"Willing and Able": How a Vague Ohio Rule is Being Enforced Differently in Every County

If your county board of developmental disabilities has told you they need to search for someone to replace you as your disabled child's Medicaid waiver caregiver, you may have been told this is required by law. You may have been told your child's services will be affected if you refuse.

What you may not have been told is that the state agency responsible for overseeing county boards already told the Supreme Court of Ohio that these searches are not legally required.

What Is a Parent Replacement Search?

Ohio Administrative Code 5160-44-32 allows parents to be hired as Medicaid waiver providers for their minor children when no other "willing and able" provider is available. Many county boards have interpreted this to mean that after the parent is hired, the county board must periodically advertise the disabled child online, gather interested applicants, and determine whether any applicant can replace the parent.

Families describe the child advertisement process as deeply distressing. They must disclose their child's most intimate medical details to unvetted strangers, facilitate interviews, and comply under the threat that refusal could cost their child’s life-sustaining Medicaid services. This process led to the infamous interaction between a family and the applicant wearing the “F*** You” hat, the applicant with the address 123 Main Street, Anytown USA, and other concerning stories as described by the families in our 2024 lawsuit.

What Did the State Say?

In January 2025, DODD's own lawyers told the Supreme Court of Ohio that the guidance requiring parent replacement searches is "not a mandatory obligation," that the expectation to conduct these searches is "aspirational rather than mandatory," and that the Ohio Administrative Code "does not set a time frame" for parent replacement searches. The searches, in other words, are not legally required, according to the state agency that oversees the counties enforcing them.

Five Counties, Five Different Experiences

Over the past several weeks, End Ohio's Parent Penalty collected stories from families across Ohio. Every family requested anonymity due to fear of retaliation against their children's services, a fact that is itself worth noting.

One county posted an online advertisement of the child without the parent's knowledge, identified twelve applicants, told the parent she must call all of them, then abruptly ended the search without replacing anyone after admitting "conversations are happening" about discontinuing parent replacement searches altogether.

One county told a parent DODD isn’t interested in parent replacement searches anymore and said it would run a performative two-day search just in case anyone ever asked. They appear to have never run the search.

One county required a parent to sign a HIPAA release authorizing her child's protected health information to be sent to online applicants, threatening loss of services if she refused. The release form itself stated: "By Federal law, [County] is not permitted to condition the provision of health care services on whether I sign this document." According to the parent, the county conditioned services on signing the document anyway.

One county, when asked what would happen if the parent refused the search, simply never answered.

One county told a parent that participation is voluntary, that not participating could lead to her disqualification, but that services would continue regardless. Voluntary and mandatory at the same time.

Five counties. Five completely different approaches to parent replacement searches. No consistent process, no consistent consequences, no consistent standards for how or even whether to replace disabled children’s long-time care workers with strangers.

What Void for Vagueness Means

We recently filed a federal lawsuit challenging the constitutionality of the “no other willing and able” rule. Courts have long held that when a regulation fails to give clear notice of what is required or allows officials to apply it arbitrarily, it may be challenged as “void for vagueness.” What we found across Ohio is vagueness in practice — the same rule used to justify posting a child's private medical information without consent in one county, running a fake provider search in another, apparently violating federal HIPAA law in a third, and doing nothing at all in a fourth. When a rule can be applied differently from county to county with no consistent standards, families may have no reliable way to know what the law actually requires.

What Families Can Do

DODD told the Supreme Court of Ohio the parent replacement searches are not mandatory. That filing is publicly available in Case No. 2024-1724. The OAC specifies no consequences for refusal. If your county board claims there are consequences, ask them in writing to identify the specific consequences and the specific statute or rule. Document everything. Your child has due process rights as a Medicaid recipient, and if your county board will not tell you what they are, that refusal is itself worth documenting.

You and your child deserve accurate information about what the law does and does not require, so you can keep your child safe. If you have experienced a parent replacement search and are willing to share your story, contact us at ohioparentpenalty@gmail.com.

This article is intended for informational purposes and should not be interpreted as legal advice. Families with specific legal questions should consult a qualified attorney.