Ohio’s home-modification rule for nursing facility-based level-of-care home and community-based services allows adaptations such as grab bars and bathroom changes when the person’s services plan authorizes them to meet an assessed need.[1] Before committing to work, ask your case manager which rules apply to your program, what scope can be approved, and which provider can perform it. A bathroom estimate is not a funding decision.
This guide explains questions to ask using Ohio Administrative Code Rule 5160-44-13, effective April 17, 2026.[1] It is not an eligibility determination or a complete guide to every Ohio waiver. Do not apply this rule’s dollar limit to another program without confirmation from that program.
Start with the program name and the bathroom problem
If you already have a case manager, ask: “Which waiver or program am I enrolled in, and does Rule 5160-44-13 govern my home-modification request?” If you do not know who handles your services, ask the member-services contact on your coverage documents where to direct the question.
Describe what is difficult before choosing a product. You might write down that entering the tub is the problem, that the doorway limits access, or that a caregiver needs room to assist. These are prompts for your own notes, not a diagnosis or a recommendation for a particular installation.
Under the rule, an adaptation must protect the person’s health, welfare, or safety, or help the person function more independently at home, and it must be authorized in the person-centered services plan.[1] That makes the person’s needs the starting point for the request.
Ask:
- What information do you need about the person and the room?
- Does the services plan need to change before you consider the work?
- Is an in-home evaluation required, and who arranges it?
- Who makes the final authorization decision?
The rule permits the administering agency or its designee to require an evaluation by an occupational therapist, physical therapist, or another appropriately qualified professional.[1] That evaluation considers the person’s ability to use the modification and whether the surrounding space is suitable.[1] A contractor’s estimate should not be treated as a substitute for a required evaluation.
Ask what work is covered, not just how much is available
Rule 5160-44-13 lists ramps, grab bars, doorway widening, and bathroom or kitchen modifications among possible adaptations.[1] It excludes general home improvements that do not directly provide medical or remedial benefit to the individual.[1]
For a bathroom, ask the reviewer to distinguish the work needed for access from the finishes or other changes you would like to add. Do not assume approval for an accessibility change includes a complete remodel.
The rule sets a limit of $15,000 per individual per calendar year and directs the agency or its designee to approve the lowest-cost alternative that meets the assessed need.[1] That limit is a ceiling under this rule, not a promise that your project will receive $15,000.
Before using that figure to plan a job, ask:
- Does this limit apply to my specific program and request?
- How much, if any, has already been used this calendar year?
- Which parts of the proposed bathroom work meet the assessed need?
- If I want additional work, can it be handled separately without affecting approval?
Get the answer to the last question before combining covered work and personal preferences in one contract.
Confirm the provider before treating an estimate as a waiver bid
Ask your case manager which providers are eligible to bid and what participation requirements apply. Then ask the contractor whether they can meet those requirements for your particular program. Do not infer waiver participation from a company’s bathroom services or general insurance claims.
For work under this rule, the provider submits a fixed-cost proposal that includes materials and labor costs, required building permits, an estimated completion time, warranty terms, and a drawing or diagram when appropriate.[1] The agency or its designee reviews proposals with the individual and awards the work to the provider offering the lowest-cost alternative that meets the assessed need.[1]
Keep these questions beside the estimate:
- Does the proposal match the approved referral and scope?
- Has the program accepted this provider for the work?
- What written authorization must be in place before I sign or pay anything?
- Who confirms that construction can begin?
- How will you handle an unexpected condition that changes the scope?
The rule permits a proposal adjustment for good cause only when the specifications change in writing and the agency or its designee approves the adjustment.[1] Ask how that approval will happen before agreeing to extra work.
Settle property permission and closeout requirements early
The provider must retain the property owner’s written consent to the modification, including acknowledgment that the waiver is not responsible for returning the property to its previous condition.[1] If you rent, bring the landlord-permission question to the case manager before planning construction.
The rule also requires legally necessary permits before work and documentation of required inspections before billing, along with final written approval from the individual and the agency or its designee after completion.[1]
Ask who will obtain the permits, arrange inspections, and collect the final approvals. Request a clear explanation of what you will receive when the work is complete. This article does not determine which permits your particular address or project requires.
Prepare for the bathroom conversation in Central Ohio
Bring the program’s written instructions, any assessment or referral, and your questions about the room to the estimate visit. Keep funding approval and construction planning separate until the program has confirmed how they fit together.
For a bathroom in Columbus or Central Ohio, NextStep’s bathroom safety and accessibility services include grab-bar installation and tub-to-shower conversions.[6] If your question is about Medicare rather than this waiver process, use the separate guide to Medicare and bathroom modifications.[7]
This article does not establish NextStep’s enrollment or approval as a Medicaid waiver provider. Confirm that separately with the program and Paul before treating any estimate as a waiver proposal. Do not assume work paid for privately will later be reimbursed.
Bring any written program requirements you already have.
Discuss the bathroom with Paul
For installation questions, schedule a free in-home estimate with Paul.[8] Confirm provider participation with the program and Paul before treating an estimate as a waiver proposal.
Sources
- [1] Ohio Administrative Code Rule 5160-44-13. Accessed September 14, 2026.
- [6] NextStep bathroom safety and accessibility services. Accessed September 14, 2026.
- [7] NextStep guide to Medicare and bathroom modifications. Accessed September 14, 2026.
- [8] Contact NextStep Bath Solutions. Accessed September 14, 2026.