Medicaid & Medicaid Waivers
Helping you understand Medicaid and Medicaid Waivers
Medicaid is a joint program of federal and state government that provides support for certain individuals who meet Medicaid eligibility requirements. The Medicaid program is administered at the federal level by the Center for Medicare and Medicaid Services. It is administered at the state level by the Ohio Department of Medicaid and at the county level by the Allen County Department of Jobs and Family Services. The Allen County Board of Developmental Disabilities has local Medicaid authority for administration of Developmental Disability waivers.
People who have Medicaid might live in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), which is funded with federal Medicaid dollars and matched with state dollars. Generally, federal funds represent about 60% of costs and “matched” funds represent approximately 40%.
An alternative to the ICF/IID program is the Medicaid waiver program. Ohio offers three waivers that are administered by county boards of developmental disabilities: the Individual Options (IO) waiver, the Level One waiver, and the Self-Empowered Life Funding (SELF) waiver. Enrollment on each waiver is based on the individual’s need, which is determined through an assessment. There is a limited number of waiver slots available, so a waiting list process has been established. Federal funds provide about 60% of the cost of waivers, with the remaining 40% coming from state or local funds.
Individuals who are supported with the IO waiver are assigned a funding range based on their needs. This funding range is determined by a state-designed assessment called the Ohio Developmental Disabilities Profile (ODDP), and it will cover costs for residential services. There are separate budgets for day services and non-medical transportation (to and from a day program or community job).
The Level One waiver does not include the assessment with the ODDP, because it has a funding maximum of $5,325 per year for most residential services. Additional funding is available for other supports, such as emergency services and adaptive equipment, in certain circumstances. There are separate budgets for day services and non-medical transportation.
The SELF waiver has a funding maximum of $25,000 per year for children and $40,000 per year for adults. There are no separate budgets under the SELF, so all services must fit within these limits.
Waivers offer a variety of services, including help at home, day services, and transportation. Our Service & Support Associates (SSAs) work with individuals, their guardians, and other team members to develop an Individual Support Plan (ISP) for every person we serve. The ISP identifies needed services, providers of the services, and funding for the services. Services must be provided and paid for in accordance with an approved ISP.
Individuals with a Medicaid waiver will also receive state plan services (also known as a Medicaid card), which provide coverage for certain medical expenses, such as doctor visits, hospital services, and medications. They also have the option of receiving their state plan services through a managed care plan.
Medicaid policy and rules are subject to change. If you have questions, you should ask your SSA for the most up-to-date information. Your SSA can also assist you with applying for Medicaid and accessing Medicaid services. If you do not receive services from us and you have questions, please call us at 419-221-1385 and ask to speak with an Intake Support Services Coordinator.