Consumer-Directed Individual Provider (Choices Waiver)
Read and understand the conditions of participation and service requirements for which you are seeking certification. You can view this information as well as all the current effective rules by clicking on the following link.
The Choices Medicaid Waiver Program (Home Care Attendant Service) is a service designed to provide supportive services specific to the needs of an individual consumer with impaired physical or cognitive functioning. Allowable home care attendant services include, but are not limited to:
(1) Personal assistance with bathing, dressing, grooming, caring for nail, hair and oral hygiene, shaving, deodorant application, skin care, foot care, ear care, feeding, toileting, ambulation, changing position in bed, assistance with transfers, normal range of motion, and nutrition and fluid intake;
(2) General household assistance with the planning, preparation and clean-up of meals, laundry, bed-making, dusting, vacuuming, shopping and other errands, the replacement of furnace filters, waste disposal, seasonal yard care and snow removal;
(3) Heavy household chores including, but not limited to, washing floors, windows and walls, tacking down loose rugs and tiles, moving heavy items of furniture to provide safe access and egress;
(4) Assistance with money management and correspondence as directed by the consumer; and,
(5) Escort services and transportation to community services, activities and resources. This activity is offered in addition to medical transportation available under the Medicaid state plan, and may not replace it. Whenever possible, other sources, which can provide this service without charge, must be utilized.
The Choices Medicaid Waiver Program is available to current PASSPORT consumers in the following counties: Adams, Athens, Brown, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Henry, Highland, Hocking, Jackson, Lawrence, Licking, Lucas, Madison, Meigs, Monroe, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Ross, Sandusky, Union, Vinton, Washington, Williams, and Wood.
To be considered as a provider for the Choices program, you must have a PASSPORT/Choices consumer that wishes to hire you for this waiver program. If you do not currently have a PASSPORT/Choices consumer that wishes to hire you, you are not eligible for certification. Spouses, parents, step-parents and legal guardians are ineligible to become a provider.
The application process is completed online by selecting the “Apply Now” link below. You will have 120 days from the start of the application process to submit an application. Please upload all required documentation prior to submitting your application. If you do not submit an application within 120 days, your application will expire and you will need to complete a new application. Required documentation can be scanned and uploaded within the application prior to selecting submit.
Documentation you will be required to submit:
Copy of valid driver’s license: A copy of a current and valid driver’s license. If you do not have a current driver’s license, you must submit a letter stating this as the required documentation.
Current and valid photo ID: A copy of at least one of the following current, valid, government-issued, photographic identification cards: driver’s license, State of Ohio identification card, or U.S. permanent residence care.
Copy of current auto insurance policy: An applicant that intends to provide Choices services must provide a copy of a current auto insurance card/policy. If you do not have an automobile, you must submit a letter stating this as the required documentation.
Criminal Record Check from BCI: You are required to obtain a criminal record check (BCI) at time of application. The original should be forwarded to your consumer and a copy sent to the Ohio Department of Aging. Please contact the Ohio Attorney General’s office at 877-224-0043 for a location nearest you. You may not submit a criminal record check from a previous employer.
FBI record check (if lived outside of Ohio in past 5 years): If you have lived outside of Ohio anytime in the past five years, you are required to submit a FBI background check. The original should be forwarded to your consumer and a copy sent to the Ohio Department of Aging.
Consumer Request for Provider Form: This form will be provided for download during the online application process. The form must be signed by both the consumer that wishes to hire you to be their provider and the PASSPORT case manager.
Completed and Signed W-9: This form will be provided for download during the online application process.
Ohio Medicaid Provider Agreement for Individual: This form will be provided for download during the online application process
Proof of Residency: Evidence that applicant/CEO has been a resident of Ohio for the last 5 consecutive years. Acceptable documentation includes: valid driver’s license; notification of registration as an elector; a copy of an officially field federal or state tax form identifying the applicant’s permanent residence; any other document the responsible entity considers acceptable that shows evidence that the applicant has been a resident of Ohio for the past 5 years.
After submission, you will have 90 days to submit all required documentation. If you do not submit all required documentation within 90 days, your application will expire and you will be required to start a new application.
PLEASE NOTE: After the application has been submitted you will be unable to upload any required documentation. You will be need to mail or fax the documentation to our office within the 90 day period.
Ohio Department of Aging
50 West Broad Street, 9th Floor
Columbus, OH 43215
Fax Number: 614-466-9812
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