We check each fact against Ohio's own rules. Tap a source to read it yourself.
- License needed?YesORC 3740.03(B)(1)· Oct 2026
- Who oversees itOhio Department of Health (ODH)ORC 3740.03(B)(1)· Oct 2026
- License nameNonmedical Home Health Services (NMHHS) LicenseORC 3740.03(B)· Oct 2026
- The rulesORC Ch. 3740; OAC 3701-60 (Home Health Agencies, incl. Nonmedical Home Health Services license)OAC Chapter 3701-60· Oct 2026
- First license fee$250ORC 3740.03(B)(1)(i)· Oct 2026
- License lasts3 yearsORC 3740.05(A)· Oct 2026
- Bond$20,000 surety bond unless the agency was providing nonmedical home health services on or just before Sept 30, 2021ORC 3740.03(B)(1)(h)· Oct 2026
- Owner/manager trainingNo state minimumORC Ch. 3740; OAC 3701-60· Oct 2026
- Caregiver trainingNo state minimumORC Ch. 3740; OAC 3701-60· Oct 2026
- Background checksBCI criminal records check for direct care hires, plus FBI check if not an Ohio resident for the past 5 years; database review (exclusion lists, registries) firstORC 3740.11 (former 3701.881); OAC 3701-60-05, -06· Oct 2026
- How long it takes30-90 DaysBest guess — not confirmed yet
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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.