In 2024, Ohio’s Department of Developmental Disabilities (DODD) issued guidance that’s putting families of severely disabled children under extreme pressure. This new guidance, led by DODD Director Kimberly Hauck, requires Medicaid-funded parent caregivers to attempt to replace themselves with strangers every 4 to 6 months. Surprisingly, this rule was established without public input, skipping Ohio’s established rulemaking process, and with no mandate or endorsement from the federal Centers for Medicare and Medicaid Services (CMS).
This “forced replacement” policy has been labeled “provider of last resort” in internal DODD communications, though in practice, it disrupts continuity of care for disabled children, destabilizes families, and removes parents from the workforce. When parents asked DODD officials how many people might be brought in to replace a single parent caregiver, Deputy Director Allan Showalter confirmed: there’s “no limit.”
How This Guidance is Hurting Ohio Families
Inconsistent and Inadequate Care for Children: Severely disabled children need stability in their care. Frequent caregiver changes make it hard for children to develop trust and adapt. When new caregivers, who may be unfamiliar with the child’s specific needs, take over, this inconsistency causes distress. Many replacements don’t speak the child’s language, making communication difficult and compromising care quality.
Forcing Parents Out of the Workforce: Under this guidance, parent caregivers are forced into an exhausting cycle: they leave their jobs to care for their child when no one else is available, then they’re replaced by temporary caregivers, only to be called back when the replacement leaves. This constant turnover makes it nearly impossible for parents to maintain stable employment and health insurance, leaving them and their children vulnerable.
Questionable Agendas vs. Child Health and Safety: DODD’s guidance seems to prioritize filling these critical care positions with people who are out of work, including those who lack experience with disabilities and those who are unable to pass a GED test. The emphasis on replacing experienced, qualified, dedicated caregivers with unfamiliar workers suggests a broader agenda that may focus on population, employment, or diversity goals rather than the health and safety of the children. These children deserve the best possible care, not revolving-door replacements that disrupt their lives.
Lack of Transparency and Accountability: DODD’s 4-6 month replacement "guidance" bypassed Ohio’s public rulemaking process, where stakeholders can voice concerns and request changes. By avoiding public input, Director Hauck has imposed a policy without oversight, despite the profound impacts it has on Ohio families. Further, CMS does not require this policy, which raises serious questions about the guidance’s legitimacy, necessity, and purpose.
What Ohio Families Need
Ohio families need policies that put children’s well-being first, not disruptive "guidance" that imposes career instability on parents while destabilizing children’s care. The current policy of attempting to replace parent caregivers every 4-6 months is excessive and unique to Ohio. No other state with a “provider of last resort” policy forces parents into such frequent turnover.
Ohio families are calling for:
An End to the Forced Replacement of Parent Caregivers: Families need stability. A clear, fair rule should allow qualified families to maintain caregiver continuity for at least a year, giving children the secure, consistent care they deserve.
Transparency and Due Process: DODD must follow Ohio’s rulemaking procedures, allowing public input and a chance for affected families to voice their concerns. This is a necessary step to ensure that policies impacting thousands of Ohio families are fair, effective, and transparent.
With the support of the community and legislative action, we can bring transparency, stability, and fairness to Ohio’s disability services. Ohio’s vulnerable children and their families deserve nothing less.
Learn more about the Provider of Last Resort policy here:
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