Medicaid and Waivers

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its program. Qualifying for Medicaid is dependent on the parent/guardian’s income. If your child receives Supplemental Security Income (SSI, also income-based) or the Waiver (eligibility is based upon the person’s support needs and is determined by your local CBDD), they will also receive Medicaid benefits. In 2019, Ohio took steps to expand Medicaid coverage to include behavioral health services for children with Autism, providing them with access to crucial therapies and treatments. Even if your child does not receive SSI, you may still qualify for one of the other Medicaid programs in Ohio.

In addition, adults with Autism may be eligible for Medicaid Buy-In. The Medicaid Buy-In program allows individuals with disabilities who are employed, earning income, and may not otherwise qualify for Medicaid due to their earnings, to “buy in” to Medicaid coverage by paying a premium. This program enables individuals with disabilities, including adults with Autism, to retain their Medicaid coverage while they are working or earning an income that would typically disqualify them from standard Medicaid coverage. The Buy-In program helps bridge the gap between employment and healthcare coverage for individuals with disabilities who might need Medicaid benefits to supplement their private insurance or cover services their private insurance might not fully address.

What are Medicaid Waivers?

In the 1950s and 1960s, if a child received an Autism diagnosis, parents were instructed to institutionalize their child. Medicaid paid money directly to the institution to tend to every child there. In the late 1960s, parents questioned and often refused this treatment, saying they wanted their children at home because it was better for the child, better for the family, better for the community, and it was cheaper. The federal government allowed states to waive the requirement that an individual live in an institution to receive access to these Medicaid funds. Waivers provide money for individuals with developmental disabilities to live in the community with services and support and to learn skills that will allow them to live more independently.

How are Waivers Funded?

Funding for waiver programs in Ohio comes from a combination of federal, state, and local sources. The federal and state governments provide Medicaid dollars, but in order to access these funds, local County Boards of Developmental Disabilities (CBDDs) must contribute a local match. This local match is primarily funded through voter-approved property tax levies, which are unique to each county. As a result, the availability and scope of services can vary significantly from one county to another, depending on the strength of local levy support. In fact, Ohio is notable for relying more heavily on local funding for developmental disability services than many other states.

Each waiver is administered by the Ohio Department of Developmental Disabilities (DODD) and coordinated locally by County Boards of Developmental Disabilities. Eligibility and service planning are determined through assessments and the development of an Ohio Individualized Service Plan (Ohio ISP).

The distribution of waivers is determined by need; family income is not considered for waiver eligibility.

Receiving a Medicaid waiver for in-home support does not guarantee 24-hour supervision, except in emergencies like the illness or death of a caregiver. Waivers are not a mandated, governmental program—eligibility depends on assessed need and available funding. Diagnosis of a disability does not automatically equal services. Modifications to Ohio’s Waiver Waiting List introduced a statewide assessment tool to better identify and prioritize individuals’ current and immediate needs, helping to coordinate services more effectively across the state.

Ohio offers several waivers through the Ohio Department of Developmental Disabilities (DODD), including:

Individual Options (IO) Waiver

  • Best for: Individuals with intensive or complex needs.
  • Services include: Residential support, nursing, transportation, day programs, employment services, and more.
  • Flexibility: Offers the broadest range of services and highest funding cap among Ohio’s waivers.
  • Ideal for: People who need 24/7 support or highly individualized care.

Level One Waiver

  • Best for: Individuals with mild to moderate needs.
  • Services include: Limited personal care, homemaker services, respite, and adult day support.
  • Funding cap: Lower than the IO waiver, with annual limits on services.
  • Ideal for: People living with family or independently who need occasional support.

Self-Empowered Life Funding (SELF) Waiver

  • Best for: Individuals who want to direct their own services.
  • Services include: Participant-directed goods and services, community inclusion, and self-directed transportation.
  • Flexibility: Allows individuals to hire and manage their own providers.
  • Ideal for: People who value autonomy and choice in how their services are delivered.

Adults choosing participant direction may direct their services, or they can choose their representative, including a friend, family member, or legal guardian.