Ohio’s Next Budget: What a Change in Medicaid Waiver Funding Could Mean for Developmental Disability Services
Ohio’s Fiscal Year 2028–2029 budget process presents an important opportunity to address one of the greatest financial challenges facing the developmental disabilities system: the rising cost of Medicaid waiver services and the burden placed on local county boards.
Currently, Ohio’s 88 county boards of developmental disabilities are responsible for paying a portion of the nonfederal cost of Medicaid waiver services. These local obligations have grown as provider reimbursement rates increase, more individuals need services, and local revenue struggles to keep pace. Hamilton County DD Services, for example, has reported that its waiver match costs have doubled between 2023 and 2025.
What Could the Transition Look Like?
If Ohio moves toward fully funding the nonfederal share of Medicaid waivers at the state level, the transition could bring several significant changes.
1. The state assumes more financial responsibility. Instead of relying on county boards to contribute local levy dollars toward waiver costs, the state would need to appropriate sufficient funding to cover that obligation. Federal Medicaid funding would continue to play its role; the proposed change concerns who pays the remaining nonfederal share.
2. County boards could redirect local resources. As waiver obligations decrease, boards could have greater flexibility to invest local funds in services that Medicaid waivers may not fully cover, including family support, transportation, early intervention, crisis services, and other community-based needs. The actual impact would depend on the final funding structure and each county’s financial circumstances.
3. Providers could benefit from a more sustainable service system. When county budgets are under pressure, maintaining access to local services becomes increasingly difficult. Relieving the waiver match burden could help county boards preserve other programs and better respond to changing community needs. However, eliminating the local match would not automatically increase provider reimbursement rates or guarantee additional funding for direct support professionals.
4. Implementation would require careful planning. The state would need to determine how much funding to appropriate, how payments would be administered, when the transition would begin, and how existing county funding arrangements would be handled. A phased transition or other safeguards may be needed to prevent disruptions to individuals and providers.
What Does This Mean for RHA?
At Resident Home Association (RHA), we recognize that financial stability is essential to providing consistent, quality services. Individuals with developmental disabilities depend on reliable staffing, safe homes, transportation, community participation, and supports that promote independence.
A more sustainable funding structure could help protect the broader network of services surrounding each individual. It could also give county boards greater capacity to address needs beyond their mandatory waiver obligations.
The important distinction is that shifting the waiver match to the state would change how services are financed—not eliminate the cost of providing them. Ohio must still ensure that funding keeps pace with the actual cost of quality care.
As the FY 2028–2029 budget takes shape, RHA encourages policymakers to consider the long-term effects of funding decisions on individuals, families, county boards, and providers.
A stronger funding system means more than balancing a budget. It means protecting the services, relationships, and opportunities that allow people with developmental disabilities to live meaningful lives in their communities.
