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Ohio self-direction: hire your own caregiver on Medicaid waivers

Ohio's self-direction option lets members of the Ohio Home Care Waiver and MyCare Waiver hire, schedule and pay their own caregivers, including some family members, with a financial management service handling payroll.

Carevo editorial team Updated October 27, 2026 Source checked by Carevo editorial team, October 27, 2026

Ohio's self-direction option lets people on the Ohio Home Care Waiver or the MyCare Waiver hire and manage their own caregivers, set their wages within a budget, and use a payroll service. The Ohio Department of Medicaid (ODM) says individuals can have family members work as paid caregivers.

What self-direction is

ODM's Self-Direction 101, updated October 8, 2024, defines self-direction as a service model for Ohioans served by Medicaid waivers that gives them choice and control over the long-term services and supports they need to live at home. People make decisions about the type of care they receive, the way certain services are delivered and the caregivers who provide them.

There are two parts, which can be used together:

  • Employer authority: you control who you hire and how you manage them. ODM says you oversee your caregivers, pick people who fit your needs and preferences, make sure they get the right training, and set schedules and routines.
  • Budget authority: you decide how funding is spent on self-directed services and supports. ODM says you determine caregiver wages and receive a yearly budget based on your assessed needs.

Medicaid.gov describes the same two ideas, calling them employer authority and budget authority.

Which waivers and services

ODM says self-direction is available to people enrolled on the Ohio Home Care Waiver (since October 1, 2024) and the MyCare Waiver (since November 15, 2024). The services you can self-direct vary by waiver. The table in Self-Direction 101 lists:

  • Ohio Home Care Waiver: home care attendant, home modifications, personal care aide, self-directed goods and services, and waiver nursing.
  • MyCare: the same list plus alternative meals, Choices home care attendant, home maintenance and chores, and home medical equipment and supplies.

Only waiver services can be self-directed. For PASSPORT, ODM's materials say people enrolled in PASSPORT should talk to their care manager or waiver service coordinator. See the Ohio overview.

What you are responsible for

ODM lists the employer duties. You must understand and instruct your caregivers' services, identify, hire and if necessary dismiss caregivers, write contracts with specific activities and training requirements, train caregivers and confirm the training is done, organize schedules, oversee work, and approve timesheets and other documents the FMS vendor requests. Under budget authority you also set wages, allocate funds as your service plan allows and keep spending within the limits. You may choose a representative to help.

ODM's resource page names Public Partnerships LLC (PPL) as the financial management service and links to PPL's Ohio forms. ODM publishes an Employer and Employee Agreement that you and your caregiver complete together, covering training, scheduling and absences.

Who can be your caregiver

ODM says family members can work as paid caregivers. Two rules refine that.

  1. Spouses and parents of minor children. ODM's Direct Care Worker Relationship Rule (Ohio Administrative Code 5160-44-32), effective January 1, 2024, allows parents of minor children and spouses to serve as direct care workers of waiver personal care and nursing services. Your case manager screens with the Extraordinary Care Instrument (ODM 10372). The July 2026 Ohio Home Care Waiver handbook says the case manager must search for other able and willing providers first, and, if a spouse or parent is authorized, contact you every two to three months to search again.
  2. Other relatives. ODM says other relatives designated or appointed legal authority can serve as direct care workers. The handbook says there may be limits if the relative is in a legal decision-making role such as Power of Attorney or Authorized Representative.

See paid family caregiver in Ohio.

How to start

  1. Speak with your care manager about your interest. ODM says to share your needs and how you prefer to receive care.
  2. Review the options for State Plan benefits, waivers and other programs.
  3. Build a person-centered service plan that identifies the services you want to direct.
  4. Your care manager walks you through finding a caregiver, your employer role and reviews.

Individuals with questions can email [email protected]. ODM publishes budget worksheets and walkthroughs for the Ohio Home Care Waiver and MyCare. We do not state wage figures because they depend on your individual budget.

Carevo is a connection platform and directory. We do not run self-direction, set budgets or process payroll. For agency-managed help, see home care in Ohio.

More about care in Ohio

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Common questions

What is self-direction in Ohio?

ODM says self-direction is a service model for Ohioans served by Medicaid waivers that gives them choice and control over the long-term services and supports they need at home. People can use employer authority (who they hire and how they manage them), budget authority (how funding is spent), or both.

Which waivers have self-direction?

ODM's Self-Direction 101 says people enrolled on the MyCare Waiver or the Ohio Home Care Waiver are eligible. Self-direction became available on the Ohio Home Care Waiver on October 1, 2024, and expanded on the MyCare Waiver on November 15, 2024.

Can I pay a family member?

ODM says individuals can have family members work as paid caregivers. Spouses and parents of minor children are covered by a separate rule that requires a screening, described below.

Who handles payroll?

ODM's designated financial management services (FMS) vendor, which ODM's resource page names as Public Partnerships LLC (PPL).

What are my responsibilities?

ODM lists identifying, hiring and, if necessary, dismissing caregivers, writing contracts, training caregivers, organizing schedules, overseeing work, approving timesheets, and, with budget authority, setting caregiver wages and keeping spending within the budget.

How do I start?

Talk to your waiver care manager or service coordinator, review Self-Direction 101, and create a person-centered service plan that includes the services you want to direct. ODM's questions line for individuals is [email protected].

Sources

Review status: Carevo checked this page against the primary sources listed above. It has not been professionally reviewed by a registered nurse, licensed social worker, benefits counselor or attorney. See our editorial standards.

This page is general information, not financial, legal or medical advice. Rules and services vary by state and by individual circumstances. Use the official sources and decision-maker named on the page. Carevo is a connection platform, not a care provider.