To help members navigate recent changes in Ohio Medicaid policy, LeadingAge Ohio developed a Private Room Payment Toolkit offering clear, actionable guidance on reimbursement for private room accommodations.
As of December 18, 2024, Ohio Medicaid-certified nursing facilities that have applied and been approved by the Ohio Department of Medicaid (ODM) may be reimbursed for private rooms under specific circumstances, such as medical necessity or infection control. However, this opportunity includes documentation and compliance requirements outlined in the Ohio Administrative and Revised Codes:
(5) Beginning July 1, 2025, to retain eligibility for private room rates, a nursing facility must do both of the following:
(a) Have a policy in place to prioritize placement in a private room based on the medical and psychosocial needs of the resident;
(b) Participate in the resident or family satisfaction survey performed pursuant to section 173.47 of the Revised Code.
Recognizing the need for practical support, LeadingAge Ohio created this sample policy to help providers properly document and justify room assignments, and submit Medicaid claims in alignment with state requirements.
Download the private room sample policy.