Ohio Medicaid Waiver Guide

Ohio's system is built around its counties. The Ohio Department of Developmental Disabilities (DODD) oversees services statewide, but the front door is your local County Board of Developmental Disabilities — one of 88, each funded partly by local property-tax levies. Your county board determines eligibility, assigns a Service and Support Administrator (SSA) to coordinate your services, and connects you to one of DODD's three Medicaid waivers: the Individual Options (IO) Waiver, the Level One Waiver, and the Self-Empowered Life Funding (SELF) Waiver. Because county boards have local levy dollars, many Ohioans also receive supports outside the Medicaid waivers — a feature that sets Ohio apart from most states.

To get services, a person must be found eligible for developmental disability services by their county board. A developmental disability is a severe, chronic disability that began before age 22, is expected to continue indefinitely, and causes substantial functional limitations in three or more major life areas (for children under 3, a delay or established risk can qualify). Eligibility for DODD services is separate from getting a waiver — to fund waiver services, a person must also have Medicaid and meet an ICF/IID level of care, and a waiver slot must be available based on assessed need.

Ohio redesigned its waiting list so it is based on need, not how long you've waited. County boards use the Ohio Assessment for Immediate Need and Current Need — the Waiting List Assessment — to identify what services a person needs now or within the next 12 months. People with an immediate need are prioritized for a waiver, while those without a current need stay connected to their county board and may receive local levy-funded supports in the meantime.

Type

Needs-based (Waiting List Assessment)

Typical timeline

If you have an immediate need — a situation risking substantial harm if not addressed within 30 days — the county board must act quickly. Without a current need, you remain assessed over time while local supports are available.

How to check status

Contact your county board's Service and Support Administrator (SSA) to review your Waiting List Assessment and current need status.

1. Contact your county board of DD

   Your local County Board of Developmental Disabilities is the front door. Find yours through the DODD county board locator.

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2. Establish DODD eligibility

   The county board reviews diagnosis, evaluations, and functional assessments to confirm a developmental disability.

3. Complete the Waiting List Assessment

   Your SSA completes the Ohio Assessment for Immediate Need and Current Need to determine whether you need waiver services now or soon.

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4. Apply for Medicaid and a waiver

   When a waiver is appropriate, apply for Medicaid and request Home and Community-Based Services (ODJFS form 02399) through your county board.

5. Build an ISP and choose how services are delivered

   Your SSA helps develop an Individual Service Plan (ISP) and choose providers — or the SELF Waiver to direct your own services.

• The person's age, diagnosis, and county of residence.
• Medicaid status or whether you still need to apply.
• Current supports, urgent needs, and living situation.
• School, medical, evaluation, or eligibility documents.
• Questions about waitlists, timelines, and next steps.

Exact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.

Ohio's SELF Waiver is the state's participant-directed waiver, letting people choose and manage their own services and staff within an annual budget cap. The IO and Level One waivers also offer participant-directed options. Effective January 1, 2026, the Support Broker service — someone who coaches and mentors you through directing your own services — was extended to the IO and Level One waivers as well, having previously been available under SELF. Support brokerage is paid up to $8,000 per twelve-month waiver eligibility span. Ask your SSA for the current SELF annual cap, which is set in Ohio's approved waiver rather than in rule and does change.

1. Early Intervention / Help Me Grow (birth–3)

   Ohio's Early Intervention program, part of Help Me Grow, serves infants and toddlers with developmental delays or disabilities.

2. School age (3–21)

   Public schools provide special education through an IEP. Connect with your county board early so services are ready when needed.

3. Transition to adulthood (14–22)

   IEP transition planning and Opportunities for Ohioans with Disabilities (OOD, vocational rehabilitation) prepare students for employment and adult life.

4. Adult services

   Your county board SSA coordinates adult supports — residential, adult day, employment, and behavioral services — through DODD's waivers.

5. Decision-making at 18

   Families weigh guardianship, powers of attorney, and supported decision-making as the person reaches adulthood.

If a waiver service is denied, reduced, or ended, you can request a Medicaid state hearing — generally within 90 days of the notice, or within 15 days if you want the service to continue while your appeal is decided. Disability Rights Ohio can help you understand and exercise these rights.

DODD

The Ohio Department of Developmental Disabilities, the state agency that oversees county boards and the IO, Level One, and SELF waivers.

County Board of DD

One of Ohio's 88 local boards of developmental disabilities that determine eligibility, coordinate services, and are funded partly by local property-tax levies.

SSA

Service and Support Administrator — the county board case manager who helps plan and coordinate a person's services.

Individual Options (IO) Waiver

DODD's most comprehensive waiver, with no annual cost cap; it can include residential supports.

Level One Waiver

A capped DODD waiver built around family and natural supports.

SELF Waiver

Self-Empowered Life Funding — Ohio's participant-directed waiver, which carries an annual cost cap.

ISP

Individual Service Plan — the person-centered plan that lists a person's goals and the services to meet them.

Waiting List Assessment

The Ohio Assessment for Immediate Need and Current Need, used to decide who needs waiver services now or soon.

Immediate need

A situation that risks substantial harm to the person or a caregiver if action isn't taken within 30 days.

Local levy funding

Property-tax dollars approved by county voters that help fund county board services, including some supports beyond Medicaid waivers.