Ohio’s New Self Determination (SELF) Waiver

The Ohio Department of Developmental Disabilities (“DODD”) will begin implementing the Self Empowered Life Funding (SELF) Waiver in July 2012.    DODD notes, “The SELF waiver is the first DODD-administered waiver that incorporates self-direction, which allows individuals with developmental disabilities to control their individual waiver budget and to direct where and how they receive those services.”

Sources
SELF Waiver rules are at Ohio Administrative Code 5123:2-9-40 to 47.  The SELF Handbook is an easily readable summary of the program.

Scope
DODD is currently projecting services under the SELF Waiver for up to 500 individuals for the first year, 1000 (cumulative) in year two, and 2000 (cumulative) by year three.  Services are available for persons with intensive behavioral needs.

Funding limits: Children (under 22) – $25,000; Adults – $40,000.   Some services have specified funding limits, either alone or in combination.

Covered Services

  • Support Brokerage ($8,000/yr. max.)
  • Functional Behavioral Assessment ($1,500/yr. max.)
  • Clinical/Therapeutic Intervention
  • Remote Monitoring & Equipment ($5,000/yr. max.)
  • Respite: Community & Residential
  • Integrated Employment
  • Participant/Family Stability Assistance
  • Community Inclusion (Personal Assistance, Transportation)
  • Participant-Directed Goods and Services
  • Adult Day Supports
  • Vocational Habilitation
  • Supported Employment – Enclave
  • Non-Medical Transportation

Eligibility
To be eligible, the participant must be

  • Medicaid eligible.
  • Meet eligibility criteria for services from an Intermediate Care Facility for MR (ICF/MR).
  • Willing and able to perform the duties associated with participant direction, including either budget authority or employer authority (or both).
  • Able to have health/welfare needs met through SELF waiver and other available supports.
  • Be in need of at least one SELF waiver service.

A pre-screen tool will be used to assess eligibility.

Alternatives for Participate in Direct Services
Eligible individuals, or their representatives, have two major tools for participation in direct services:

  • Budget authority, which allows participants to allocate and manage budgets for waiver services.
  • Employer authority, which allows participants to manage staff providing waiver services, including hiring, firing, and supervision of employees.  Employer authority may be exercised by Direct Employment or Co-Employment.

Under the Direct Employment model, the participant employs staff directly and is responsible for all taxes, unemployment and workers’ compensation costs, and is legally liable for any employment issues which may arise.

Under the Co-Employment, or Agency with Choice model, a third party takes care of the payroll and legal aspects of the employment relationship, but the participant retains management authority over the staff.

Help for Participants and Families
The waiver allows families/participants to get the services of an independent Support Broker who will act as agent for the participant and assist in navigating the system, selecting providers, coordinating services and facilitating participant direction.   Support Brokers may be paid up to $8,000/yr. at defined rates.  Family members and guardians can provide the service, but cannot be paid if they live with the participant.  All support brokers, whether volunteer or paid, must attend training.

Participants will also have access to state-wide Financial Management Services (“FMS”) to assist in budget and other financial management issues.  The FMS can ensure that persons employed under the co-employment model are paid with proper management of payroll taxes and withholding.  DODD will enter into a contract with a single FMS provider initially.

Service Coordination
The DD Board Service and Support Administrators will be responsible for Level of Care assessment, developing service plans and providing a single point of accountability.

Training Opportunities
DODD has announced that Family Advocate Peggy Martin is collaborating with The Arc of Ohio to provide intensive training for individuals and family members regarding this new waiver, and allows time for families’ comments and questions. For more information on training or to request training, contact Peggy Martin at peggy.martin@dodd.ohio.gov or Gary Tonks of The Arc at arcohio@rrohio.com.

Posted in Blog, Disabilities.