# Selling a Home Care Agency in Ohio: 2026 M&A Guide > Ohio is one of the most active Midwest home care M&A markets, with concentrated buyer interest across PASSPORT-funded personal care, Medicare home health, and hospice. Here is what Ohio owners should know. Source: https://www.hendonpartners.com/insights/selling-home-care-agency-ohio Author: Neli Gertner Published: 2026-05-05 Category: State Guides Tags: Ohio, ODH, PASSPORT, MyCare-Ohio, M&A, state-guide ---Ohio has emerged as one of the most consistently active Midwest home care M&A markets through 2026. The combination of strong demographic profile, the breadth of PASSPORT-funded personal care, MyCare Ohio managed care depth, and concentrated buyer interest across Cleveland, Columbus, and Cincinnati has produced a steady cadence of transactions. For Ohio home care owners considering a sale, this guide covers the regulatory framework, payer dynamics, regional buyer interest, and 2026 valuation realities. --- ## Ohio Regulatory Framework ### Medicare-Certified Home Health and Hospice Regulated by the **Ohio Department of Health (ODH)**: - State licensure required - Medicare certification (CMS) required for Medicare billing - ODH survey oversight - Accreditation through Joint Commission, ACHC, or CHAP common ### PASSPORT and Medicaid Personal Care The **Ohio Department of Aging (ODA)** administers PASSPORT (Pre-Admission Screening System Providing Options and Resources Today) — Ohio's primary HCBS waiver for elderly Medicaid beneficiaries. - ODA certification of providers - Area Agencies on Aging (AAA) coordinate services - Provider type categories define services ### MyCare Ohio MyCare Ohio integrates Medicare and Medicaid for dual-eligible beneficiaries. Five MyCare Ohio MCOs contract with home care providers: - Aetna Better Health of Ohio - Buckeye Health Plan (Centene) - CareSource - Molina Healthcare of Ohio - UnitedHealthcare Community Plan ### Other Ohio Programs - Ohio Home Care Waiver (ODM-administered, for younger adults with disabilities) - Self-Empowered Life Funding (SELF) Waiver - Individual Options (IO) Waiver ### Private Pay Non-medical private-pay home care does not require state licensure but should follow standard business registration and worker classification compliance. --- ## Ohio Regional Dynamics ### Greater Cleveland (Cuyahoga + adjacent counties) - ~2M metro population - Strong managed care market - Active strategic and PE buyer interest - Hospital-affiliated home health competition (Cleveland Clinic, University Hospitals) - Significant hospice market ### Greater Columbus - ~2.2M metro - Fastest demographic growth among Ohio metros - Strong private pay market - Active buyer interest - OhioHealth and Mount Carmel hospital-affiliated home care presence ### Greater Cincinnati - ~2.3M metro (Ohio + KY + IN) - Strong managed care market - Cross-state operations common - TriHealth and UC Health hospital-affiliated home care presence ### Dayton, Toledo, Akron, Youngstown - Secondary Ohio metros - More limited buyer competition - Strong regional operator presence - Specific demographic and payer mix considerations ### Rural Ohio - More limited buyer interest - Specialty regional consolidators - Distance and operational density considerations --- ## Valuation Ranges (Q2 2026) | Asset Type | EBITDA Size | Multiple Range | |---|---|---| | Personal care / PASSPORT (sub-$1M) | sub-$1M | 3x–4.5x | | Personal care / PASSPORT ($1M–$3M) | $1M–$3M | 4x–6x | | Personal care / PASSPORT ($3M+) | $3M+ | 5.5x–7.5x | | Medicare-certified home health | $1M+ | 7x–11x | | Hospice | $1M+ | 8x–12x | | Multi-license platform | $3M+ | 6.5x–9x | | MyCare Ohio integrated provider | $2M+ | 6x–8.5x | Premiums apply for: multi-MyCare Ohio MCO contracts, multi-metro footprint, multi-service mix, strong compliance history. --- ## Most Active Ohio Buyers ### National Strategics - **Help at Home** — Active in Ohio personal care - **Addus HomeCare** — Active in Ohio - **BrightSpring Health Services** — Multi-service platform - **Care Synergy / Pennant Group** — Home health, hospice - **Encompass Health** — Home health - **VITAS / Chemed** — Hospice - **Compassus** — Hospice and home health - **BAYADA** — Multi-service, strong Mid-Atlantic / Midwest ### PE-Backed Platforms - Multiple PE-backed Midwest-focused platforms - National PE platforms with Ohio footprints - Independent sponsors and family offices ### Regional Strategics - Hospital-affiliated home care entities - Multi-state Midwest consolidators - Ohio-specific consolidators --- ## Ohio-Specific Diligence ### ODH Survey History (Home Health / Hospice) - Survey deficiencies - Plans of correction - Civil monetary penalties - Re-survey timing ### PASSPORT Provider Certification - Certification status - AAA relationships - Service performance ### MyCare Ohio Contracts - Contract status across MCOs - Authorization-to-billing performance - Rate environment by MCO - Care coordinator relationships ### EVV Compliance - Ohio EVV vendor compliance - Visit verification rates ### Caregiver Workforce - Training compliance - Background check - Workforce stability - Shortage exposure ### Real Estate - Office locations - Lease assignability --- ## Common Ohio Seller Mistakes **1. PASSPORT-only positioning when MyCare Ohio is achievable.** MyCare Ohio contracting expands buyer universe. **2. Single-metro positioning.** Multi-metro Ohio operators benefit from broader buyer outreach. **3. Inadequate EVV compliance.** EVV deficiencies create payment exposure. **4. Underweighting hospital-affiliated competition.** Hospital-affiliated home care presence affects competitive positioning. **5. Not testing multi-state operator path.** For Cincinnati operators, KY/IN expansion may attract additional buyer interest. --- ## How Hendon Partners Helps Ohio Sellers Hendon Partners advises Ohio home care owners across PASSPORT personal care, MyCare Ohio integrated services, Medicare home health, and hospice through preparation and sale process. Our buyer network includes the strategic acquirers and PE platforms most active in the Ohio market. **[Schedule a confidential Ohio-focused conversation with Hendon Partners →](/contact-us)** --- *Hendon Partners is a sell-side only M&A advisory firm with Midwest home care transaction experience.* --- ## Frequently Asked Questions ### What licensure does an Ohio home care agency need? Ohio regulates Medicare-certified home health and hospice through the Ohio Department of Health (ODH). Personal care services for Medicaid recipients are typically delivered by Ohio Department of Aging (ODA) PASSPORT and MyCare Ohio providers, with provider certification through ODA and contracting through area agencies on aging or MyCare Ohio MCOs. Private-pay non-medical home care does not require state licensure but should be registered as a business. ### How active is the Ohio home care M&A market? Ohio is one of the most active Midwest home care M&A markets, with strong PE platform interest and concentrated activity across the three major metros (Cleveland, Columbus, Cincinnati). Strategic acquirers are active across personal care, home health, and hospice. ### What are typical valuations for Ohio home care agencies in 2026? Personal care / PASSPORT providers: 4x–6.5x adjusted EBITDA. Medicare-certified home health: 7x–11x adjusted EBITDA. Hospice: 8x–12x adjusted EBITDA. MyCare Ohio fully-integrated providers may command premium for managed care contracting depth. ### What is MyCare Ohio? MyCare Ohio is the state's managed care program for dual-eligible (Medicare and Medicaid) beneficiaries. Multiple MyCare Ohio MCOs (Aetna, Buckeye, CareSource, Molina, UnitedHealthcare) contract with home care providers for both LTSS and home health. MyCare Ohio contracting status is a primary diligence focus for buyers. ### Who are the most active buyers in Ohio? National strategics including Help at Home, Addus, BrightSpring, Care Synergy/Pennant, and Encompass are all active in Ohio. PE-backed platforms with Midwest concentration actively pursue Ohio tuck-ins. Regional Midwest strategics also compete.