Ohio DD waivers explained: IO, Level One, and SELF

Almost every family we meet arrives with the same question, phrased a hundred different ways: how do we pay for the help we need? In Ohio, the answer usually involves a Medicaid waiver. and the waiver system is genuinely confusing until someone lays it out in order.

So here it is in order.

First: what a waiver actually is

A waiver is one way to pay for services that support someone with a developmental disability living in the community: on their own, with family, with a roommate, or with a provider. It uses Medicaid funds to cover support delivered at home and out in the community, rather than in a facility.

The Ohio Department of Developmental Disabilities (DODD) administers three of them:

• the Individual Options Waiver, usually called the IO Waiver
• the Level One Waiver
• the Self-Empowered Life Funding Waiver, usually called the SELF Waiver

The step almost everyone skips: county board eligibility comes first

You don't apply for a waiver first. In Ohio, services, supports, and eligibility determinations are managed at the county level by your local county board of developmental disabilities. Every county has one. In our area, that's the Cuyahoga County Board of Developmental Disabilities.

To be eligible for county board services, a person has to meet both of these:

1. A developmental disability that appears before age 22 and is likely to continue throughout the person's life.
2. Substantial functional limitations, determined through an assessment the county board conducts.

Two details that trip families up

"Appears before age 22" does not mean "diagnosed before age 22." DODD is explicit that a formal diagnosis before 22 isn't required. A doctor or other qualified professional can look at history and records and determine that the disability was present. If the diagnosis came later, the county board may ask for documentation from the health care provider.

The functional limitations don't have to have started early. They can show up at any point in a person's life. What matters is that they're clearly connected to the developmental disability rather than to a separate medical condition. The assessment looks at major life areas: self-care, mobility, learning, and others.

The assessment tool depends on age: the COEDI for children ages 6-15, and the OEDI for people 16 and older.

Next: your Service and Support Administrator

If the county board determines the person is eligible, it assigns a Service and Support Administrator (SSA). This is the person who becomes your main contact inside the system, and their role is bigger than the title suggests. An SSA:

• works to understand the person's needs
• develops the plan, called the Ohio Individual Service Plan, or OhioISP
• coordinates the support around that plan
• can help you choose the providers who will actually deliver the services

If a waiver is needed to pay for services in the plan, your county board can help you apply for one. That's the correct order: eligibility → SSA → plan → waiver → provider.

The three waivers, and who each one fits

Individual Options (IO) Waiver

The most comprehensive of the three. DODD describes it as a good fit for people who may need a lot of help in their home, and for people who need many different kinds of services. Services are built into each person's service plan based on the needs identified in their assessment, and each person enrolled is assigned an individual funding level based on an assessment of their needs and the services in their plan.

Waiver spans, the start and end dates listed in the plan, are usually 12 months long.

Level One Waiver

A good fit for people who don't need a lot of paid staff. DODD's own description is worth quoting almost directly: usually, people using a Level One Waiver only need help with a few things, or they have people they know who can help with some of what they need: cooking meals, taking showers, driving places.

SELF (Self-Empowered Life Funding) Waiver

Built for people who want more direct control over their own services. With SELF, a person can take a hand in hiring and directing the people who provide their support, and in managing the budget for the services they choose. It trades some convenience for a lot more say.

Choosing a provider is your decision

Once there's a plan and a way to pay for it, someone has to actually do the work, and which agency or independent provider does it is your family's choice. Your SSA can help you compare options, but they're not assigning you one.

Two things worth doing before you pick:

• Ask for certification information and verify it. Providers of homemaker/personal care in Ohio have to be certified by DODD and hold a Medicaid provider agreement. Any provider worth hiring will hand that over without hesitating.
• Ask about consistency of staff. Who will actually be in the home, how often the person changes, and what happens when someone calls off. This matters more day-to-day than almost anything on a brochure.

And if the match doesn't work out, you can change providers. That conversation goes through your SSA, who can update the plan so services continue without a gap.

Where Sam Adult Care fits in all of this

We want to be clear about this, because some providers aren't: we don't administer waivers and we don't determine eligibility. That's your county board's role, and no provider can shortcut it.

What we are is a DODD-certified provider, including certification for Homemaker/Personal Care (HPC), one of the agencies you can choose to deliver the support once your plan exists. We were founded by a family that has lived this process from the inside, which is why we'll happily spend time on the phone helping you understand a step even if you never become our client.

If you're somewhere in this process and stuck, call us at 216-759-1032. We'll tell you what we know and point you to the right office for the rest.

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