OH Individual Options Waiver Explained

Ohio's Individual Options Waiver (IO Waiver) is a vital Medicaid program that plays a significant role in the state's healthcare landscape. It is a comprehensive waiver, offering essential assistance to individuals who require substantial help in their homes or need access to diverse services. The IO Waiver is well-suited for those with complex care needs, providing a safety net for vulnerable individuals.

Overview of the Individual Options Waiver

Ohio's Individual Options Waiver is a critical Medicaid program designed to provide comprehensive support and services to individuals with significant care needs, allowing them to remain in their homes and communities rather than living in institutions. The program is part of Ohio's commitment to promoting community-based care and ensuring that individuals with disabilities or chronic conditions have the opportunity to live as independently as possible.

The IO Waiver targets a wide range of individuals, including older adults, individuals with physical disabilities, intellectual and developmental disabilities, and those with acquired brain injuries. The program caters to people who require extensive assistance with daily activities such as bathing, dressing, eating, and mobility and those who need specialized medical and therapeutic services.

The IO Waiver's overarching goal is to enhance participants' quality of life while addressing their unique needs and preferences. It strives to empower individuals to lead self-determined lives, making choices that align with their goals and aspirations. By providing a comprehensive array of services, ranging from personal care to assistive technology and respite care, the program aims to create a supportive environment that fosters independence, dignity, and inclusion.

Eligibility Requirements

To be eligible for Ohio's Individual Options Waiver (IO Waiver), individuals must meet the following criteria:

1. Medicaid Eligibility: Applicants must be eligible for Medicaid, a federally funded healthcare program assisting low-income individuals and families.
2. Developmental Disabilities Level of Care: Eligible individuals must have a documented developmental disabilities level of care, indicating that they require the support typically provided in institutional settings. The cost of their waiver services cannot exceed the cost of care in an ICF/IID.‍
3. Need for at Least One IO Waiver Service: Applicants should demonstrate a need for at least one of the services offered under the IO Waiver program. These services encompass a wide range of support, including personal care, assistive technology, behavioral support, respite care, and more.
4. Income: The income limit for this waiver is 300% of the Supplemental Security Income (SSI) federal benefit rate. The SSI federal benefit rate for 2023 is $914 for an individual and $1,371 for a couple. The income limit for this waiver is 300% of these amounts, which is $2,742 for an individual and $4,113 for a couple per month.

The IO Waiver does not impose any age requirements, making it accessible to children and adults with developmental disabilities who meet the eligibility criteria. This inclusivity ensures that individuals across different life stages can receive the necessary support to live fulfilling lives within their communities through this comprehensive Medicaid waiver program.

Services and Supports

Ohio's Individual Options Waiver (IO Waiver) offers a comprehensive range of services and supports tailored to meet the unique needs of each participant. These services are incorporated into each person's personalized service plan based on the specific requirements identified during their assessment. Some of the services and supports available under the IO Waiver include:

1. Homemaker/Personal Care: Assistance with daily living activities, such as grooming, bathing, and meal preparation, to enable individuals to live independently.
2. Adult Day Support: Structured activities and care in a supervised setting for adults, promoting socialization and community engagement.
3. Participant-Directed Homemaker/Personal Care: Empowers participants or their representatives to manage and direct their care services.
4. Vocational Habilitation: Support to develop vocational skills and engage in meaningful employment opportunities.
5. Remote Support and Equipment: Technological assistance that enables remote monitoring and support for individuals with specific needs.
6. Career Planning: Guidance and support to identify career goals and create pathways to achieve them.
7. Ohio Shared Living: Support for individuals to live in shared homes with caregivers who provide personalized care.
8. Individual Employment Support: Assistance to secure and maintain individualized employment opportunities.
9. Community Respite: Temporary relief for caregivers by providing substitute care for the participant.
10. Waiver Nursing: Skilled nursing services for individuals requiring medical support.
11. Non-Medical Transportation: Transport assistance for participants to access medical appointments, community activities, and other essential services.
12. Nutrition: Guidance and support for proper nutrition and meal planning.
13. Transportation: General transportation services for various needs.
14. Group Employment Support: Assistance in finding and maintaining group-based employment opportunities.
15. Specialized Medical Equipment and Supplies: Provision of specialized equipment and supplies to support health needs.
16. Home Delivered Meals: Nutritious meals delivered to individuals' homes.
17. Environmental Accessibility Adaptations: Modifications to homes to improve accessibility and mobility.
18. Interpreter Services: Language interpretation services for effective communication.
19. Waiver Nursing Delegation: Training and delegating specific medical tasks to non-medical caregivers.
20. Self-Directed Transportation: Empowers participants to arrange and manage their transportation.
21. Money Management: Assistance with financial matters related to the waiver services.
22. Residential Respite: Short-term residential care for individuals requiring temporary relief from their usual living arrangements.

Compensation for Caregivers

Ohio's Individual Options Waiver (IO Waiver) recognizes the significant contributions of unpaid family caregivers and offers a compensation option for their dedicated work. The program acknowledges that family caregivers are crucial in supporting individuals with developmental disabilities, allowing them to remain in their homes and communities.

Under the IO Waiver, eligible participants have the option of self-direction, which means they can choose to manage and direct their care services, including selecting their caregivers. This self-directed option enables participants to hire and pay their family members for their caregiving services, allowing family caregivers to receive financial compensation for their valuable efforts.

By offering compensation and self-directed options, the IO Waiver addresses the challenges families face caring for their loved ones, promoting the well-being of individuals with disabilities and the caregiver's recognition and financial support.

Learn more about Medicaid self-directed care >>

Limitations and Challenges

The IO Waiver has certain limitations and challenges that individuals and their families should know. Some of these include:

1. Limited Waiver Span: Each person's service plan is usually valid for 12 months, meaning recipients must reapply and reassess their eligibility regularly.
2. Individual Funding Levels: The funding range for each participant is determined based on the results of the Ohio Developmental Disabilities Profile (ODDP) assessment and the services in their service plan, which may result in varying levels of financial support for different individuals.
3. Prior Authorization: Counties may need authorization from the board of developmental disabilities to exceed the assigned funding range, which could create delays in accessing certain services.
4. Service Limitations: Some services have specific limitations, such as a maximum number of units available per year or a cap on the service cost. For instance, certain services like Community Respite and Residential Respite have limits on the number of days they can be used within a waiver span.
5. Funding for Specific Services: The ODDP assessment does not assign a funding range for all services available through the IO Waiver. Some services, like Adult Day Support, Career Planning, Group Employment Support, Individual Employment Support, and Vocational Habilitation, rely on the Adult Acuity Instrument (AAI) assessment results.
6. Waiver Nursing Services: Waiver nursing services are subject to specific assessments every 60 days, and recipients can receive up to 10 hours of waiver nursing delegation or consultation each month, regardless of the number of providers delivering the service.
7. Cost Limitations: Certain services, like Specialized Medical Equipment and Supplies and Environmental Accessibility Adaptations, have predefined cost limits, which may impact the type and amount of support individuals can receive.

Understanding these limitations and challenges is crucial for care recipients and their families to effectively plan and navigate the services available under the IO Waiver program.

A Note from Givers

If you care for a loved one with developmental disabilities, take action now and fill out this form to determine your eligibility for compensation.