Special Needs Resource Directory

  • Waivers

    A waiver is a program that can waive, or set aside, some of the strict eligibility requirements, including income guidelines, benefits and health care delivery options required under federal Medicaid program regulations. A Home and Community Based Services Waiver can provide extra services that make living at home possible. This can include personal care, nursing, respite, adult day care, supported employment, home modifications, assistive technology and transportation. While waivers can differ substantially between states in eligibility and services, an important advantage is that they can expand services to cover individuals that may be over income for traditional Medicaid. However, because states have the discretion to choose the number of consumers to support in a waiver program, there are often long waiting lists for services.

    The Complex Care Center at Cincinnati Children's provides information to help families and health care providers identify sources of financial assistance.

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    + Home and Community Based Waivers in Ohio

    Medicaid Home and Community Based Services Waivers are programs of in home and community care that help eligible Medicaid consumers stay at home instead of in a nursing home, hospital or institution for people with mental retardation and / or developmental disabilities:

    • Ohio Home Care Waivers, administered through The Ohio Department of Medicaid, can assist individuals with severe disabilities and medically unstable conditions who would require care in a hospital or nursing home. The benefit package consists of nursing services, personal care assistance services and/or skilled therapy services plus, one or more waiver specific service such as: home modifications, home delivered meals, adult day health care, respite care, supplemental transportation, adaptive/assistive devices, and emergency response systems. It is designed to meet the needs of consumers eligible for Medicaid who have been assessed to require an intermediate or skilled level of care. Without the services available through the Waiver benefit, these consumers are at risk for hospital or nursing home placement. Consumers approved for the Ohio Home Care Waiver benefit may receive care and services at home, or they may choose to receive their care in a nursing facility.

      Nursing, aide and/or skilled therapy services must be provided by a Medicare-certified home health agency, accredited home health agency, or non-agency RN / LRN. 

      • Home Health Services is designed for people who need a limited amount of home care services. Individuals can receive part time, intermittent services up to a total of 14 hours per week. Eligibility is based on medical need and requires a doctor's order. 
      • Increased Home Health Services can provide services up to 28 hours per week for up to 60 consecutive days from the date of hospital discharge. Eligibility requires medical need and requires a 3 day hospital stay. A physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.   
      • Private Duty Nursing Post-Hospital Stay is designed for individuals requiring continuous skilled nursing up to 56 hours per week for up to 60 consecutive days from the date of hospital discharge. Eligibility requires medical need and requires a 3 day hospital stay. A physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.
      • Private Duty Nursing provides continuous skilled nursing. The physician must submit a Certificate of Medical Necessity and the individual must qualify for an institutional level of care.
    • Level One, Individual Options and the Self-Waiver, administered through the Ohio Department of Developmental Disabilities, can assist people with developmental disabilities to stay in their homes and get support rather than living in an intermediate care facility (ICFMR).

    In addition to the usual Medicaid benefits, like doctor visits and prescriptions, a waiver can provide extra services that make living at home possible. This can include personal care, nursing, respite, adult day care, supported employment, home modifications, assistive technology and transportation, depending on the waiver. However, there are generally long waiting lists for waivers since they support a limited number of individuals.

    + Eligibility

    Waivers allow Ohio Medicaid to try new programs that can waive, or set aside, some of the traditional requirements. Individuals have to be eligible for Medicaid and meet both financial and medical criteria. However, the financial criteria is based only on the income of the individual. The advantage is that the family's income and resources are not considered. Parents and other family members often want to put money aside to provide lifetime care for their child with special health care needs. Having assets in the name of the child with special health care needs, regardless of their age, often disqualifies them from important government programs including Medicaid. Learn more about special needs trusts and Estate and Future Planning.

    + Ohio Waiver Comparison

    In addition to the usual Medicaid benefits, like doctor visits and prescriptions, an Ohio Home and Community Based Waiver can provide extra services that make living at home possible. The following table is a brief overview of some helpful Ohio waivers that can pay for services for children and adults with special health care needs. Click on the waiver name to find more detailed information:

    Waiver Eligibility Services Contact 
    Ohio Home Care WaiverSkilled or Intermediate Level of Medical Care, Financial Criteria, All Ages.Respite, Nursing, Personal Care Aide / Daily Living Services, Therapy, Home Modifications, Transportation, Adaptive and Assistive Devices, Adult Day Health, Emergency Response, Home Delivered Meal.

    Ohio Home Care Program. Contact your Ohio Dept. Job & Family Services county office.
    Level One WaiverMental Retardation / Developmental Disabilities, Skilled Level of Care, Financial Criteria, All Ages. Has spending limits for services.Homemaker / Personal Care, Informal Respite, Institutional Respite, Transportation, Personal Emergency Response Systems, Home Modifications, or Specialized Medical Equipment and Supplies, Emergency Assistance, Adult Day Support, Vocational Assistance and Supported Employment.

    Level One Waiver Services. Contact your county board or case manager.
    Individual Options WaiverMental Retardation / Developmental Disabilities, Skilled Level of Care, Financial Criteria, All Ages.Homemaker / Personal Care, Home Modifications and Adaptations, Transportation, Respite Care, Social Work Home-delivered Meals, Nutrition, Interpreter Services, Specialized Adaptive or Assistive Medical Equipment and Supplies, Supported Employment, Day Programs and Adult Day Services.

    Individual Options Waiver Services.
    Contact your county board or case manager.
    Self WaiverMental Retardation / Developmental Disabilities, Skilled Level of Care, Financial Criteria, All AgesHelps fund items or services in the Individual Services Plan. There is an annual cap of $25,000 for children and $40,000 for adults. The waiver becomes effective 7/1/12.

    Self Waiver Services.
    Contact your county board or case manager.


    Home and Community-Based Waivers Medicaid Fact Sheet
    provides a comparison of all Ohio waivers.

    + Applying for an Ohio Waiver

    Since waiver programs pay for services for a limited number of people, their openings can fill up quickly and there may be a waiting list. Children who have been hospitalized for more than 30 consecutive days will be given priority on the waiver waiting list, thereby significantly reducing their waiting time.

    Ohio Department of Job and Family Services, Bureau of Home and Community Services oversees Medicaid's integrated program of home care services. The Ohio Home Care Waiver is administered through their county agencies. When an individual is approved, services are coordinated through a single case management agency, CareStar. CareStar provides information about services, resources and supports. 

    Ohio Department of Developmental Disabilities oversees the Individual Options Waiver and the Level One Waiver through their county boards.

    Centers for Medicare & Medicaid Services provides information on Medicare, Medicaid and Waiver programs throughout the United States.

    + Ohio Medicaid School Program

    The Medicaid School Program is overseen by the Ohio Department of Education and the Ohio Department of Job and Family Services. It can reimburse participating schools for related services provided to Medicaid-eligible students. Services must be identified in the IEP and can include nursing, occupational therapy, physical therapy, speech therapy, specialized medical transportation and medical equipment and supplies for use only in school. This also covers students who receive the Ohio Home Care or Transitions MRDD waivers. It is possible for a family's current Ohio Home Care waiver provider to go to school with the child if the waiver team determines that the IEP is not adequate to ensure the child's health and welfare.

    + Kentucky Waivers

    Kentucky Cabinet for Health and Family Services provides a variety of services and supports including:

    + Indiana Waivers

    Indiana Family & Social Services Administration provides comprehensive services to help the families of children with disabilities live, work, and remain healthy and safe in their communities. They oversee 5 Waiver Programs:

    + Waivers in Other States

    Medicaid has information on waivers that are available in other states. They provide an easy to use map.