Despite Waiting Lists, Medicaid Waivers Go Unused
COLUMBUS, Ohio — People with developmental disabilities often wait months or years to obtain a Medicaid waiver, which they can use to pay for various home- and community-based services.
But despite waiting lists that stretch to tens of thousands of adults and children, there also are many Ohioans — a little more than 900, according to state records — who have received waivers but haven’t used them for at least a year.
The largest share of dormant waivers is in Franklin County, which includes Columbus. Officials with the county board of developmental disabilities say they are reviewing the cases of 384 waiver recipients who haven’t been submitting expenses and could be removed from the popular Medicaid program.
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Cuyahoga County, including Cleveland, by comparison, had 31 on the list.
The tally raises questions about whether county boards such as Franklin’s are making sure recipients meet priority guidelines, said Gary Tonks, executive director of The Arc of Ohio, a membership association and advocacy group for people with developmental disabilities.
“There are waivers being distributed, and I just want to know that they’re being fairly distributed,” Tonks said. “It’s important.”
He and others say there could be many reasons the waivers aren’t being used, from problems finding suitable providers and services to a lack of understanding about how the program works.
Another possibility is that some families did not obtain the waivers primarily for in-home or community services for their children, because a waiver also extends Medicaid health coverage to a child with disabilities — regardless of whether the family has a middle or even high income.
“That’s the gold card,” Tonks said.
He doesn’t begrudge families for seeking the valuable coverage and he said he thinks county motivations are good. “But technically, you’re not supposed to do that. You’re supposed to get a waiver because you need waiver services,” Tonks said.
In a letter sent to county boards last year by the Ohio Department of Developmental Disabilities, the state said it had begun analyzing waiver use.
Ohio’s disabilities waiver system must be compliant with a Medicaid rule that says “waiver programs are not to be utilized for the sole purpose of Medicaid eligibility,” the letter said.
In an emailed statement, the Ohio Department of Developmental Disabilities said county boards “generally do an excellent job with this — 97 percent of waivers statewide are in compliance.”
Still, an update in late February found the number of unused waivers had gone from 826 to 914. Those who don’t start using them could be disenrolled starting July 1, a memo said.
Statewide, some 40,000 people are on waiting lists for one of the waivers administered by the state disabilities department and managed by Ohio’s 88 county disabilities boards.
The needs of recipients vary, as do the types of waivers. A basic-level waiver provides about $5,000 worth of services, such as homemaker assistance and transportation, while a high-option waiver offers more extensive coverage to help people live in their communities instead of institutions.
“Franklin County has been very aggressive about providing families waiver support — more so than any other county,” said Jed Morison, superintendent of the county board of developmental disabilities.
Waivers can help county boards free up money, as the federal government generally pays about 60 percent of the cost of waiver services, with the rest locally funded.
Franklin County has 5,253 waivers, Morison said. Almost all of those on the county’s non-use list are so-called Level 1 waivers, or the waiver with the $5,000 cap, and they largely were given to children.
Some families obtain that basic waiver for intermittent use, for equipment or to pay for respite or camps.
Morison said county officials are following state waiting-list guidelines, which say waivers should first go to those with emergencies, intensive needs, caregivers over 60 or to people — usually adults — whose county-paid services can be refinanced with a federally-funded waiver.
But the non-use numbers bear a closer look, he said. “We, frankly, stood out on the list,” Morison said.
“We’re double-checking it and trying to understand.”
© 2016 The Columbus Dispatch
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