How Ohio pays for disability services

Waiver inventory

Combined DD waiver enrollment: DODD stated "more than 40,000 Ohioans with developmental disabilities are enrolled in a DD waiver" in February 2025 testimony, and the enacted budget describes funding for "more than 44,000 Ohioans to receive HCBS." Ohio has no 1915(k) Community First Choice option and no I/DD-specific 1915(i) or 1115 authority identified.

Sources for enrollment counts: stateofthestates.ku.edu (secondary) and search-prod.lis.state.oh.us

State-only funded programs

Ohio's DD system is structured so that the non-federal share flows predominantly from local levies rather than from a separate state-only service program. Two GRF streams function as state-only supports rather than match:

• State-Funded HCBS and ICF Formula (GRF). DODD's February 2025 budget testimony identifies $26,400,000 (a 2.6 percent increase) in the FY25 to FY26 GRF build for the state-funded HCBS and ICF formula. search-prod.lis.state.oh.us
• Developmental Centers direct care services, ALI 653632. $7,000,000 per year in FY2026 and FY2027. lsc.ohio.gov
• Technology First, $2.7 million to $3.2 million per fiscal year for assistive technology and remote supports, and youth with complex needs, $5 million per fiscal year for multi-disciplinary assessment and residential support partnerships. dodd.ohio.gov

Beyond these, county boards deliver a large volume of non-Medicaid services (early intervention, service and support administration beyond the Medicaid-billable portion, adult services, transportation) directly from local levy funds. Those are county money, not state money, and are covered in the next section.

County / regional / local funding

This is the defining feature of Ohio's system, and it is unlike any other state.

Mechanism. All 88 counties have a County Board of Developmental Disabilities. Each board levies at least one voter-approved property tax levy under Ohio Revised Code Chapter 5705; some counties carry multiple levies. Local levy revenue is used as the non-federal share of Medicaid HCBS expenditures, so every local dollar draws roughly two federal dollars at Ohio's 64.85 percent FMAP, and local funds also pay for services Medicaid does not cover.

Scale. - ALI 653624, County Board Waiver Match, the appropriation through which county boards' non-federal share is expended: $688,000,000 in FY2026 and $752,000,000 in FY2027. The line item description reads "Expends the county DD boards' nonfederal share of expenditures for HCBS Medicaid services." lsc.ohio.gov - Ohio Association of County Boards testimony on HB 96 puts the county board contribution at approximately $567 million in SFY 2025, $628 million projected in SFY 2026, and $691 million projected in SFY 2027, describing this as about half of the state's Medicaid match for DD services. search-prod.lis.state.oh.us - Total local property tax funds for DD services statewide exceed $1 billion, and more than half of all funds raised at the local level for DD services in the entire United States are raised in Ohio (Jefferson County Board of DD, secondary). jcbdd.com - Cuyahoga County example: $80 million in local match in 2025 unlocked $475 million in federal Medicaid, roughly a six-to-one return. The county's DD levy was last approved by voters in 2005 (Signal Cleveland, secondary). signalcleveland.org - County boards pay a 1.25 percent administrative fee to the state, which funds ALI 653622 Medicaid Administration at $36,000,000 per year in FY2026 and FY2027. lsc.ohio.gov - Failed-levy backstop: OAC 5160-41-16 lets a county board request state financial assistance to cover the non-federal share of HCBS Medicaid expenditures when a local operating levy fails. DODD must consult the Office of Budget and Management and the Ohio Department of Medicaid before approving. regulations.justia.com - ICF/IID franchise fee, ALI 653606, funds ICF/IID and waiver match at $60,000,000 per year, an additional non-GRF, non-local, provider-assessed stream. Greenbook, same source.

There is no standardized local share across counties. Each board's mix of local, state, and federal funds differs, and access to local levy dollars is a documented driver of inter-county variation in who gets served. communitysolutions.com

Funding scale

• Total DODD appropriations all funds: $5.51 billion in FY2026 and $5.75 billion in FY2027. lsc.ohio.gov
• FY2026 fund composition: GRF $1.178 billion (21.0 percent), federal $3.496 billion (63.6 percent), Dedicated Purpose Fund $816.6 million, internal service activity $20 million. FY2027: GRF $1.188 billion (20.7 percent), federal $3.661 billion (63.7 percent), DPF $880.9 million, internal service activity $20 million. Same source.
• Approximately 93.1 percent of all funds support subsidies for home and community based services, residential services, and county DD board assistance. Same source.
• ALI 653654, federal share of Medicaid for community waivers, targeted case management, ICFs/IID, and developmental centers: $3,385,530,510 FY2026 and $3,545,767,920 FY2027. Same source.
• ALI 653407, state share of Medicaid services: $1,127,127,000 FY2026 and $1,140,627,000 FY2027. Same source.
• ALI 653624, county board waiver match: $688,000,000 FY2026 and $752,000,000 FY2027. Same source.
• State versus federal versus local share, FY2026, approximate: federal about 63.6 percent, state GRF about 21.0 percent, county board local levy funds most of the remainder through the Dedicated Purpose Fund.
• FMAP, FFY 2026: 64.85 percent. kff.org
• People served: more than 44,000 receiving HCBS (enacted budget); more than 40,000 enrolled in a DD waiver and over 100,000 Ohioans with developmental disabilities and their families supported systemwide (DODD testimony, Feb. 26, 2025); over 4,000 people in about 440 ICFs; about 600 in 8 developmental centers.
• Spending per participant: not published as such. Level One and SELF carry hard annual caps of $62,136 for an adult and $41,424 for a child effective July 1, 2026; IO has no universal cap and instead assigns funding ranges by Ohio Developmental Disabilities Profile score. codes.ohio.gov and codes.ohio.gov
• Waiting list: DODD publishes a monthly dataset of people assessed to have a current need for a waiver, defined as an unmet need anticipated within 12 months, on DataOhio, but the dataset requires login and no current count is publicly displayed. data.ohio.gov The most recent public figure found is approximately 1,300 individuals in February 2023, down from over 45,000 in 2014 after the September 1, 2018 assessment-based rule replaced date-of-request ordering (Center for Community Solutions, secondary). communitysolutions.com Average wait time is not published.

Residential funding detail

Ohio funds residential support primarily through Homemaker/Personal Care (HPC), which is not a facility payment but a staffing payment that follows the person. Rules: OAC 5123-9-30 for IO and Level One, OAC 5123-9-31 for the daily billing unit where people share services at one site under the IO waiver, OAC 5123-9-32 for participant-directed HPC across all three waivers.

HPC payment structure. The base unit is 15 minutes, counted as any span of 8 to 22 minutes. Rates vary by county cost-of-doing-business category (eight categories) and by whether the provider is independent or an agency, and by staffing configuration (1 through 5 staff). When one direct support professional serves multiple people, the base rate is adjusted upward and then split: 107 percent of the one-to-one rate for two people, 117 percent for three, 130 percent for four or more, divided among the people served. Separate service codes exist for routine care and for on-site/on-call. Four rate modifications stack on the base:

The $0.39 competency add-on is confirmed current on the DODD service page. The behavioral, complex care, and medical assistance amounts come from the December 2021 appendix to OAC 5123-9-30 and should be re-verified against the current appendix before use. Sources: codes.ohio.gov dodd.ohio.gov codes.ohio.gov

Daily billing unit. For congregate settings where people share services under the IO waiver, DODD's Monthly Rate Calculator derives a Daily Billing Unit by taking HPC and on-site/on-call costs for each person in a calendar month and dividing by the number of dates of service in that month, with a 3 percent tolerance between projected and actual service hours. dodd.ohio.gov

Shared living, Ohio's host home and family home model, is paid on a daily rate and requires that 20 percent or more of the personal care and support be provided by one or more adult caregivers who live in the same home. Group size reduces the per-person daily rate: 100 percent for one person, 85 percent each for two, 75 percent each for three, 65 percent each for four. Rates differ for independent versus agency providers and vary by county cost-of-doing-business category. codes.ohio.gov

Residential respite is paid daily when respite exceeds 7 hours in a 24-hour period with an overnight stay, capped at 90 calendar days per waiver eligibility span, or in 15-minute units for people in shared living, capped at 208 units per calendar month with the same 85/75/65 percent group-size reductions. The rule states plainly: "Payment for residential respite does not include payment for room and board or transportation." codes.ohio.gov

ICF/IID is a separate per diem, with the non-federal share partly financed by a franchise fee on ICF/IID operators ($60 million per year, ALI 653606).

Room and board. Not Medicaid-payable and not state-funded in waiver settings. It falls to the person's SSI, SSDI, and other personal income. Ohio's housing supports are handled separately through DODD's housing initiatives rather than through the service rate.

Comparable service rates

Ohio does not publish a consolidated DD fee schedule. Dollar rates live in numbered appendices attached to each OAC 5123-9 service rule, and the current appendix PDFs were not retrievable in this session (the DODD document server returned 403 and the Ohio Laws pages present appendices as separate downloads not exposed in page text). Structure, units, multipliers, and modification amounts are given above and are confirmed from the rules themselves.

Official rate schedule links

• DODD Rules in Effect, the index from which every 5123-9 service rule and its rate appendices are reached: dodd.ohio.gov
• OAC 5123-9-30, Homemaker/Personal Care under IO and Level One, with Appendix A, B, and C: codes.ohio.gov
• OAC 5123-9-31, HPC daily billing unit for shared sites under IO: codes.ohio.gov
• OAC 5123-9-33, Shared Living: codes.ohio.gov
• OAC 5123-9-34, Residential Respite: codes.ohio.gov
• OAC 5123-9-17, Adult Day Support: codes.ohio.gov
• OAC 5123-9-06, Administration of the IO and Level One waivers, with funding ranges in Appendix A and the Level One cap: codes.ohio.gov
• OAC 5123-9-40, Administration of the SELF waiver, with caps: codes.ohio.gov
• HPC service page confirming the $0.39 per 15-minute Competency-Based Training and Longevity add-on: dodd.ohio.gov
• Homemaker/Personal Care appendix, service codes and rate structure, dated Dec. 20, 2021: codes.ohio.gov
• Monthly Rate Calculator, the tool that converts HPC and on-site/on-call cost into a Daily Billing Unit: dodd.ohio.gov

Notable features and flags

• July 1, 2026: amendments to the IO and SELF waivers and a full renewal of the Level One waiver took effect. Level of care evaluations must now be conducted in person rather than remotely; environmental accessibility adaptations were expanded to interior and exterior work with the cost limit raised to $15,000 and independent-provider subcontracting prohibited; vehicle modifications now allow raised doors and relocation of equipment between vehicles; service plan monitoring now requires regular in-person visits to residences and day program settings plus unscheduled visits when health and safety concerns arise. Public comment ran March 2 to April 1, 2026. dodd.ohio.gov
• July 1, 2026: OAC 5123-9-06 and 5123-9-40 set the Level One and SELF annual caps at $62,136 per waiver eligibility span for an adult and $41,424 for a child, with a separate $8,000 support brokerage cap and a $1,500 functional behavioral assessment cap under SELF.
• Reimbursement System Refresh, rate changes not anticipated until July 2027. DODD is moving to acuity-based rates driven by the interRAI assessment, replacing the separate complex, behavioral, and medical add-on process. Affected services: congregate HPC, 15-minute HPC, adult day array services, and shared living. dodd.ohio.gov
• HB 96, the FY2026-27 operating budget, sustains the prior biennium's direct support provider rate increases. The FY25 to FY26 GRF build includes $88,284,758 (8.8 percent) for rate sustainment, $26,400,000 (2.6 percent) for the state-funded HCBS and ICF formula, and $8,108,242 (0.8 percent) for developmental center payroll. The FY24-25 rate investment was $1.3 billion across local, state, and federal funds. search-prod.lis.state.oh.us
• County board local match rises 22 percent over the biennium, from $688 million in FY2026 to $752 million in FY2027, a growing demand on locally approved property tax levies with no corresponding statewide levy authority. County boards flagged this in HB 96 testimony as funding about half the state's Medicaid match for DD. search-prod.lis.state.oh.us
• Direct support professional wages: July 2024 estimates put the starting wage at $16.04 per hour and the overall average at $17.04, up from an $11.12 average in 2019, with a stated target of at least $18 per hour. DODD runs an annual DSP Compensation Survey, with the 2026 cycle in progress. analytics.das.ohio.gov

Confidence

Solid: the appropriation detail, which is line-item specific and drawn from the LSC Greenbook on the enacted HB 96; the county board local match figures from both the Greenbook and OACB testimony; the FMAP; the Level One and SELF caps and the July 1, 2026 rule effective dates, taken directly from the Ohio Administrative Code; the July 2026 waiver amendment contents; the rate structure and all multipliers for HPC, shared living, residential respite, and adult day support; institutional census figures; DSP wage data. Estimated or secondary: the three per-waiver enrollment counts (24,282 IO, 14,960 Level One, 1,866 SELF) come from the University of Kansas State of the States project rather than a DODD publication, and the waiver years they correspond to are not stated; DODD's own figures are the rounder "more than 40,000 in a DD waiver" and "more than 44,000 receiving HCBS." The behavioral support, complex care, and medical assistance rate modification amounts come from a December 2021 appendix and may have been revised. The $1 billion statewide local levy total and the Cuyahoga figures are from secondary sources. Could not find: any current dollar rate for any Ohio DD waiver service. Ohio publishes rates only as appendices attached to individual administrative rules, the DODD document server rejected retrieval of those appendix PDFs, and Ohio Laws exposes them as separate downloads not rendered in page text. Also not found: a current statewide waiting list count, since the DODD dataset on DataOhio requires authentication, leaving the February 2023 figure of roughly 1,300 as the most recent public number.