Prepared with support from The Cleveland Foundation
For the full report, including more on the Governor’s budget, a complete set of recommendations, and much more information on the DD system in Ohio, click here.
Ohio’s system of services for individuals with developmental disabilities is facing transformational change. The state relies heavily on institutional care and sheltered workshops for individuals with developmental disabilities, which many advocates argue are isolating, restrictive, and don’t promote independence. The system will undergo profound change in the coming years, and additional measures are needed to strengthen its ability to adapt to change. This study explains the developmental disabilities system in Ohio, and analyzes these recent important changes, including the impact of new federal Medicaid rules and changes proposed in the governor’s budget. We outline a series of recommendations at the close of the report that will help the system to increase access to integrated, community-based services and fully realize the rights of individuals with developmental disabilities. Recommendations include:
An Overview of the Developmental Disabilities System in Ohio
ICFs and Developmental Centers
Residents, by size of Private ICF, 2014
The advocacy group Disability Rights Ohio recently called into question the state’s heavy reliance on ICFs, which many believe promote segregation, impede the rights of those with developmental disabilities, and may violate federal law. 2,500 individuals currently living in ICFs are on waiting lists to leave and receive services in the community. The state is currently working to convert ICF beds to Medicaid Waivers, which allow individuals to waive their right to institutional care in favor of receiving services in a home-or community-based setting. Relatedly, efforts are underway to decrease the size of large-bed facilities. To date, these efforts have been slow. And, because the state pays the nonfederal Medicaid match for ICFs, Boards may have a financial incentive to direct individuals into ICFs rather than onto Waivers, where county Boards are responsible for the nonfederal Medicaid match.
ICF and Developmental Center Location & Size
Estimated percentage of individuals with developmental disabilities receiving waivers, February 2015
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Click on the county for a pop-up with estimated percentage of individuals with developmental disabilities in ICFs, number of ICF residents & waivers per county by type
As of October, 2014, there were over 45,000 people on the waiver waiting list across the state. The median wait time is about 6.4 years. A 2014 study suggests that approximately 22,000 individuals on waiting lists had current unmet needs for services. The number of individuals on waiting lists varies significantly by county, but overall, DODD reports that the statewide list grows by 100 to 200 individuals each month. Several counties only remove individuals from the waiting list on an emergency basis or as other individuals with waivers no longer require these services, due to death or relocation.
Many factors contribute to long waiver waiting lists, including a lack of adequate local funds to make the match. However, data demonstrate that funding alone does not determine waiver accessibility. County Boards may elect to divert available funds to other programming. Given the many restrictions and requirements tied to waiver services, counties may be reluctant to expand their Waiver programs for fear of losing local control. The IO Waiver, the most frequently utilized waiver, has no monetary cap, and boards may be cautious to offer new waivers without knowing what their contribution will be in future years.
Day and Employment Services
Many advocates argue that sheltered workshops and adult day programs segregate individuals with developmental disabilities from the community, do not provide adequate employment training, and often pay less than a minimum wage. Others praise the benefits of sheltered work, maintaining that many individuals with developmental disabilities cannot fully adjust to community employment, and will face harassment or bullying, and that local communities are not ready and willing to accept integrated employment.
Ohio’s Employment First Initiative emphasizes the importance of integrated employment for all persons with developmental disabilities and consequently is working to design a funding system to shift resources to accommodate that vision. However, since its inception, Employment First has not led to significant change in the employment landscape throughout the state.
Employment and Day Services, 2012-2014
Annual Spending Per Person Served by County, 2012
CMS Rule Change
States will have as many as five years to come into full compliance on the new rule; Ohio is requesting 10 years for certain provisions, including those described above. Transition plans were submitted to CMS in mid-March, 2015.
The Governor’s Budget
Key Recommendations for System Change
As a result of our research, we recommend the following changes to improve the Ohio developmental disabilities system.
For more on the Governor’s budget, a complete set of recommendations, and much more information on the DD system in Ohio, read the full report.
To access a PDF of the executive summary, click here.
To view a webinar, recorded March 30, 2015, which provides an overview of the report's findings, click here.