Understanding Medicaid

Medicaid is a program of the federal government that provides support for certain individuals who meet Medicaid eligibility requirements. The Medicaid program is administered at the federal level by the Center for Medicare and Medicaid Services (CMS). The Franklin County Board of Developmental Disabilities has local Medicaid administrative responsibilities to assist individuals with developmental disabilities.

The Franklin County Board of Developmental Disabilities provides and authorizes services to many individuals who are Medicaid eligible because of limited income and assets due to their disability. Service Coordinators assist individuals and families with the paperwork to become Medicaid eligible.

People who are Medicaid eligible might live in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), which is funded with federal Medicaid dollars and matched with state dollars. Generally, federal funds represent about 60% of costs and “match” funds represent approximately 40%.

An alternative to the ICF/IID program is the Medicaid Waiver program. Based on need, some people have the Individual Options Waiver (IO), some have the Level 1 Waiver and some have the Self-Empowered Life Funding or Transitions Developmental Disabilities Waiver. There are a limited number of waivers that are available so a waiver waiting list is established.

Those who are supported with the IO waiver are assigned a funding range based upon their needs. This funding range is determined by a state designed assessment called the Ohio Developmental Disabilities Profile (ODDP). Once the ODDP is completed and the funding range established, an Individual Service Plan (ISP) is developed with the individual, his or her guardian or other representatives and the service coordinator. This plan, once approved, is then implemented and services are provided. Funds to pay for the services are authorized and paid to providers consistent with the plan and funding range. On rare occasions, individuals may request services that would exceed the funding range. This must go through a special review process called “prior authorization”.

The Level 1 Waiver is also an option for some individuals. This waiver does not include the assessment with the Ohio Developmental Disabilities Profile (ODDP) because it has a funding maximum or cap for most residential services which is fixed at $5,325. Other support, such as emergency services and adaptive equipment can exceed this funding cap in certain circumstances. Funds to pay for the services are authorized and paid to providers consistent with the individual service plan.

The Self Empowered Life Funding (SELF) and the Transitions Developmental (TDD) Waivers are also administered by the Ohio Department of Developmental Disabilities, with support from County Boards of Developmental Disabilities. These waivers have different services and funding that can be explained by the Service Coordination Department at 614-464-2743.

When a person has a Medicaid Waiver, he or she is also eligible to receive a Medicaid card and support for other services such as day habilitation and transportation. When one has a Medicaid card, he or she is eligible for Medicaid coverage for certain medical expenses, such as doctor’s visits, hospital services and medications.

Recognizing that Medicaid policy or rules may change, Medicaid questions should be directed to the Service Coordination Department at 614-464-2743 for the most up to date information.