Medicaid is a program of the federal 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 (CMS). The Perry County Board of Developmental Disabilities has local Medicaid administrative responsibilities to assist individuals with developmental disabilities.
The Perry County Board of Developmental Disabilities provides and authorizes services to many individuals who are Medicaid eligible because of limited income and assets due to their disability. Service and Support Administrators (SSA) assist individuals and families with the application process to become Medicaid eligible.
People who are Medicaid eligible 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.
An alternative to the ICF/IID program is the Medicaid Waiver program. Based on need, some people have the Individual Options Waiver (IO), some have the Level 1 Waiver and some have the Self-Empowered Life Funding (SELF) Waiver. There are a limited number of waivers that are available so a waiver waiting list with an assessment process has been established. Generally, federal funds represent about 60% of waiver costs and “match” funds represent approximately 40%. Each Waiver contains a different service package that can be explained by the SSA Department or located on the Ohio Department of Developmental Disabilities website.
Those who are supported with the IO waiver are assigned a funding range based upon their needs. This funding range is determined by a state designed assessment called the Ohio Developmental Disabilities Profile (ODDP). Once the ODDP is completed and the funding range established, an Individual Service Plan (ISP) is developed with the individual, his or her guardian or other representatives and the SSA. This plan, once approved, is then implemented and services are provided. Funds to pay for the services are authorized and paid to providers consistent with the plan and funding range. On rare occasions, individuals may request services that would exceed the funding range. This must go through a special review process called “prior authorization”.
The Level 1 Waiver is also an option for some individuals. This waiver does not include the assessment with the Ohio Developmental Disabilities Profile (ODDP) because it has a funding maximum or cap for most residential services which is fixed. Other support, such as emergency services and adaptive equipment can exceed this funding cap in certain circumstances. Funds to pay for the services are authorized and paid to providers consistent with the individual service plan. This waiver is ideal for someone who has additional supports in their life and needs minimal assistance from the waiver.
The Self Empowered Life Funding (SELF) Waiver is also administered by the Ohio Department of Developmental Disabilities, with support from County Boards of Developmental Disabilities. This waiver has different services and funding that can be explained by the SSA Department at 740-342-0416.
When a person has a Medicaid Waiver, he or she is also eligible to receive a Medicaid card. When one has a Medicaid card, he or she is eligible for Medicaid coverage for certain medical expenses, such as doctor’s visits, hospital services and medications.
Recognizing that Medicaid policy or rules may change, Medicaid questions should be directed to the Service and Support Administration Department at 740-342-0416 for the most up to date information.
County boards are required to add two links on their websites in order to achieve compliance with 5123-4-01 (T) – Administration and operation of a county board of DD (Residential Resources).
The revised OAC 5123-4-01 rule, is expected to take effect on October 1, 2021, and requires that county boards post the following specific links regarding ICF services available to people and families served by county boards:
The new requirement stems from the Ball v. DeWine lawsuit that has been making its way through the federal court system since 2016. In short, the guardian-intervenors in the case, who were permitted to enter the proceedings after the lawsuit was filed by Disability Rights Ohio, believe that the State of Ohio and county boards of DD have not been doing enough to make families aware of ICF service options available to them.
DODD Online ICF Search Tool: https://dodd.ohio.gov/wps/portal/gov/dodd/your-family/community-living/icf_search_map
DODD Electronic ICF Informational Booklet: https://dodd.ohio.gov/wps/portal/gov/dodd/forms-and-rules/forms/pamphlet-options-counseling