Ohio Medicaid Waivers Explained: Level One, IO, and SELF Waivers for Individuals with Developmental Disabilities
If you or a loved one has a developmental disability, understanding Ohio Medicaid waivers is one of the most important steps toward accessing the services needed to live safely and independently in the community.
Ohio offers three primary Home and Community-Based Services (HCBS) Medicaid waivers for individuals with developmental disabilities: the Level One (L1) Waiver, Individual Options (IO) Waiver, and Self-Empowered Life Funding (SELF) Waiver. Each waiver provides different levels of funding, services, and flexibility based on an individual's unique needs.
In this guide, we'll explain the differences between each waiver, who qualifies, available funding, and how to determine which program may be the best fit.
What Is an Ohio Medicaid Waiver?
A Medicaid waiver allows eligible individuals with developmental disabilities to receive long-term services and supports in their homes and communities instead of living in an institutional setting.
Ohio's developmental disabilities waivers are administered through the Ohio Department of Developmental Disabilities (DODD) in partnership with the Ohio Department of Medicaid and your local County Board of Developmental Disabilities.
These waivers are designed to promote:
Independence
Community inclusion
Employment opportunities
Health and safety
Person-centered planning
Family support
Level One (L1) Waiver
The Ohio Level One Waiver is designed for individuals who need moderate support while continuing to receive assistance from family members or other natural supports.
Who Is the Level One Waiver Best For?
The Level One Waiver is often appropriate for:
Children living with parents
Adults living with family
Individuals with lower to moderate support needs
People who need part-time personal care or community supports
Services Covered
The Level One Waiver may pay for:
Homemaker and personal care
Adult day support
Transportation
Community respite
Employment services
Career planning
Behavioral supports
Assistive technology
Environmental accessibility modifications
Remote supports
Level One Waiver Funding
Annual funding is capped based on age.
Adults (22 and older):
Up to $62,136 annually
Children (under 22):
Up to $41,424 annually
Because funding is limited, services are prioritized based on the individual's assessed needs and person-centered plan.
Individual Options (IO) Waiver
The Individual Options (IO) Waiver provides the highest level of community-based support available through Ohio's developmental disabilities system.
It is intended for individuals with significant medical, behavioral, or personal care needs who require ongoing daily assistance.
Who Benefits from the IO Waiver?
The IO Waiver is often appropriate for individuals who:
Require extensive personal care
Need nursing services
Receive 24-hour staffing
Live independently with paid supports
Have complex behavioral or medical needs
Services Covered
The IO Waiver includes nearly every service available under Ohio's HCBS waiver system, including:
Homemaker personal care
Supported living
Skilled nursing
Adult day services
Transportation
Behavioral support
Employment services
Home modifications
Assistive technology
Community transition services
Shared living
Remote supports
IO Waiver Funding
Unlike the Level One Waiver, the IO Waiver does not have a fixed statewide funding cap.
Instead, funding is determined through an Individual Funding Level (IFL), which is based on:
Medical needs
Behavioral supports
Staffing requirements
Personal care needs
Frequency of services
Individuals with intensive support needs may receive funding that exceeds $200,000 annually, depending on their assessed needs and approved services.
SELF Waiver (Self-Empowered Life Funding)
The SELF Waiver offers participants greater flexibility and control over how their Medicaid funds are used.
Rather than relying primarily on provider agencies, participants can direct many of their own services and hire workers of their choice.
Who Should Consider the SELF Waiver?
The SELF Waiver is ideal for:
Families who want greater flexibility
Individuals interested in self-direction
People comfortable managing an individual budget
Those wanting greater control over service delivery
SELF Waiver Services
Participants may receive:
Personal care
Respite
Transportation
Employment supports
Participant-directed goods and services
Financial management services
Support brokerage
Assistive technology
Community supports
SELF Waiver Funding
The SELF Waiver uses an individualized annual budget based on assessed need.
Participants work with their Service and Support Administrator (SSA) to determine how their approved funding will be used while remaining within their annual budget.
Comparing Ohio Medicaid Waivers
FeatureLevel OneIOSELFSupport NeedsModerateHighModerate to HighAnnual FundingFixed capIndividualizedIndividual budgetSelf-DirectionLimitedOptionalPrimary featureBest ForLower support needsComplex support needsIndividuals wanting flexibilityFamily InvolvementHighVariesHigh
Who Qualifies for an Ohio DD Waiver?
To qualify for an Ohio Medicaid waiver, an individual must generally:
Be eligible for Ohio Medicaid
Meet the developmental disabilities level of care
Require long-term services and supports
Participate in person-centered planning
Be enrolled through their local County Board of Developmental Disabilities
Because waiver availability is limited, some applicants may be placed on a waiting list depending on county resources and eligibility category.
How to Apply for an Ohio Medicaid Waiver
The first step is contacting your local County Board of Developmental Disabilities.
After contacting your county board, you will:
Complete eligibility determination.
Apply for Ohio Medicaid if needed.
Meet with a Service and Support Administrator (SSA).
Complete assessments.
Develop a person-centered service plan.
Receive waiver enrollment when funding becomes available.
Frequently Asked Questions
What is the difference between the Level One and IO Waiver?
The Level One Waiver has annual funding limits and is intended for individuals with moderate support needs. The IO Waiver provides individualized funding for people with significant medical, behavioral, or daily support needs.
Is there a waiting list for Ohio Medicaid waivers?
Yes. Many Ohio counties maintain waiting lists for developmental disabilities waivers. Emergency and priority situations may qualify for expedited enrollment.
Can family members provide services?
Depending on the waiver and the specific service, certain family members may be eligible to provide paid supports. Eligibility depends on Ohio Medicaid and DODD rules.
Which Ohio waiver offers the most flexibility?
The SELF Waiver offers the greatest flexibility because participants direct their own budgets, hire workers, and make many decisions about how services are delivered.
Choosing the Right Ohio Medicaid Waiver
Every individual has different goals, strengths, and support needs. The right waiver depends on factors such as medical needs, daily living assistance, employment goals, family involvement, and the level of independence desired.
Whether you're just beginning the application process or considering a change in services, understanding the differences between the Level One, IO, and SELF Waivers can help you make informed decisions and advocate for the supports that best fit your situation.
Need Help Navigating Ohio's Developmental Disabilities System?
Navigating Medicaid waivers can be overwhelming, especially if you're applying for the first time. Working closely with your County Board of Developmental Disabilities and your Service and Support Administrator (SSA) can help ensure you understand your options, complete the necessary assessments, and develop a person-centered plan that reflects your goals.
The right waiver can provide the services and supports needed to promote independence, community participation, employment, and a higher quality of life for years to come.
