DODD Announces Cost-Cutting Strategy: “This Is Just the Beginning”

In a mandatory statewide training on Medicaid waiver cost containment, DODD Assistant Deputy Director Nyoka Craddolph told SSAs and other county board staff that DODD’s waiver modernization initiative may reduce add-ons and provide financial “relief” to county boards. She presented several cost containment measures and described them as “bridging the gap” until waiver modernization is implemented.

This training provides the clearest evidence yet that DODD expects waiver modernization to cut waiver spending. County boards pay about 40% of many waiver costs.

DODD says the interRAI assessment (a key part of the waiver modernization project) will help place people into funding levels and help set provider payment rates. NBC News details the heartbreaking funding reductions in Nebraska following the state’s change to interRAI.

DODD has not said whose funding or services could be cut in Ohio, or by how much.

 If you are concerned, you can attend either of two upcoming DODD town hall meetings and try to submit a question or comment. Register here for either session:

Monday, September 28, 2026 at noon

Tuesday, September 29, 2026 at 6 p.m.

Cost cutting measures Nyoka Craddolph presented as part of “bridging the gap” until the expected savings from the waiver modernization project include:

• Approving 2:1 care for only 90 days at first, then assuming the person will need only 1:1 care for the rest of the year unless the continuing need for 2:1 care is proven;

  
  

• Refusing to approve a second care worker to clean, prepare meals, or supervise the disabled person while the first care worker uses the bathroom*;

  
  

• Directing SSAs to reconsider doctors’ orders. Craddolph stated: “The fact that something is quote unquote ‘ordered’ does not make it so”;

  
  

• Directing county boards to consider having disabled people share waiver services with their neighbors;

  
  

• Reconsidering 24/7 awake care every year: “Just because the person had awake HPC 24/7 last span does not mean that they need to have that this span”;

  
  

• Subjecting overtime authorizations to continuous reevaluation and scrutiny;

  
  

• Shared Living exceptions: “We must be reviewing exceptions at all times”;

  
  

• Saying that some people may “outgrow their waiver.”

DODD’s 2026 cost containment training is available for free on the MyLearning platform and is available to view until October 15, 2026. If you want to watch the session, be sure to do so by October 15. Log in to your existing MyLearning account and search “All Courses” for “2026 Medicaid Updates for Service and Support Administrators” to enroll. The cost containment session is Part 3 and is about ten minutes long. Alongside the training DODD issued a written guidance document you can find here.

In the training, Craddolph told county board staff:

“The other thing we wanted to note is that [waiver] modernization may reduce add-ons, so some of these exceptions in the future may change. So that’s something that people just need to keep in mind, not anything we’re telling you to start doing now, but just something that, you know, may provide you some relief in the future on this.”

Craddolph concluded:

“These are all things we have put together as the department to try to support counties in containing costs and as a system. So, you know, we’re open to other, you know, ideas that people have, but this is just the beginning of what we’re working toward as, you know, bridging the gap until we get modernization together and things like that.”

* Craddolph did not explain how/whether the sole care worker can use the bathroom during their shift when the individual requires close and constant supervision.