By Seniorlink on Jan 27, 2020 12:59:36 PM
The 1915c Ohio Individual Options (IO) Waiver is a Home & Community Based Services (HCBS) waiver program. HCBS was first introduced by the U.S. Congress in 1983 to give states an option to receive a waiver of Medicaid rules that govern institutional care through the addition of section 1915c to the Social Securities Act. Section 1915c allows states to develop home- and community-based services to meet the needs of those who wish to receive long-term services and support in their home or in the community instead of in an institutional setting.
Definition of 1915c Ohio Individual Options Waiver
The 1915c Ohio Individual Options Waiver is one of four HCBS waiver programs available in the state, allowing people with chronic conditions and/or disabilities to have more control over the care they receive, opting to receive care in their own homes or in community settings rather than in institutions or hospitals. In turn, these individuals can often remain more active in their communities and enjoy a greater quality of life.
The program pays for certain services to be received in the home or community setting in cases in which, without the availability of those funds, the individual would require institutionalization. In order to be eligible for the 1915c Ohio Individual Options Waiver, individuals must require a minimum level of care and meet certain financial criteria, and the cost of providing care in the home or community setting must be less than the cost of comparable institutional care.
How the 1915c Ohio Individual Options Waiver Works
The Individual Options Waiver, specifically, is designed for those with developmental disabilities. IO Waivers are difficult to obtain, as there is no cap on the cost of services provided. Services provided to eligible individuals can include:
- Homemaker/personal care services – including participant-directed homemaker/personal care services
- Waiver nursing and waiver nursing delegation
- Home modifications and adaptations
- Transportation – both medical and non-medical
- Community and residential respite care
- Social work
- Home-delivered meals
- Interpreter services
- Specialized adaptive or assistive medical equipment
- Supplies for medical equipment or other needs
- Adult day care services
- Supported employment – group and individual
- Money management
The services provided to an eligible individual may vary based on the recipient’s needs as well as the setting in which services are provided.
Benefits of the 1915c Ohio Individual Options Waiver
The IO Waiver provides supportive services to individuals with disabilities who are living with their families or in the community. While it doesn’t provide funds for paying rent or other living expenses, it does give individuals greater control and choices among services and supports received through the development of an Individual Service Plan (ISP). For example, individuals can choose from providers who are certified by the Ohio Department of MR/DD.
Another benefit of the IO Waiver is that individuals can move from one county to another without disruptions to their funding or services.
Disadvantages of the 1915c Ohio Individual Options Waiver
Because there’s a higher income limit, it’s easier for individuals to meet the financial eligibility requirements for Medicaid. However, for those with Medicaid with a current monthly “spend down,” receiving the IO Waiver may result in an end to the “spend down” arrangement. Likewise, those with income exceeding the monthly waiver income limit may incur a Patient Liability, a monthly fee that must be paid by the recipient to the provider. The Patient Liability is often less than a spend down amount.
Because County Boards have agreed to pay about 40% of the cost of services under the IO Waiver in exchange for receiving federal funding to cover the remaining 60%, the non-capped nature of the IO Waiver places County Boards at significant financial risk. For this reason, IO Waivers can be difficult to obtain, and individuals must meet strict eligibility criteria.
Eligibility for the 1915c Ohio Individual Options Waiver
Individuals seeking an IO Waiver must be eligible for Medicaid, although the income limits are greater when applying for Medicaid through a waiver program compared to the limits when applying for traditional Medicaid.
In addition to meeting income limitations, individuals must meet the level of care requirements for an intermediate care facility for developmentally disabled (ICF/DD or ICF/MR). These requirements include:
- Must have received a diagnosis prior to age 22 of either mental retardation or a developmental disability by a physician and psychologist
- Must have a substantial functional limitation in at least three of the following areas:
- Understanding or use of language
- Capacity for independent living
- Economic self-sufficiency (applicable only to those age 16 or older)
- 3 developmental delays (applicable only to those from birth to age 5)
- Must benefit from skills acquisition
Enrollment is limited by county based on the number of slots received from the Ohio Department of MR/DD. Typically, slots are distributed based on the waiver application date, although those who meet emergency status criteria may be given priority under Ohio Administrative Code 5123:2-1-08 (the waiting list rule). There is no minimum or maximum age for IO Waiver eligibility.
Financial Eligibility Requirements for the 1915c Ohio Individual Options Waiver
Financial eligibility requirements are determined on a county by county basis, rather than at the state-wide level, unlike most state Medicaid waiver programs. Because counties fund about 40% of the cost of services provided, each county Department of Job and Family Services (ODJFS) determines the financial criteria for Medicaid eligibility and that of waiver programs. The income limits for the IO Waiver are higher than the income limits for those applying for standard Medicaid.
How to Apply for the 1915c Ohio Individual Options Waiver
The first step in applying for the 1915c Ohio Individual Options Waiver is to get in touch with your local Ohio County Board of Developmental Disabilities. Talk with your county board representative about the support you need and what services and options are available to you.
Your County Board of Developmental Disabilities may use several assessment tools to determine your needs and eligibility for various programs, including the IO Waiver program. Individuals are able to have a family member or close friend with them to assist with answering questions.
If you qualify for the IO Waiver, you’ll also need to apply for Ohio Medicaid benefits. This application can be completed online. A representative from your local county board can assist you with this process, as well.
Finally, to maintain services, individuals may need to update information provided during assessments each year. Should your needs change, you can request a new assessment, as well.
The 1915c Ohio Individual Options Waiver allows for self-direction of services, including participant-directed homemaker/personal care services, meaning that recipients can choose their own homemaker or personal care provider. For information on paid family caregiving programs, visit our How to Become a Paid Caregiver for a Family Member guide.