Ohio’s Medicaid Home‑Care Enrollment Freeze Nears Nov. 14 End Amid Growing Care‑Gap Concerns for Disabled Residents

Six‑Month Moratorium Set to Expire on Nov. 14

A six‑month moratorium on new Medicaid home‑care and hospice provider enrollments in Ohio is slated to lapse on Nov. 14 unless federal regulators grant an extension. The pause, instituted by the Ohio Department of Medicaid as part of an anti‑fraud initiative, has prevented new agencies and independent aides from joining the program since May 14.

As the deadline approaches, the policy is drawing renewed criticism. An NBC News report highlighted Ohio legislators’ concerns that the crackdown is impeding access to care for disabled residents. State officials contend the measures safeguard a program that enrolled roughly 3.2 million Ohioans in 2024, according to WSYX.

For many families, the stakes are immediate. Individuals who rely on Medicaid waivers to remain at home depend on aides and nurses for essential tasks such as bathing, dressing, eating, and managing medical needs. When a worker leaves or an agency withdraws from the program, families must locate a replacement from a limited pool of providers that cannot expand while the freeze remains in place.

A Six‑Month Pause Built on Federal Rules

The statewide moratorium applies to eight categories of providers, including accredited and Medicare‑certified home‑health agencies, private‑duty nurses, hospice organizations, non‑agency personal‑care aides, non‑agency home‑care attendants, and waivered services organizations and individuals. New applications are not accepted, and any pending applications submitted before May 14 have been rejected, with applicable fees refunded.

Current providers may continue serving their existing clients, but they are prohibited from opening additional service sites. The notice assures Medicaid recipients that they can retain their present providers and encourages them to reach out to their case or care manager if they experience any access issues.

The pause stems from a federal initiative. On May 13, the Centers for Medicare & Medicaid Services (CMS) issued six‑month moratoria on new Medicare hospice and home‑health enrollments, allowing states to impose comparable restrictions on Medicaid programs. Ohio based its action on 42 CFR 455.470, which authorizes an initial six‑month period and permits extensions in six‑month increments when the state can document continued need.

The regulation also includes an access‑protect safeguard. Prior to enacting its own limits, a state must evaluate that the action will not impair beneficiaries’ access to care, and a state may opt out of a federal moratorium if it determines that doing so would be detrimental. Ohio has not indicated whether it intends to request an extension.

Fraud Concerns Behind the State’s Crackdown

On May 13, Governor Mike DeWine announced the moratorium request, coupled with immediate payment suspensions for high‑risk providers, GPS‑based electronic visit verification, and more frequent provider revalidation. “Ohio has long been a national leader in fighting Medicaid fraud,” DeWine remarked, as reported by WSYX ABC6.

The initiative followed a Daily Wire investigation alleging that roughly 300 Columbus‑area home‑health firms shared addresses and billed over $250 million between 2018 and 2024. Ohio has not fully substantiated those allegations. Ohio Medicaid officials noted that they were already probing Franklin County providers prior to the reports and that several of the named companies have ceased billing the program.

The state highlights its enforcement track record. Ohio Medicaid and the Attorney General’s Medicaid Fraud Control Unit have secured 444 indictments, 481 convictions, and recovered more than $78 million in recoveries since the beginning of 2023.

Subsequently, legislators enacted anti‑fraud measures as part of Senate Bill 315, which include stricter penalties and mandatory electronic visit verification. The bill omitted a proposed ban on compensating family caregivers. “Safeguarding the funds is not optional,” asserted Representative Mike Dovilla (R‑Berea), as reported by the Statehouse News Bureau.

Families Describe Gaps in Care

Critics argue that the rapid implementation has left some patients struggling to maintain care. Jeremy Pauley, a 37‑year‑old resident of Whitehall who has been paraplegic since age 18, reported to WSYX ABC6 that he lost his certified nurse when his agency, facing a payment suspension, terminated services. “They gave me a three‑day notice they would no longer provide services,” Pauley said.

Pauley’s situation resulted from a payment suspension rather than the enrollment freeze itself, yet advocates contend that the freeze exacerbates the difficulty of securing replacements. Jennifer Kucera, chair of the Ohio Olmstead Task Force, who requires round‑the‑clock assistance, cautioned in June that “there will be nowhere for us to go to get new providers,” according to STAT.

State officials maintain that they are not terminating care. Under the suspension protocol, providers may continue serving patients while a review is underway and may receive retroactive payment if cleared. “The decision to stop providing care is not made by ODM, but rather by the provider,” department spokesperson Stephanie O’Grady told ABC6.

There is no publicly available data quantifying how many Ohioans have lost an aide due to the freeze or the payment suspensions, making it difficult to assess the policy’s actual impact on access to care.

Steps for Ohioans Who Lose an Aide

Those most vulnerable are individuals who require daily hands‑on assistance, such as adults with spinal‑cord injuries, cerebral palsy, muscular disorders, or developmental disabilities, as well as older adults enrolled in home‑care waiver programs. Rural residents and patients needing skilled nursing services confront the most limited provider pools.

If you receive notice that an agency is terminating services, promptly contact your case manager or care coordinator. Individuals served by county boards of developmental disabilities should reach out to their service and support administrator. The Ohio Medicaid Consumer Hotline (1‑800‑324‑8680) can address access inquiries, and the state’s long‑term care ombudsman program (1‑800‑282‑1206) assists home‑care recipients in resolving issues.

Disability Rights Ohio offers guidance for those experiencing service disruptions, and families are encouraged to retain copies of termination notices, relevant dates, and care plans. Any abrupt interruption in care for someone unable to manage independently—such as missed medications, feeding, or respiratory support—should be considered an emergency, prompting families to seek immediate assistance.

The central question now is whether Ohio will pursue an extension of the moratorium beyond Nov. 14 or allow new providers to begin enrolling. For disabled Ohioans, the decision will determine whether replacement assistance will be accessible the next time an aide departs.

Key Questions Answered

What is Ohio’s Medicaid home‑care moratorium? It is a pause, effective May 14, that blocks new Medicaid enrollments for home‑health agencies, hospice providers, private‑duty nurses, and independent aides. Current providers may continue serving existing clients without interruption.

When does the freeze end? The state indicates the moratorium remains in effect until Nov. 14, 2026, unless federal regulators approve a formal extension.

Why did Ohio impose it? State officials cite the need to curb Medicaid fraud and preserve program integrity, pointing to allegations of extensive billing irregularities among Columbus‑area home‑health firms, though the state has not definitively confirmed those claims.

Can I keep my current aide or agency? Yes. The moratorium does not affect enrolled providers; Medicaid recipients may continue receiving services from their existing aides or agencies.

Who is most affected? Individuals who require daily, hands‑on assistance—including those with severe physical or developmental disabilities and older adults enrolled in home‑care waiver programs—are most vulnerable, particularly in rural areas where provider availability is limited.

What should I do if my agency stops providing care? Immediately contact your case manager or care coordinator. If you are served by a county board of developmental disabilities, reach out to your service and support administrator. Additional assistance is available through the Ohio Medicaid Consumer Hotline (1‑800‑324‑8680) and the state’s long‑term care ombudsman program (1‑800‑282‑1206).

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