1-Minute Action: Send Public Comments on Level 1, IO, and SELF Waivers

Ohio's Level 1, Individual Options, and SELF waivers are all open for comment until September 27, 2025. This is a great time to go on the record with Ohio's policies that don't match what the law says. Below is a suggested comment you can paste into a blank email, but feel free to write your own if you wish!

Send to: waiverfeedback@dodd.ohio.gov

Deadline: September 27, 2025

Subject Line: Public Comment on Ohio’s IO, Level 1, and SELF Waiver Applications

To Whom It May Concern,

I am submitting this comment regarding Ohio’s Individual Options (IO), Level 1, and SELF waiver applications. Although the current renewal seeks input on other changes, I urge the state to correct serious problems in the waiver applications that affect thousands of families:

1. Loss of Due Process for Waiver Enrollees Who Wish to Hire Family Caregivers

The waiver applications state: “Waiver enrollees who are affected by any decision made to… deny the choice of a qualified and willing provider… including any changes made to the individual service plan, shall be afforded Medicaid due process. All waiver enrollees receive prior notice for any adverse action proposed. This notice includes the right to a state hearing and an explanation of the hearing procedures.”

However, OAC 5160-44-32(J) states the opposite: “A decision by ODM, ODA, DODD, or their designee related to whether someone qualifies under this rule to serve as a provider or a direct care worker for an individual [waiver enrollee] is not subject to notice and appeal rights under division 5101:6 of the Administrative Code.”

This provision strips due process from disabled children and adults who wish to have family members serve as care workers when those family members hold certain legal powers. The waiver applications assure CMS that full due process rights are preserved for all waiver enrollees, but that is not the case according to the Ohio Administrative Code.

2. Parent Replacement Searches

The waiver applications currently state that parents may only provide care “while a willing and able provider is sought.” This language comes from an earlier draft of the Ohio Administrative Code that never passed. It creates an expectation of forced parent caregiver replacement, implying that parents can be dismissed at any time once another worker is found.

In contrast, OAC 5160-44-32 requires only an initial search for willing and able non-parent providers. Once that search has been completed and no such provider is available, the parent may be hired like any other direct care worker. There is no ongoing replacement requirement.

Despite this, DODD instructed counties through a “Frequently Asked Questions” document to replace parents, originally every 4–6 months, later changed to annually after a lawsuit. When sued, DODD admitted in its legal filings that its "Frequently Asked Questions" document is “aspirational rather than a mandatory obligation,” all while DODD staffers continue to instruct various county boards that the replacement searches are, in fact, required. County boards of developmental disabilities are left in confusion and vulnerable children face disruptive and destabilizing threats of removal and replacement of their long-standing providers. This has no basis in law.

3. Guardianship Approval Not Updated

As of July 2024, amendments to Rule 66 of the Rules of Superintendence removed the requirement for guardians to obtain court approval to serve as direct care workers. Waiver applications do not appear to have been updated to reflect this change. Unless corrected, they inaccurately impose additional barriers that no longer exist in Ohio law.

Request

I respectfully request that Ohio update its waiver applications to:

• Accurately reflect current state law regarding no need for court approval for legal guardians to work as direct care workers;

• Update the waiver applications so CMS knows that DODD has removed state and federal due process protections for waiver enrollees choosing certain types of family caregivers;

• Correct the language implying that parents may only serve temporarily “while a provider is sought,” which is inconsistent with the Ohio Administrative Code.

  
  

These issues affect the stability of care for vulnerable children and adults and undermine federal protections of free choice of provider and due process under Medicaid law.

Sincerely,

[Your Name]