Ohio's Medicaid waivers are a lifeline for people with developmental disabilities, enabling them to access critical home and community-based services instead of living in institutions. However, a troubling trend has emerged over the past three years: while the number of waivers granted to adults has steadily increased, the number allocated to children has decreased.
In late 2021, adults accounted for 39,025 waivers, and children held just 3,067. Fast forward to 2025, and adult waivers have risen to 41,142, while children’s waivers have dropped to 2,964. This shift is alarming, especially considering that children make up 22% of Ohio's population but now hold fewer than 7% of all DODD-administered waivers.
What About School Services?
The disparity is particularly perplexing because both the Level 1 and SELF waivers, the most common waivers for children, already factor in school-based services. These waivers allocate less funding to children than adults because it is assumed that schools will shoulder part of the cost for daytime services. Yet, despite these built-in budget reductions, children’s share of waivers has continued to shrink.
The Expanding Gulf
Instead of addressing the existing inequity, Ohio has widened the gap. Over the past three years, the state has added 1,946 waivers for adults but removed 116 from children. This downward trend for kids is happening even as parents were finally approved to be hired as direct care workers as a “last resort.”
Misleading Claims from the OACB
Meanwhile, the Ohio Association of County Boards of Developmental Disabilities (OACB) has actively lobbied against hiring parents as direct care workers for their children. In a May 2023 letter to state officials, the OACB claimed that 4,067 children could gain access to parents as Medicaid waiver caregivers if these policies were implemented. However, this number is demonstrably false. With only about 3,000 Ohio children holding DODD waivers at the time, it was physically impossible for 4,067 Ohio children to have paid parent care workers. As fewer and fewer children in Ohio hold waivers, this is even more impossible.
Confusion About "Parents of Minors" as a Service
A recent waiver waiting list training from the Ohio Department of Developmental Disabilities (DODD) repeatedly emphasized that “Parents of Minors is not a service.” While the exact reason for this emphasis is unclear, it suggests widespread confusion among county board employees. It appears some county board workers may have incorrectly assumed that hiring parents as direct care workers is a new and distinct waiver service, separate from Homemaker Personal Care (HPC) or nursing.
Click Here for a copy of this training:
In reality, the parents who are hired are simply filling existing vacancies to fulfill federally mandated homemaker personal care or nursing house. The care promised to minor children has not changed—it remains HPC or nursing—but the ability for parents to fill these vacant positions has become a critical solution during Ohio's direct support professional (DSP) crisis.
This misunderstanding could have significant consequences. If county boards misinterpret “parents of minors” as some sort of additional new “program,” they may inappropriately deny waivers or turn children away from the waiting list, mislabeling their legitimate care needs. This adds another layer to the significant challenges facing children with disabilities in Ohio.
Living Too Long?
When asked why it is more difficult for a qualifying child to receive a waiver than an adult, one county board employee suggested that children with disabilities are living too long these days, making them undesirable candidates for county board services because their care costs will go on for a longer amount of time:
“There’s a lot of counties that don’t give any waivers to kids under the age of eighteen no matter what… When you [the county board of DD] get a waiver, you have to look at how will you sustain that waiver for the rest of their lives… So a lot of counties can’t sustain that. They can’t guarantee that they can have this kid—especially people with medical issues are living so much longer, that you no longer have the people with Down Syndrome passing away before 50. They’re living to 75, 80.”
It is time for Ohio to take a hard look at its priorities. The state must explain why children—who represent 22% of Ohio’s population—are increasingly being left behind. If waivers are meant to ensure access to care, they cannot be distributed in a way that discriminates against an entire demographic group.
Families of children with disabilities are not asking for special treatment; they are asking for fairness. Ohio’s policymakers must address the shrinking share of children’s waivers and the barriers that are increasing the gap.
Ohio’s children deserve better.
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