In late 2025, Ohio took a major step in tightening its Electronic Visit Verification (EVV) requirements for Medicaid-reimbursed services—and the ripple effects are just beginning to be felt across the home- and community-based services (HCBS) sector.
Effective October 1, 2025, the Ohio Department of Medicaid (ODM) moved beyond gentle warnings and voluntary compliance: claims that require EVV must include a valid, matching visit record or they will be denied. This means EVV isn’t simply documentation support anymore—it’s a hard gatekeeper for payment. myEZCare+1
Why This Matters
EVV systems were originally mandated under the federal 21st Century Cures Act to fight fraud and ensure services billed to Medicaid were actually delivered. Ohio’s phased rollout started in early 2025, gradually requiring more service types to link claims with validated EVV visit data. CareSource
By October 1, the changes hit a critical threshold:
- Medicaid claims tied to services now must have their visit data recorded in the EVV system before payment will be approved. myEZCare
- Missing or mismatched EVV details—including caregiver, service, location, and times—are no longer correctable after the fact if a claim is submitted. myEZCare
This transforms EVV from a compliance checkbox to a payment compliance requirement.
What’s New in the EVV Rules
The Ohio Administrative Code (OAC) 5160-32-02, updated October 30, 2025, lays out operational requirements for EVV:
- Visit data must be collected via approved devices or telephony and include all required elements (service type, date/time, caregiver identity, location, recipient, etc.). Ohio Laws
- Providers are responsible for resolving exceptions (errors or gaps in EVV data), and claims cannot be paid until exceptions are cleared. Ohio Laws
- GPS visit location can only be used with signed annual consent from the individual served, and consent can be revoked at any time. Ohio Laws
In short: accuracy and real-time validation are now non-negotiable.
How Providers Are Feeling the Impact
For many agencies and providers, the October shift means:
- Real consequences for documentation gaps: Even when the service was delivered, missing or mismatched EVV data will now result in automatic denials. myEZCare
- No more post-billing cleanup fallback: Previously, errors could often be fixed after submission. With enforcement in place, those fixes are too late. myEZCare
- Administrative workflows must change: Providers must now design operations so that EVV capture happens before claims submission. That means tighter scheduling, training staff on real-time EVV use, and proactively managing exceptions. myEZCare
Claims denial isn’t just a paperwork headache—it directly affects cash flow and financial stability, especially for smaller agencies with thin margins.
What’s Next in 2026 and Beyond
Ohio’s EVV implementation is rolling forward in phases. Starting January 1, 2026, even more claims—like those for Ohio Home Care and PASSPORT waiver services—will be subject to complete EVV matching before payment. GovDelivery
Here’s what providers can expect going into 2026 and beyond:
✔️ 1. Full Integration of EVV and Billing
EVV systems cannot exist in a silo anymore. Claims workflows must be tightly integrated with EVV capture so that every visit’s data automatically transfers into billing. Real-time verification becomes a standard operating necessity.
✔️ 2. Higher Stakes for Exception Management
Providers will need strong protocols for handling EVV exceptions—where data doesn’t line up—before claims are submitted. That means dedicated staff or systems for real-time monitoring and correction.
✔️ 3. Training & Tech Investments
Ongoing training for direct care workers and agency staff will be critical. Software, telephony solutions, and alternate EVV vendors (once certified) will continue to play a role in helping organizations meet compliance. GovDelivery
✔️ 4. Industry-Wide Standardization
Ohio’s stricter model aligns with broader national trends: states are increasingly tying payment directly to EVV validation. Agencies that adapt now gain a competitive edge and are better positioned for future policy shifts.
Bottom Line
The EVV changes that hit Ohio in October 2025 mark a structural shift in how home- and community-based service billing works. What was once a compliance task is now a core financial control, shaping revenue integrity, operational workflows, and technology investment decisions.
Providers who treat EVV as an afterthought risk denials, cash-flow disruption, and administrative overload. Those who integrate it into daily operations will not only survive—but thrive—as Ohio’s Medicaid environment continues to evolve.