Continuing the Improvement of Ohio’s Developmental Disabilities System
Two years ago, Governor Kasich, with the endorsement of the Ohio Legislature made the most significant investment in the history of the Department of Developmental Disabilities, $286 million new dollars.  Much of this funding was used to expand opportunities for Ohioans to live, work, and play in their communities.   Ohio’s investment has attracted positive attention.  The 2016 United Cerebral Palsy report, entitled the Case for Inclusion, ranks Ohio 16th in the nation for community inclusion and integration, and one of the most improved states in the nation.

Executive Budget Proposal and Impact
The Executive Budget continues to prioritize funding for individuals with developmental disabilities and invests $122 million (state and federal) over the next two years to further increase opportunities for individuals who want to live in the community, and also provides additional support for ICFs to meet the needs of their residents with the most complex needs.  

Home and Community Based Services-Waiver System  
The Executive Budget builds on transformational gains made in the last budget, and makes additional investments in programs that support individuals who want to live and work in the community. It invests an additional $22.4 million ($8.5 million state share) in 2018 and $76.8 million ($29.2 million state share) in 2019.
 

• Increases options for individuals who want to avoid or leave an institution. The Executive Budget continues funding to support 1,100 IO waivers that were created in the last budget for individuals who prefer a waiver setting over living in an ICF, and adds approximately new 300 IO waivers in 2019. Final waiver numbers will be adjusted based on demand.  This provision costs $14.7 million ($5.6 million state share) in 2019.
  

 

• Increases options for individuals on a waiting list for community services. The Executive Budget retains funding for 1,800 IO and SELF waivers that were created in the last budget for individuals on waiting lists, and adds approximately 700 new IO waivers and approximately 300 new SELF waivers to further reduce waiting lists. Final waiver numbers will be adjusted based on demand.  This provision costs $3.8 million ($1.4 million state share) in 2018 and $26.8 million ($10.2 million state share) in 2019.
  
  

• Increases waiver reimbursement to cover complex care needs.  Individuals who are dependent in all areas of daily living, require a workforce that is stable and well trained to meet their everyday needs and maximize their quality of life. The Executive Budget incentivizes providers to serve these complex individuals. This provision costs $10.8 million ($4.1 million state share) in 2018 and $12.9 million ($4.9 million state share) in 2019.
  

 

• Increases wages for direct support staff. DODD depends on direct service staff to provide support to over 90,000 individuals in the developmental disabilities system. Providers face increasing challenges to recruit and retain staff. The longevity of staff is critical to providing quality services, enabling individuals to work, live and play in their communities.  Direct support staff with two years’ experience and 60 hours of training will be eligible to receive up to a six percent wage increase. This provision costs $12.9 million ($4.9 million state share) in 2019.
  

• Ensure safety in delegated nursing. Funding will be made available to pay a registered nurse to conduct assessments, provide training, and consult with direct support staff performing health related tasks, delegated by a nurse.
  

 

• Expands cost-saving opportunities for shared living.  Shared Living is a cost-effective and stable alternative to 24-hour shift staffing. The Executive Budget aligns the rates of the two existing shared living services. While this change adds costs to this budget, it provides long-term savings by creating a rate structure that encourages the use of shared living services, rather than relying on costlier staffing models.  This provision costs $7.9 million ($3.0 million state share) in 2018 and $9.5 million ($3.6 million state share) in 2019.
  

 

• Expand technology to support community living. DODD is expanding the use of technology to reduce reliance on direct care staff. Ohio was one of the first states to gain approval from the Centers for Medicare and Medicaid Services for the use of remote monitoring in Medicaid waiver programs. For the past few years, developmental disability providers have been experimenting with remote monitoring technologies. Currently, 170 individuals with a developmental disability rely on remote monitoring technology, and anecdotal reports indicate the use of remote monitoring has resulted in reduced costs and greater satisfaction from both a health and safety perspective. DODD plans to increase the use of remote monitoring to 600 individuals within two years with support from a $500,000 grant from the Ohio Department of Higher Education.
  

• Fund two programs for youth with complex needs. In 2016, DODD entered into a grant agreement with Oesterlen Services for Youth to address growing concerns about youth with complex needs served by multiple state systems, and the need to improve outcomes for those youth and avoid out of state placement, institutionalization in state facilities, and custody relinquishment. This program is now operational and showing positive results. The Executive Budget continues funding for Oesterlen Services for Youth and allows the Department to add an additional provider to serve children with complex needs. This provision provides $2.0 million each year of the biennium in non-Medicaid State GRF.
  

Private Intermediate Care Facilities
Since 2013, DODD has been working with private ICF providers to downsize large ICFs of nine or more beds and convert ICF homes into waiver homes. As a result, the number of ICF residents has decreased 6 percent. However, that means the residents who remain have greater needs. The Executive Budget recognizes this dynamic and proposes to modernize ICF reimbursement to support residents with higher acuity. It invests an additional $2.7 million ($1.0 million state share) in 2018 and $16.2 million ($6.2 million state share) in 2019.

 

• Modernizes ICF reimbursement and increases rates. The ICF reimbursement system is over 20 years old and in need of restructuring. The Ohio General Assembly recognized this need and required DODD to form a stakeholder workgroup to modernize the system. After consulting with the workgroup, the department made the following changes: (1) replace the current Individual Assessment Form with a more objective Developmental Disabilities Profile,  (2) expand the current peer group structure from three to five categories to better align cost structures in direct and indirect categories of reimbursement, (3) implement a fair rental value methodology to replace the current cost-based reimbursement, (4) and collect data necessary to implement a quality incentive payment program in the next biennium. Upon enactment of these changes, the Executive Budget will (5) increase the ICF reimbursement rate 2.5 percent in 2019. This provision costs $13.5 million ($5.1 million state share) in 2019.
  

 

• Increases ICF reimbursement to cover complex care needs. For the past four years the Department has provided an add-on so that children on ventilators could be served in an ICF.  The Executive Budget removes the age requirement so when children become adults they will not be discharged to a hospital or nursing home when they reach adulthood.  This provision costs $2.7 million ($1.0 million state share) in 2018 and $2.7 million ($1.0 million state share) in 2019.