Ohio’s IDD billing system has a structure that is distinct from most states and that requires specific knowledge to navigate correctly. The Ohio Department of Developmental Disabilities, known as DODD, administers the state’s IDD waivers and serves as the billing payer for those services, separate from the Ohio Department of Medicaid’s standard fee-for-service system. Providers who are new to Ohio or who are expanding from a different state’s billing environment need to understand this DODD-specific billing structure before submitting their first claim.
In 2026, that structure is also in active transition, with confirmed rule changes effective July 1 across all three DODD waivers and proposed waiver amendments awaiting CMS approval. Here is what Ohio IDD providers need to know.
Ohio’s Three DODD Waivers
DODD administers three Medicaid HCBS waivers for individuals with developmental disabilities in Ohio:
The Individual Options waiver, known as IO, is Ohio’s comprehensive IDD waiver for adults with developmental disabilities who need a broad range of community-based supports. IO supports a wide service array including homemaker/personal care, adult day support, vocational habilitation, residential services, and behavioral support services.
The Level One waiver is a lower-intensity waiver for adults who need at least one waiver service but whose overall support needs do not require the full IO service array. The Level One waiver has spending caps of $62,136 per waiver span for adults and $41,424 for children, and it includes services such as homemaker/personal care, adult day support, vocational habilitation, career planning, individual employment support, community respite, and assistive technology.
The Self-Empowered Life Funding waiver, known as SELF, is Ohio’s self-direction option, allowing individuals and their families to manage their own services and hire their own workers within a defined budget framework.
Each waiver uses a distinct set of DODD-specific service codes that are different from standard CPT or HCPCS codes used in other Medicaid billing contexts. The code that applies to a specific service depends on the waiver type, the provider type (agency or independent), and whether the service is participant-directed. Billing coordinators new to Ohio IDD billing need to learn the DODD code structure specifically, not just standard Medicaid billing codes.
How Ohio IDD Billing Actually Works: eMBS
Ohio IDD Medicaid billing runs through DODD’s electronic Medicaid Billing System, known as eMBS. Every dollar of IDD waiver billing in Ohio flows through this portal. eMBS is where providers submit claims, track billing activity, view PAWS authorizations, and download the weekly provider reports that surface EVV exceptions and billing discrepancies.
Ohio DODD billing does not go through the Ohio Medicaid fee-for-service system for most IDD waiver services. Providers who attempt to submit DODD waiver claims through Ohio Medicaid’s standard portal rather than through eMBS will not be billing in the correct destination.
Authorization management in Ohio flows through the PAWS system, which is the authorization and support planning platform used by county boards of developmental disabilities and DODD. Service authorizations visible in PAWS are what billing in eMBS is validated against. A claim submitted in eMBS for a service not authorized in PAWS for that client and waiver span will be denied regardless of whether the service was legitimately delivered.
EVV in Ohio: Sandata and Hard-Edit Enforcement
Ohio Medicaid selected Sandata as the state’s EVV aggregator for DODD waiver services. As of October 1, 2025, EVV hard-edit enforcement took effect for DODD-billed services. Claims for covered services, including homemaker/personal care under the IO and Level One waivers and participant-directed homemaker/personal care under SELF, must have a matching EVV visit record in Sandata or they will be denied without payment.
This enforcement is not advisory. A claim submitted in eMBS without a matching Sandata EVV record is automatically denied. Ohio providers cannot appeal this type of denial by providing documentation after the fact. The EVV record must exist before the claim is processed.
Common EVV compliance problems Ohio DODD providers encountered during and after the enforcement transition include:
- Provider Medicaid Number mismatches between eMBS and Sandata, where the MPN registered in Sandata does not match the MPN used for billing in eMBS
- Incomplete clock-out records that leave visit end times open, preventing the EVV record from matching the claim
- Community-based service location exceptions where GPS verification does not match an expected address
- New provider enrollment in eMBS without completing the separate Sandata registration required for EVV
Ohio consolidated multiple Medicaid IDs into a single active ID during 2025. Providers who had multiple MPNs need to confirm that the single active MPN is the one registered in Sandata, or EVV records will not match billing claims regardless of how accurately the visits were documented.
DODD provides weekly EVV exception reports through eMBS’s provider weekly reports. Ohio DODD providers should review these reports every Friday to identify EVV discrepancies before they affect claim submission in the following billing cycle.
The July 2026 Rule Changes
Ohio DODD implemented confirmed rule changes effective July 1, 2026 across multiple administrative code sections affecting the IO, Level One, and SELF waivers. Key changes that directly affect billing and service delivery include:
Vocational habilitation updates: Rule 5123-9-14 was updated for all three waivers. Providers delivering vocational habilitation services should review the updated rule to ensure their documentation and billing practices align with the revised requirements.
Remote support modifications: Rule 5123-9-35 was updated to include specifications for real-time service delivery, provider staffing requirements, backup systems, and privacy safeguards. The Level One waiver amendment that was proposed for January 2026 adoption included modifications to billing units for Remote Supports in Waiver Year 5, which affects how providers calculate and submit Remote Support claims.
Level One medication administration: The July 2026 updates formally incorporated medication administration language into the Level One waiver, aligned with Ohio Administrative Code rule 5123-6-06. Providers delivering medication administration services under Level One should confirm their policies align with OAC 5123-6-06.
Support Brokerage addition: The Level One waiver amendment added Support Brokerage as a new service. Providers interested in delivering this service type need to confirm the enrollment and billing requirements with DODD before submitting claims.
DODD also proposed amendments to all three of its waivers with a July 1, 2026 target date pending CMS approval. As of the public comment period closing in April 2026, these amendments had been submitted to CMS. Providers should monitor DODD communications for the CMS approval announcement and the effective date for the federal waiver changes, which may differ from the July 1 state rule effective date.
What Ohio IDD Providers Need From Their Billing System
Ohio’s DODD-specific billing environment creates requirements that general Medicaid billing platforms frequently fail to meet.
DODD code structure: The billing platform must support Ohio DODD’s specific service code structure rather than generic CPT or HCPCS coding. Codes vary by waiver type and provider type, and a billing system that does not handle this specificity correctly requires billing staff to manage code selection manually, which is where coding errors enter the Ohio billing process.
eMBS claim submission: Claims must flow through eMBS rather than through a standard Medicaid clearinghouse. A billing platform that does not support eMBS submission requires a workaround for every Ohio DODD claim.
Sandata EVV integration: Visit verification data must transmit to Sandata with the correct provider MPN before claims can be submitted and paid. A billing platform that does not connect EVV data directly to the billing workflow requires the manual reconciliation that is most likely to produce the MPN mismatches and timing gaps that cause Ohio EVV denials.
PAWS authorization alignment: Authorization data from PAWS must be reflected in the billing system so claims are validated against current authorizations before submission. A billing system that does not track PAWS authorizations in real time is always at risk of submitting claims against exhausted or modified authorizations.
Vertex Systems supports Ohio DODD billing with state-specific billing logic and EVV integration for the Ohio market. Connect with the Vertex team to discuss Ohio-specific billing support and what the platform looks like for IDD providers in the Ohio DODD environment.
