Ohio Department of Medicaid
Medicaid Id
Mandatory Fields Optional or Conditionally Mandatory Fields
( must be at least 18 yrs.)
Eligibility Requirements – If you have transitioned through the HOME Choice program since July 2019 you are not eligible to reapply. To qualify for this program, you must be at least 18 years of age, have needs that can safely be met in a home or community-based setting as determined by the Ohio Department of Medicaid or its designee, and meet each of the additional four requirements listed below .
Name of Facility Admission Date Discharge Date Facility Type
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