OHIO
C+Ohio's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Call your County Board of Developmental Disabilities and ask, in writing as well as by phone, for a Waiting List Assessment. Ohio no longer orders its lists by the date you applied — the assessment is what decides whether you are recorded as having an Immediate Need, a Current Need, or neither. You can ask for a new assessment any time circumstances change.
Last verified 2026-07-03
HOW WE GRADE OHIO
Full methodology (v2.1) →Ohio's strongest area is waitlist burden; what pulls the grade down most is hcbs spending per capita.
Waitlist Burden
30% of grade93/10016 people waiting per 100,000 residents
Nobody waiting scores 100. 225 per 100,000 scores 0.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade50/100$436 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade61/10061 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade65/10065 out of 100 on program breadth
Scored directly on its own 0–100 scale.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so Ohio's grade moves when Ohio moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN OHIO
Use these exact words when you search, call, or fill out forms — they're what Ohio's own offices use.
- Medicaid here is
- Ohio Medicaid
- The DD agency is
- Department of Developmental Disabilities (DODD)
- You contact
- County Board of Developmental Disabilities
- The plan is
- Individual Service Plan (ISP)
- Self-direction is
- Self-Directed / Participant-Directed servicescontrolling your own budget and hiring your own people
- A denial arrives as a
- Notice of Action / Prior Noticethe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In Ohio, you contact County Board of Developmental Disabilities.
- 2
Health coverage — Ohio Medicaid
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Self-Directed / Participant-Directed services. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Disability Rights Ohio.
Disability Rights Ohio · 1-800-282-9181
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for Ohio; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Yes — 'budget authority' is defined in Ohio rule: you set the dollar amount for each self-directed service and can negotiate what you pay
Can a family member be paid to provide care?
Yes — Ohio's self-directed waivers allow family caregivers to be paid
Who is legally the employer of the people you hire?
Your choice — 'employer authority' is separate from budget authority and is optional unless you hire an independent provider
How freely can money move between services?
Not verified yet — ask, don't assume the answer is no.
Can the budget buy things, not just staff time?
Yes on two of the three waivers — Participant-Directed Goods and Services (PDGS) is a named service on the Level One and SELF waivers, NOT on Individual Options, so ask which waiver you are on before counting on it. It buys services, equipment or supplies not covered by another waiver service, Medicaid state plan, Healthchek/EPSDT or IDEA, and the seller does NOT have to be a Medicaid-certified provider. The item must be tied in your Individual Service Plan to a need found in your assessment and must do one of: reduce your need for other Medicaid services, increase community participation, increase safety at home, increase independence, improve cognitive/social/behavioural function, or build personal, social or physical skills. Rates and dollar limits are in the rule's appendix and purchases run through the financial management services entity.
Is your case manager independent of your providers?
Partial, and this is the live structural question in Ohio. Your case manager is a Service and Support Administrator employed by your county board of developmental disabilities — the same county board that determines your eligibility, and that has historically also been a direct provider of the services it coordinates. CMS accepted a DODD compliance plan to unwind that, under which county boards are not permitted to provide HCBS to new enrollees. The compliance timetable was set years ago and the source describing it is dated, so ask your county board directly whether it still provides any service you receive, and whether you may choose a different provider for it.
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN OHIO
- DD/HCBS Medicaid-covered service (county DD board) or FFS: request ODJFS state hearing within 90 days of the notice
- Continuation: request state hearing within the 15-calendar-day prior notice period
- Managed care: file MCP/MCOP internal appeal within 60 days of the notice
- After MCP/MCOP appeal resolution: request state hearing within 90 days of the resolution mail date
- Administrative appeal / judicial review: file within 30 days of the decision
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
Individual Options (IO) Waiver
SourceAdults with developmental disabilities who need comprehensive home and community-based services.
Waitlist: Managed by County Boards of DD; waitlist varies by county.
Level One Waiver
SourceIndividuals with developmental disabilities needing a lower level of support services.
Waitlist: Verify with your County Board of DD.
SELF (Self-Empowered Life Funding) Waiver
SourceIndividuals with developmental disabilities who want to self-direct their services and budget.
Waitlist: Administered through County Boards of DD.
Ohio Home Care Waiver
SourceIndividuals under 60 with physical disabilities or complex medical needs.
Waitlist: Verify with ODM (Ohio Department of Medicaid).
PASSPORT Waiver
SourceSeniors 60+ needing in-home long-term care.
Waitlist: Apply through Area Agencies on Aging.
Full milestone guide
View the Ohio Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
