Ohio Waivers 101: Who Makes the Rules?

If you’ve ever tried to follow changes to Ohio’s disability waiver system, you’ve probably felt a bit confused. Policies appear, disappear, change language, go through hearings, and somehow end up approved by CMS months later. It can feel like a maze with no map. This post is your map!

The Big Picture: Two Tracks, Not One

When Ohio changes anything related to Medicaid waivers, the approval usually has to travel down two roads:

1. Ohio Administrative Code (OAC) – state rules written by DODD or ODM

2. Waiver applications or amendments – federal approval by CMS (Centers for Medicare & Medicaid Services)

For a new policy to fully take effect, it typically must be approved at both the state level and the federal level. The OAC sets the legal rules in Ohio. The waiver application tells the federal government how Ohio plans to run its Medicaid program, and the federal government approves the plan.

Track 1: Ohio Administrative Code (OAC) Rulemaking

Step 1: Proposed Rules for Review

DODD posts draft rules for public review and comment. You can always find them by clicking here. At this stage, the rule is not final. You can submit comments by email. DODD might revise the draft rule if enough people send feedback and request changes. When a proposed rule comes out, it is not set in stone. There is still time to change it!

In one case, DODD tried to make a new rule placing strict out-of-state travel restrictions on people with developmental disabilities. The public comment campaign opposing this proposal was so intense that DODD pulled the rule from consideration. Thanks to public comments sent by people like you, individuals with IDD remain free to travel outside the state without restrictions. If lots of people had not spoken up, the rule would probably have gone into effect.

Step 2: Public Hearing and Formal Comment Period

After DODD finalizes a draft, it files the rule and schedules a public hearing. You can find out what hearings are coming up by clicking here. At this step, you could attend the hearing in person, but most people just submit written comments by email. After the hearing is over, DODD publishes a hearing summary describing who commented and what they said. You can find all the past hearing summaries at the Register of Ohio. Sometimes there is some interesting dish in these summaries because you can see who spoke up and who stayed silent. Get your popcorn ready before reading one of these!

Step 3: JCARR (Joint Committee on Agency Rule Review)

After the hearing, the rule goes to JCARR, a committee within the General Assembly that reviews rules. This is usually the hardest stage to change a rule. Lawmakers can object to rules, but advocacy at this stage requires strong legal and policy arguments narrowly tailored to specific prongs JCARR reviews. It is usually (but not always) too late to speak up at this point. Once JCARR approves the rule, it becomes part of the Ohio Administrative Code.

Track 2: Waiver Applications and CMS Approval

Changes that affect Medicaid waiver services usually also appear in waiver applications or amendments submitted to CMS. This process is similar, but separate. First, Ohio publishes a draft waiver amendment. Next, there is a public comment period. The state might or might not make changes to the waiver amendment at the point. Ohio then submits the waiver to CMS, and CMS reviews and approves (or requests changes). Only after CMS approval can many waiver changes take effect.

Why Are There Sometimes Multiple Comment Campaigns?

Because rules can change a lot between drafts, hearings, and waiver amendments, you may see multiple comment periods, multiple draft versions of the same rule, and changes made at different stages.

How End Ohio’s Parent Penalty Helps

We know most families don’t have time to track dozens of rules, read legal language, analyze policy changes, or draft formal comments, so our team of volunteers does all that work for you.

We track all DODD rules under development and keep an eye out for those that affect family caregivers. Our team analyzes what the rules really mean, drafts suggested comments, workshops them (if there is time), and sends email Action Alerts to families who have signed up with ready‑to‑use language.

For most families who receive our email Action Alerts, participating in public comment campaigns takes only 1–2 minutes, since most of the work is already done for you.

Your voice matters. Over the years, we have found that the more people who comment, the more likely it is that DODD or ODM will make positive changes to a rule.

If you want to participate in Action Alerts, just scroll down to the bottom of this page and enter your email. Now you won’t miss any future alerts!

Do County Boards Make Waiver Rules?

County boards of developmental disabilities do not write rules for the Ohio Administrative Code or send waiver applications to CMS. We sometimes hear people say their county board told them something that’s not in the rule. For example, a county board might tell a family that their particular county does not serve children under age 18. This is not correct. Ohio’s waiver applications approved by CMS are effective statewide. The laws don’t change in each county.

Sometimes a county board will enact a policy that goes against the waiver application or the state rules, but families can use their due process rights to challenge the policy. For example, if your county board says your child is not eligible for a Medicaid waiver because they are not 18 or older, you could appeal that decision at a state hearing. Ohio’s waiver applications approved by CMS will quickly prove that waivers are for ages zero and up.

The Bottom Line

Ohio’s waiver system is complex, but the rule-making process gives members of the public the power to participate, be heard, and have a real influence on policy. When you know where a rule is in the pipeline, you know when your voice can have the greatest impact. Be sure to sign up for email alerts below so you can participate, too!