Medicaid Nursing Home Rates by State

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Ohio

Medicaid nursing facility payment · Peer-group price · researched October 2026

Ohio’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Peer-group price

Case-mix level

Facility average

Classification

Transitioning to PDPM

Rate updates

Twice a year

Managed care (LTC)

Yes

Quality program

Quality incentive payment

Paid outside the rate

None

Bed hold

Hospital and leave

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$75 / month

Overview

• Ohio sets a price for each cost area and every facility in the same peer group (a group set by county and bed count) gets that price.
• Direct care = the peer group's cost per case-mix unit (set at the 70th-percentile facility) x the facility's Medicaid case-mix score.
• Ancillary/support and capital are flat prices at the 25th-percentile facility of six peer groups.
• Tax costs are passed through per facility.
• A flat $16.44 add-on and a per-day quality incentive payment are added, and a 5% cut applies to facilities under 65% occupancy.
• July 1, 2026 posted rates: 915 facilities, median total $278.44/day (range $191.79-$373.70).

What matters in Ohio

• The quality incentive pays a median $41.72 a day inside the rate, about 15% of the $278.44 median.
• A new operator keeps the old rate but gets no quality payment for at least 6 months after a change of operator on or after 7/1/2025 (HB 96).
• Low case-mix residents (two lowest acuity groups) are paid a flat $115 a day instead of the home's rate.
• Case mix moves from RUG-IV to the PDPM nursing index (federal acuity measure): one-third January 2026, fully by 7/1/2027.
• Homes under 65% occupancy lose 5% of their whole rate; 38 homes took the cut at 7/1/2026.
• An $875M settlement ($310M state) funds one-time quality back pay after a 2025 Ohio Supreme Court ruling.
• Bed hold pays only 18% of the rate unless prior-year occupancy exceeded 95%, which earns 50%.

Frequently asked

How is Ohio's nursing home quality incentive payment paid?

It is paid per Medicaid day inside the rate, with a median of $41.72 at 7/1/2026, about 15% of the $278.44 median rate. It is scored on CMS quality, staffing and occupancy points.

How much does Ohio pay for a Medicaid resident in the lowest acuity groups?

Residents in the two lowest case-mix groups are paid a flat $115 a day in place of the home's full rate.

How does low occupancy affect an Ohio home's base rate and bed hold pay?

Occupancy under 65% cuts the whole rate by 5%. Bed hold pays 18% of the rate, or 50% if prior-year occupancy exceeded 95%.

Does a new operator of an Ohio nursing home receive the quality incentive payment?

Not at first. The new operator keeps the old rate, but after a change of operator on or after 7/1/2025 it gets no quality incentive payment until the first January 1 or July 1 at least 6 months after the change (HB 96).

How much is paid outside the posted rate in Ohio?

None; all money above the base is paid as add-ons inside the per diem.

What does Ohio Medicaid pay on Medicare coinsurance days?

Lesser-of: Medicaid pays its rate minus Medicare's payment, capped at the coinsurance, which is usually $0.

Does Ohio require a minimum share of spending on care?

No; there is no direct care spending floor or recoupment of unspent money.

How is the Ohio nursing home provider tax charged?

A franchise permit fee per licensed bed per day, not returned as a separate add-on; the current amount was not found.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Ohio Medicaid nursing facility cost report (state-specific, calendar-year, filed through MITS within 90 days of year-end; four cost centers: ancillary/support, capital, direct care, tax) - State Plan Att. 4.19-D Supp. 1 sec. 001.27

Base year and rebasing

Rebasing uses the 'applicable calendar year' = the calendar year just before the first fiscal year of the rebasing (ORC 5165.01). ORC 5165.36: rebase at least once every five fiscal years starting FY2024, and only the direct care and tax cost centers are rebased. Last rebase took effect 7/1/2023 (FY2024, CY2022 costs, per HB 33). The July 1, 2026 update was NOT a rebase; the next one is due by FY2028 at the latest. Ancillary/support and capital peer-group prices are the same in the posted 7/1/2023, 1/1/2025 and 7/1/2026 rate files (e.g. peer group 3-S $61.85 / $9.54).

Components

Component	Method	Notes
direct care	price: peer-group cost per case-mix unit at the 70th-percentile facility (3 county-based peer groups) x facility semiannual Medicaid case-mix score	70th percentile since HB 33 (was 25th). Outliers >1 SD and facilities with <12 months in the program are excluded. ORC 5165.19 (as amended by HB 96, eff. 9/30/2025). PDPM phase-in in progress; see case_mix.
ancillary and support	price: 25th-percentile facility in each of 6 peer groups (3 county tiers x under/over 100 beds); days = greater of actual or 90% occupancy	ORC 5165.16. 7/1/2026 prices: 1-S $68.12, 1-L $63.11, 2-S $67.01, 2-L $64.29, 3-S $61.85, 3-L $61.88. Inflation update removed by HB 33.
capital	price: 25th-percentile facility in each of 6 peer groups; days = 100% occupancy; straight-line depreciation (40 yrs buildings)	ORC 5165.17. Not fair rental value. 7/1/2026 prices $7.99-$11.11.
tax	facility-specific pass-through: desk-reviewed actual allowable tax costs / inpatient days at 100% occupancy	ORC 5165.21. 7/1/2026: median $2.67, max $17.68; $0 for 94 of 915 facilities.
flat add-on	$16.44 per Medicaid day added to every facility's rate (ORC 5165.15(B))	Shown as 'Add-on for ORC 5165.15(B)' in the rate file; HB 33 removed the old $1.79 deduction.
quality incentive payment	statewide pool split by quality points	See quality_incentive.

Inflation

None. HB 33 (eff. 7/4/2023) removed the inflation adjustments for ancillary/support and direct care. Prices only change at rebasing or case-mix updates.

Verified October 11, 2026

Case mix

System

Transitioning to PDPM

Applied at

Facility average

How it works

One rate per home: direct care x the home's semiannual Medicaid case-mix score (low case-mix residents are paid a flat $115/day instead).

Classification

Moving from RUG-IV 57-group to the PDPM nursing component (nursing index only); phase-in SFY2026-2027

Applies to

direct care only

Acuity measured from

Medicaid residents (semiannual Medicaid case-mix score; MDS required for all residents of Medicaid-certified beds). July 1 rates use quarters ending Dec 31 and Mar 31; Jan 1 rates use quarters ending Jun 30 and Sep 30 (State Plan sec. 001.8).

Updated

semiannual (January 1 and July 1)

Move to PDPM

CMS stopped OBRA RUG support Oct 2023; for 1/1/2024-6/30/2025 facilities could use the Optional State Assessment (OSA) or freeze their March 31, 2023 score (HB 33). HB 96 (eff. 9/30/2025) switched the grouper to PDPM nursing (Oct 1, 2019 grouper). From 1/1/2026 each peer group's cost per case-mix unit is multiplied by a case-mix multiplier (peer-group avg RUG score at 12/31/2025 / peer-group avg PDPM score at 1/1/2026) to keep it budget neutral. Each facility's direct care rate moves 1/3 of the way from its 1/1/2025 rate to the PDPM rate on 1/1/2026, 2/3 in FY2027 (from 7/1/2026), and fully PDPM from 7/1/2027 (State Plan TN 25-0017; HB 96 Section 333.280).

Verified October 11, 2026

Low-acuity residents

Flat $115 per Medicaid day replaces the facility's whole per diem (all components and add-ons) for 'low case-mix residents' (ORC 5165.152; current text effective 7/4/2023 under HB 33; $115 already in ODM's MCO encounter guidance in 2018-2019). ORC 5165.01(Z) defines a low case-mix resident as a Medicaid resident placed in either of the two lowest case-mix groups used for the direct care rate, not counting the default group used for incomplete assessments. Under RUG-IV those are PA1 and PA2 (reduced physical function; CMI 1.0000 and 1.1111 in the State Plan appendix; MCO billing codes 0169/0220 'PA1/PA2 low acuity'). Under the PDPM nursing index (State Plan Appendix B, TN 25-0017) the two lowest groups are also PA1 (0.62) and PA2 (0.67). The exact date ODM began grouping low case-mix residents on PDPM during the 2026-2027 phase-in is not confirmed. These residents are also left out of the facility's Medicaid case-mix score (ORC 5165.192(A)(1)(a)(i)). Leave days for them are billed under code 0189 at 50% or 18%.

Verified October 11, 2026

Capital

Peer-group price at the 25th-percentile facility's actual allowable capital cost per day (6 peer groups, 100% occupancy days, straight-line depreciation); not fair rental value; not rebased since FY2024 law change (ORC 5165.17, 5165.36)

Verified October 11, 2026

Budget adjustment factor

None in effect as a separate factor. The PDPM case-mix multiplier (from 1/1/2026) is meant to keep the switch budget neutral in FY2026-27 (HB 96). SB 390 (introduced 3/2026) would cut cost per case-mix unit to save $71M/yr in FY2027-28 and move it into the quality pool, but it was still in Senate Finance at last check.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

none

Estimate

No recurring NF supplemental, UPL, IGT-funded or MCO directed payment found. Money above the base per diem is paid as add-ons inside the rate (quality incentive ORC 5165.26, private room incentive ORC 5165.158 capped at $160M/yr from FY2025, critical access ORC 5165.23), not as separate supplemental payments.

Components

None outside the rate. ORC Chapter 5165 (all sections checked) has no supplemental/UPL/IGT section; HB 96 (FY26-27 budget) directed-payment and IGT provisions cover hospitals only (Rural Ohio Hospital Tax Pilot, hospital SDP rules). MCOs must pay at least the ORC 5165.15 rate (a floor, not an add-on). The one-time $875M HB 479 settlement excluded per request.

Source

https://codes.ohio.gov/ohio-revised-code/chapter-5165

Verified October 11, 2026

Payments by owner type

Applies

no

Detail

No payment depends on ownership. County homes (ORC Chapter 5155) appear in Chapter 5165 only in an admissions provision (may admit only county residents); they are paid the same peer-group prices as private homes. No county-home UPL/IGT program found in ORC 5165 or HB 96.

Funding

n/a (no such payment). Rates are funded by GRF plus the NF franchise permit fee (ORC 5168.40-5168.56).

Source

https://codes.ohio.gov/ohio-revised-code/chapter-5165

Verified October 11, 2026

Quality program

Program

Nursing facility quality incentive payment (ORC 5165.26)

Funding

Set by statute as part of the state per diem (state funds plus federal match); not an MCO directed payment and not tied to the franchise fee. Pool = for each facility (5.2% of its July 1 base rate + $1.79 + 60% of the per diem change in its cost per case-mix unit from the last rebasing) x its prior-calendar-year Medicaid days, summed, plus $125 million. The 5.2% + $1.79 piece dates from when the program was carved out of base rates (HB 59 / HB 166); the $125M is added money. Not budget neutral overall.

Size

Total annual pool not found published. Per day: the 7/1/2026 rate file shows a median of $41.72 (max $50.47) across the 811 of 915 facilities paid more than $0.

Paid as

per-diem add-on (its own 'Quality Payment Rate per ORC 5165.26' column in the posted rate; paid on each Medicaid day billed)

Measures

Measure	Source	Weight	How points are earned
Long-stay high-risk residents with pressure ulcers	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay urinary tract infection	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay residents whose ability to move independently worsened	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay catheter inserted and left in bladder	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay increased need for help with daily activities (FY2025+)	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay falls with major injury (FY2025+)	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Long-stay antipsychotic medication use (FY2025+)	MDS QM (CMS Five-Star QM points)	CMS points / 20	CMS Five-Star points for the measure, divided by 20; 0 if CMS places the facility in the lowest percentile for that measure
Adjusted total nurse staffing hours per resident day (FY2025+)	PBJ (CMS Five-Star staffing points)	CMS points / 20, scored in quintiles (uses the higher decile's points of the two deciles in each quintile)	same as the QM measures
Occupancy above 75%	state (Ohio Medicaid cost report, licensed beds, prior calendar year)	3 points flat (7.5 in FY2024)	occupancy > 75%; not recalculated mid-year

Scoring period

Uses the most recent four-quarter average CMS data on Care Compare as of the latest month available in the calendar year the fiscal year begins. Points are set for the July 1 rate and recalculated for the January 1 rate with newer Care Compare data; the occupancy points and the dollar value per point stay fixed for the year. Occupancy and Medicaid days come from the prior calendar-year cost report. Exact data lag not confirmed (see open_questions).

Payment formula

Pro-rata share of a fixed pool: value per point = pool / (statewide average quality score x statewide prior-year Medicaid days); facility per-day payment = value per point x facility score. A facility's total points go to 0 if below the 25th percentile of all facilities (percentile fixed at the July 1 rate setting) until the next recalculation; a single measure scores 0 if CMS places the facility in its lowest percentile.

Eligibility

All Medicaid NFs, except: none for facilities on CMS Special Focus Facility Table A on May 1; new facilities get the statewide median for their first and second fiscal years; facilities with a change of operator effective 7/1/2025 or later get none until the first Jan 1 or Jul 1 at least 6 months after the change; facilities below the 25th percentile of points get 0.

Cadence

Scored twice a year (July 1 and January 1 rates); paid per Medicaid day as part of the per diem.

Scores published

Partly. Each facility's per-day quality payment is in ODM's posted rate component report (https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Pr…); per-facility point totals and the value per point were not found posted.

Notes

Paid as a per-day add-on recalculated Jan 1 and Jul 1. No payment for facilities on CMS Special Focus Facility Table A on May 1. New facilities get the median for 2 fiscal years. Facilities with a change of operator on/after 7/1/2025 get none for at least 6 months (HB 96). In Sept 2025 the Ohio Supreme Court (2025-Ohio-3066) held ODM had to use the 'rate for direct care costs', not just the price, in the 60%-of-rebasing pool term for FY2024-25; HB 184 (eff. 3/20/2026) changed the statute to 'cost per case-mix unit' going forward, and HB 479 (June 2026) appropriated $875M ($310M state) to settle the back pay. ORC 5165.26(G) (added by HB 184) states the legislature's intent that the pool be calculated the way ODM actually paid it in FY2024-25.

Verified October 11, 2026

Provider tax

Charged

per bed

Standard amount

Franchise permit fee per licensed bed per day x days, set each fiscal year from estimated net patient revenue, paid quarterly. Current per-bed-day amount not found on a primary source.

Lower for high-Medicaid homes

no

Returned in the rate

Not returned as a separate rate add-on; the franchise permit fee rate component was dropped after SFY2012 (State Plan sec. 001.16).

Source

https://codes.ohio.gov/ohio-revised-code/section-5168.42

Verified October 11, 2026

Provider tax notes

Franchise permit fee on nursing home beds (ORC 5168.40-5168.56): fee rate per bed per day x licensed beds x days, set each fiscal year from estimated net patient revenue, paid quarterly; assessments issued by Oct 1. Not returned as a separate rate add-on: the franchise permit fee rate component was dropped after SFY2012 (State Plan sec. 001.16). Current per-bed-day amount not found on a primary source.

Verified October 11, 2026

Other add-ons

Private room incentive (ORC 5165.158; from 4/1/2024 or later): +$30/day Category 1 (own toilet and sink), +$20/day Category 2; facilities on SFF Table A/D or with a 1-star overall rating are not eligible. Ventilator program (ORC 5165.157, OAC 5160-3-18): an enhanced all-in rate instead of the per diem, $1,364.08/day ventilator-dependent and $1,636.89/day weaning (7/1/2024 rates, revised each July; applies to FFS, MyCare and MCO members). Critical access incentive (ORC 5165.23): +5% of rate for facilities in a 2011 federal empowerment zone with >=85% occupancy and >=65% Medicaid (4 facilities at 7/1/2026). Low case-mix residents paid a flat $115/day (ORC 5165.152). Outlier/special-care contracted rates with prior approval (State Plan sec. 001.20.3). Deduction: -5% of total rate for occupancy <65% (38 facilities at 7/1/2026).

Verified October 11, 2026

Units paid separately

(1) Ventilator program (ORC 5165.157, OAC 5160-3-18): approved discrete units get a flat all-inclusive daily rate instead of the per diem, based on 34% of the statewide average long-term acute care hospital per diem: $1,364.08/day ventilator-dependent and $1,636.89/day weaning (weaning up to 90 days/year), 7/1/2024 rates, revised each July. Facilities on SFF Table A/D or with a 1-star rating can't join, and approved units drop to the regular rate for new admits. (2) Low case-mix residents: flat $115/day (ORC 5165.152). (3) Outlier units for special needs the MDS doesn't capture: contracted rates with prior approval; direct care, ancillary/support and capital can each be raised (State Plan 001.20.3). No separate brain injury, pediatric or behavioral per diem found apart from the ventilator and outlier models.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

Next Generation MCOs and MyCare Ohio (duals); plans pay at least the state per diem

Verified October 11, 2026

Who pays

mixed: fee-for-service plus Medicaid managed care (Next Generation MCOs) and MyCare Ohio plans for dual-eligibles; NF room-and-board encounters are paid at the state per diem

Verified October 11, 2026

Managed care rate floor

Yes. ODM guidance says managed care plans must pay a nursing facility at least the rate set by ORC 5165.15, and ODM uses that rate to build MCO capitation. Source: ODM 'FAQ Managed Care and Nursing Facility-Based Levels of Care' (rev. 07/2020), https://medicaid.ohio.gov/static/Providers/ProviderTypes/Mana… ODM's NF encounter memo (rev. 6/25/2019) also tells MCOs/MyCare plans to pay room-and-board at '100% per diem' and leave days at 50% or 18%: https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Pr…

Verified October 11, 2026

Included in the daily rate

Included in the per diem (State Plan 001.4, TN 24-004 eff. 10/1/2024): PT/OT/speech therapy and audiology, respiratory therapy, emergency oxygen, OTC drugs and nutritional supplements, medical supplies (incl. disposable ventilator circuits), standard medical equipment (hospital beds, standard wheelchairs, IPPB machines), drawing and forwarding lab specimens, TB tests, personal hygiene, and transport other than by ambulance or wheelchair van. Paid separately: lab and x-ray, prescription drugs, ventilators, non-emergency oxygen, prostheses/orthoses, custom wheelchairs, dental, physician, podiatry, vision, behavioral health, ambulance/wheelchair-van transport, acupuncture.

Verified October 11, 2026

Bed hold

Hospital stays

Paid. Hospital, therapeutic and visitation leave share one limit of 30 days per calendar year; 50% of per diem if prior-year occupancy >95%, otherwise 18%

Leave days

Paid (therapeutic and visitation leave need physician approval); same 30-day annual limit and 50%/18% rates

Occupancy rule

No minimum to qualify; the percentage depends on prior calendar-year occupancy from the cost report (>95% gets 50%, <=95% gets 18%)

Notes

Ventilator program residents' leave days are paid at the regular per diem bed-hold rate, not the vent rate.

Source

https://codes.ohio.gov/ohio-revised-code/section-5165.34

Verified October 11, 2026

Personal needs allowance

Per month

75

Effective

rule version 2026-01-01

Notes

OAC 5160:1-6-07: PNA $75 plus up to $65 of earned income. VA pensions incl. aid and attendance up to $90/month excluded. ORC 5163.33 floor is $50 individual / $100 couple. Not COLA-indexed.

Confidence

confirmed

Source

https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-07

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

OAC 5160-3-64 (NFs: payment for Medicare Part A cost sharing; eff. 8/31/2017) is the Chapter 5160-3 rule that 5160-1-05(E) points to. (A) 'Medicaid maximum allowable amount' = 100% of the NF's Medicaid rate on the date of service. (B) For QMBs and Medicaid residents admitted under Medicare Part A, ODM pays the lesser of (1) the Part A coinsurance or (2) the Medicaid maximum allowable amount minus the Part A payment. If Part A paid more than the Medicaid maximum, ODM pays nothing.

Effect

For MA residents the home usually gets $0 or a small amount. For traditional Part A coinsurance days it is probably capped at the Medicaid per diem minus Medicare's payment, which is usually $0.

Confidence

confirmed

Source

https://codes.ohio.gov/ohio-administrative-code/rule-5160-3-64

Verified October 11, 2026

Required care spending

Applies

no

Rule

No direct-care spending floor, medical-loss-type ratio, or recoupment of unspent direct-care money. ORC 5165.19 sets the direct care price (peer-group cost per case-mix unit x case-mix score) with no use-it-or-lose-it requirement; the only conditions tied to quality money are quality-incentive eligibility rules (e.g., no payment for SFF Table A homes, ORC 5165.26). Neither HB 33 nor HB 96 analyses contain a NF spending requirement.

Source

https://codes.ohio.gov/ohio-revised-code/section-5165.19

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) -5% of the total rate for homes under 65% occupancy (38 facilities at 7/1/2026; added by HB 33). (2) Ancillary/support cost per day uses the greater of actual days or 90% occupancy; capital and tax use 100% occupancy days. (3) The critical access incentive (+5%) requires 85%+ occupancy. (4) Bed hold pays 50% if prior-year occupancy is over 95%, else 18%. (5) The quality incentive includes an occupancy bonus (3 points since 7/1/2024).

Source

https://lsc.ohio.gov/assets/legislation/135/hb33/en0/files/hb…

Verified October 11, 2026

MDS accuracy penalties

(1) Late or inaccurate MDS data: ODM may assign a case-mix score 5% below the prior quarter's for one or more months of a quarter (ORC 5165.192(B)(1)), after giving the facility until the earlier of 45 days after quarter-end or the CMS correction deadline to fix it. (2) If a facility is paid on an assigned score for more than 6 months in a calendar year, ODM may assign a cost per case-mix unit 5% below the prior year's for the next fiscal year (5165.192(B)(3)). (3) Exception reviews (MDS audits; ORC 5165.193), triggered by surveys, risk analysis or past performance: if findings exceed tolerance levels set in rule, ODM recalculates resident and facility case-mix scores and the direct care rate, or recovers overpayments for past periods (5165.41). Tolerance levels not confirmed.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

semiannual

When

Jul 1 with a Jan 1 case-mix and quality update; corrected files re-posted mid-year

Verified October 11, 2026

When rates change

July 1 (state fiscal year) with a January 1 semiannual update for case mix and quality points; ODM posts revised files during the year when rates are corrected (e.g. 7/1/2026 rates re-posted 9/21/2026 and 9/25/2026).

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Pr…

Format

pdf

Cadence

semiannual (Jul 1, Jan 1) plus re-posted 'as of' corrections

History

At least back to 1/1/2022 on ODM's site (1.1.22 file at medicaid.ohio.gov/static/...; 7.1.23, 1.1.25 and 7.1.26 files on dam.assets.ohio.gov). Older files not confirmed.

Home identifier

NPI and Medicare CCN (7/1/2026 file); older files (7/1/2023, 1/1/2025) have NPI and name only; the 7/1/2023 file also has county

Verified October 11, 2026

Rate build-ups

Published

No

What they show

No public per-facility worksheet found. The public rate component report shows each facility's built-up rate: direct care, ancillary/support peer group and price, capital, tax, critical access add-on, $16.44 add-on, 5165.15(C) deduction, quality payment, low-occupancy deduction, total. It does not show case-mix scores, cost per case-mix unit, or quality points.

Format

pdf

Example file

https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Pr…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Ohio Assisted Living HCBS Waiver, 1915(c), administered by ODA for ODM (OAC 5160-1-06.5, Chapter 5160-33)

What is paid

Services only; room and board is the individual's responsibility (OAC 5160-33-07).

Rate

Base $130.00/day; Memory Care $155.00/day (ODA rate sheet effective January 2024). A critical-access rate ($145/day) is reported but not confirmed.

Limits

Age 21+, NF level of care; enrollment limited to waiver slots

Source

https://dam.assets.ohio.gov/image/upload/aging.ohio.gov/Effec…

Verified October 11, 2026

Sources

1. ORC 5165.15 Total per Medicaid day payment rate · statute
2. ORC 5165.16 Ancillary and support costs · statute
3. ORC 5165.17 Capital costs · statute
4. ORC 5165.19 Direct care costs · statute
5. ORC 5165.21 Tax costs · statute
6. ORC 5165.23 Critical access and low occupancy · statute
7. ORC 5165.26 Quality incentive payment · statute
8. ORC 5165.01 Definitions (applicable calendar year, rebasing) · statute
9. ORC 5165.36 Rebasing · statute
10. ORC 5165.34 Bed-hold payments · statute
11. ORC 5165.152 Low case-mix residents · statute
12. ORC 5165.157 Ventilator alternative purchasing model · statute
13. ORC 5165.158 Private room incentive · statute
14. ORC 5168.42 Nursing home franchise permit fee · statute
15. OAC 5160-3-16.4 Bed-hold days · regulation
16. State Plan Attachment 4.19-D NF Supplement 1 Payment for Services · state plan
17. SPA OH-25-0017 (PDPM transition) · state plan
18. ODM Provider Rate Component Data Report NF 7.1.26 (as of 9/25/26) · rate file
19. ODM Provider Rate Component Data Report NF 7.1.26 (as of 9/21/26) · rate file
20. ODM NF rates 1/1/2025 · rate file
21. ODM NF rates 7/1/2023 · rate file
22. ODM NF rates 1/1/2022 · rate file
23. ODM FAQ Managed Care and NF-Based Levels of Care (rev. 07/2020) · agency page
24. ODM NF Encounter Guidance memo to MCOs (rev. 6/25/2019) · agency page
25. ODM NF Ventilator Program fact sheet (rev. 7/31/2024) · agency page
26. ODM Franchise Permit Fee fact sheet (NF) · agency page
27. LSC HB 33 (135th GA) Medicaid final analysis · statute
28. LSC HB 96 (136th GA) final analysis · statute
29. LSC HB 479 (136th GA) analysis, as reported by Senate Finance (6/10/2026) · statute
30. LSC SB 390 (136th GA) analysis, as introduced (4/14/2026) · statute
31. ORC 5165.192 Case-mix scores · statute
32. ORC 5165.193 Exception review of resident assessment data · statute
33. ODA Medicaid Waiver Rates by Service Groups (effective January 2024) · rate file
34. Medicare crossover / coinsurance rule · regulation
35. off_rate_revenue source · regulation
36. Medicare crossover rule · regulation
37. Personal needs allowance · regulation
38. Court News Ohio: State must recalculate Medicaid payments to nursing homes (2025-Ohio-3066) · secondary
39. LeadingAge Ohio: Legislature finalizes prospective change to QIP formula (HB 184) · secondary
40. LeadingAge Ohio: Legislature approves $875 million (HB 479) · secondary
41. Pease Bell: What changed on July 1, 2026 (used only to confirm 7/1/2026 was not a rebasing) · secondary
42. BillTrack50: OH SB 390 status · secondary

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