I/DD Waivers in Ohio

All states: Medicaid disability services map

Ohio I/DD services at a glance

Last verified against state sources: 2026-10-28.

Who runs I/DD services in Ohio?

The Ohio Department of Developmental Disabilities (DODD) runs Ohio's three I/DD waivers under an agreement with the Ohio Department of Medicaid (ODM), the state Medicaid agency. Locally, each county has a county board of developmental disabilities (county board) that is the front door for services and provides case management. DODD says more than 40,000 Ohioans with developmental disabilities are enrolled in a waiver.

• Ohio Department of Medicaid (ODM): the administering Medicaid agency. ODM gives final approval to waiver rates and holds the Medicaid provider agreements that waiver providers sign.
• Ohio Department of Developmental Disabilities (DODD): operates the Individual Options, Level One and SELF waivers, certifies providers, licenses residential facilities and pays waiver claims as a limited fiscal agent for ODM.
• County boards of developmental disabilities: take requests for waiting list assessments and waivers, manage the local waiting list and, starting July 1, 2026, employ the interRAI assessors who complete needs assessments.
• Case management: service and support administrators (SSAs), who work for or under contract with a county board, write the individual service plan, prepare cost projections and monitor services.

What Medicaid waivers and programs serve people with I/DD in Ohio?

Ohio has three 1915(c) waivers for people with developmental disabilities, all run by DODD: Individual Options (IO), Level One and Self-Empowered Life Funding (SELF). A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. All three serve people of any age who meet the developmental disabilities level of care and are eligible for Medicaid.

• Individual Options (IO) Waiver (1915(c), control number OH.0231): the comprehensive waiver, for people who need more paid support. Services include homemaker/personal care (HPC, billed in 15-minute or daily units), participant-directed HPC, shared living, adult day support, vocational habilitation, career planning, individual and group employment support, community and residential respite, remote supports, waiver nursing and nursing delegation, support brokerage, transportation, and assistive technology, environmental and vehicle modifications. Each person gets a funding range set by the Ohio Developmental Disabilities Profile and the county's cost-of-doing-business category. Plans above the range need prior authorization.
• Level One Waiver (1915(c)): for people who rely mainly on unpaid natural supports, such as family, and need a limited amount of paid help. Services include HPC, participant-directed HPC, adult day support, vocational habilitation, career planning, employment supports, informal, community and residential respite, clinical/therapeutic intervention, functional behavioral assessment, participant-directed goods and services, participant/family stability assistance, support brokerage, remote supports and transportation. Services are capped at $62,136 per waiver eligibility span for an adult and $41,424 for a child under rule 5123-9-06. We did not confirm the Level One control number from a state source.
• Self-Empowered Life Funding (SELF) Waiver (1915(c), control number OH.0877): for children and adults who agree to direct their own services. It covers participant-directed HPC, respite, participant-directed goods and services, participant/family stability assistance, support brokerage, day and employment services, clinical/therapeutic intervention, remote supports, environmental accessibility adaptations and vehicle modification. It uses the same yearly cost limits as Level One ($41,424 for children, $62,136 for adults). A state-contracted financial management services entity handles payments.

Other Ohio waivers, such as Ohio Home Care and PASSPORT, are run by ODM or the aging network and are not counted here as I/DD waivers. Ohio also has Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), the institutional option that the waivers are an alternative to; DODD licenses them as residential facilities.

Does Ohio pay for I/DD services through managed care?

No. Ohio's three I/DD waivers are paid fee-for-service. DODD pays provider claims as a limited fiscal agent for ODM, and rates are set in the service rules in Ohio Administrative Code Chapter 5123-9.

• Who pays claims: providers submit IO, Level One and SELF claims to DODD through its eMBS billing system, according to ODM's EVV resource guide.
• Who coordinates services: the county board's service and support administrator (SSA), not a health plan, builds the service plan and monitors services.

Is there a waiting list for I/DD services in Ohio?

Yes. Waiver slots are limited, and county boards keep a waiting list in a DODD web-based system. We did not find a current statewide count of people waiting from a state source. People with an immediate need are served first, and others are ordered by how many current-need criteria they meet and how long they have been waiting.

• Waiting List Assessment: a person can ask their county board for an assessment at any time. Under DODD's waiting list rules, the county board must schedule the interview within 15 days of the request and decide waiting list status within 45 days.
• Priority order: rule 5123-9-04 (effective July 1, 2025) puts immediate need first, then people who have met more than one current-need criterion for 12 months or more, then people with fewer criteria. The earliest status date breaks ties.
• Count: the state's own reports may include a figure, but we could not read one. For a person's place on the list, ask the county board.

How do people apply for I/DD services in Ohio, and how are budgets set?

People apply through the county board of developmental disabilities in the county where they live. They need Medicaid financial eligibility, decided by the County Department of Job and Family Services, and a developmental disabilities level of care. IO budgets come from funding ranges tied to the Ohio Developmental Disabilities Profile, while Level One and SELF have fixed yearly caps.

• Level of care: under rule 5123-8-01, the person must have a severe, chronic disability that began before age 22 and is not caused only by mental illness.
• Waiting list status: set with the Waiting List Assessment Tool, described above.
• IO funding ranges: assigned from the person's Ohio Developmental Disabilities Profile score and the county's cost-of-doing-business category. Plans above the range need prior authorization.
• Level One and SELF caps: $62,136 per year for an adult and $41,424 for a child.
• interRAI assessments: starting July 1, 2026, people on DODD waivers get an interRAI assessment every three years or after a significant change. Adults 18 and older get the interRAI ID, and children 17 and under get the interRAI Child and Youth Mental Health and Developmental Disability assessment. County board interRAI assessors complete them under rule 5123-9-06.

What day and residential services can I/DD providers offer in Ohio?

All three waivers cover adult day support, vocational habilitation and employment services, delivered by providers certified by DODD with an ODM Medicaid provider agreement. Most day services bill in 15-minute units, or a daily unit when 5 to 7 hours are delivered in one day. For housing, Ohio uses supported living (HPC in the person's own home), shared living and DODD-licensed residential facilities.

Day and employment services

• Adult Day Support: regularly scheduled activities that build self-help, social and adaptive skills for adults who have finished school. Agency providers are certified by DODD under rule 5123-2-08 and may subcontract with adult day centers certified by the Ohio Department of Aging. Staffing is set by each person's needs and shown in billing codes by staff and group size; the small group option is one direct support professional to no more than four people in an integrated community setting. Billed in 15-minute units, or a daily unit when 5 to 7 hours are delivered in person, under rule 5123-9-17. A provider cannot bill both unit types for the same person on the same day.
• Vocational Habilitation: learning and work experiences, including volunteer work, that build skills leading to competitive integrated employment. Billed in 15-minute or daily units. The research did not find a published ratio.
• Group Employment Support: services and training in regular business, industry and community settings for groups of two or more workers with disabilities. Billed in 15-minute or daily units. The research did not find a published ratio.
• Individual Employment Support and Career Planning: individual help to find and keep a community job, plus career planning, from agency or independent providers. Billed in 15-minute units, and rates include an Employment Quality Program outcome payment for eligible providers. The research did not find a published ratio.

Residential services

• Homemaker/Personal Care in supported living (IO and Level One): hands-on care and support in the person's own home or with roommates, from agency or independent providers certified by DODD. Supported living homes are not licensed as residential facilities. IO also has a daily billing unit version of HPC.
• Shared Living (IO): care and support for an adult when 20 percent or more of it comes from adult caregivers who live in the same home. Paid as a daily unit adjusted by county cost-of-doing-business category. Providers are certified by DODD; county boards may not provide it.
• Licensed residential facilities and ICF/IID: group homes and other facilities where people with developmental disabilities live, other than family homes and supported living, are licensed by the Director of DODD under Ohio Revised Code 5123.19. DODD's Office of Compliance reviews licensed settings and ICFs.

How are I/DD provider rates set and how do agencies enroll in Ohio?

DODD develops statewide fee schedules, ODM gives final approval, and the rates are written into the service rules in Ohio Administrative Code Chapter 5123-9. Several services adjust for the person's acuity group and the county's cost-of-doing-business category. Agencies enroll by getting DODD certification and an ODM Medicaid provider agreement.

• Latest rate changes: the most recent rebasing, funded by the legislature, took effect January 1, 2024 and July 1, 2024, according to the state's IO waiver document. Rates are driven mainly by the state's two-year budget. We did not confirm whether the 2026 to 2027 budget changed waiver rates.
• Recent service changes: support brokerage was added to IO on January 1, 2026 at an agency rate of $9.68 per 15-minute unit, and remote supports moved from hourly to 15-minute billing.
• Enrollment: agencies and independent providers apply for DODD certification through the Provider Network Management (PNM) module and sign a Medicaid provider agreement with ODM. Agencies that run residential homes also need a DODD residential facility license. Start at DODD's providers page.
• EVV: electronic visit verification (EVV) applies to homemaker/personal care, participant-directed HPC and waiver nursing type services. In SELF, residential respite billed in 15-minute units is also verified, while daily residential respite is exempt. Providers use the state's Sandata EVV system or a certified alternate EVV system. Since October 1, 2025, DODD has checked claims against EVV data, and claims with unresolved EVV exceptions may be denied.

What is changing next for I/DD services in Ohio?

DODD posted draft amendments to the IO and SELF waivers that would add rules for adult day support settings, raise the environmental adaptation cap to $15,000 and require in-person assessments by SSAs. The drafts are dated February 13, 2026 and were written to take effect July 1, 2026, but we did not confirm that the federal Centers for Medicare and Medicaid Services (CMS) approved them.

• Draft IO and SELF amendments: new settings and health and safety requirements for adult day support, a $15,000 cap on environmental accessibility adaptations, and in-person SSA assessments and monitoring visits.
• Level One renewal: the SELF waiver document says a Level One renewal was prepared with more capacity. We did not confirm that it was approved or when it took effect.

Changes already in place: interRAI needs assessments began July 1, 2026, support brokerage was added to IO on January 1, 2026, and DODD began denying claims with unresolved EVV exceptions on October 1, 2025. The SELF renewal of July 1, 2025 lowered SELF's capacity to 4,000 because enrollment had stayed near 1,900 to 2,200.

Ohio I/DD sources

• Ohio Department of Developmental Disabilities: Waivers
• Ohio Department of Developmental Disabilities: Ohio Waiver Waiting List
• Ohio Administrative Code 5123-9-04 (waiting list, effective July 1, 2025)
• Ohio Administrative Code 5123-9-06 (waiver eligibility, budgets and assessments)
• Ohio Administrative Code 5123-9-17 (adult day support)
• DODD: Individual Options waiver (OH.0231) draft amendment, July 1, 2026
• DODD: SELF waiver (OH.0877) draft amendment, July 1, 2026
• Ohio Department of Medicaid: Level One Waiver program information
• Ohio Department of Developmental Disabilities: Providers
• Ohio Department of Medicaid: EVV Resource Guide (March 2026)

Related reading

• Disability Services and Independent Living Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Disability Services DayHab has a dilemma - how to solve it
• Essential Acronyms in Disability Services: A Quick Reference Guide
• I/DD services in every state (map)
• Ohio EVV requirements

Page history

• October 28, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.