In this issue:
- State, County DD Boards Must Take Proper Steps Before Recommending Disenrollment from IO Waiver
- Watch Our Job Openings Page for New Opportunities
- Actions and Results: Case Summaries
- Help us keep the victories coming! Donate online to Disability Rights Ohio
Thanks to the 1999 Olmstead decision, people with disabilities have the right to live in the community. To do this, they often need services that will come to their home. The Medicaid Individual Options (IO) waiver program is designed to provide this help, including assistance with personal care, home modifications, transportation, home-delivered meals, nutrition help, interpreter services, specialized equipment, adult day services and even supported employment. These services help a person stay in the community, rather than living in an institution. However, getting approved for an IO waiver is difficult because there are long and slow-moving waiting lists in each county in Ohio.
Once a person does have an IO waiver, it is very important that the waiver is not taken away because it is extremely difficult to enroll on this waiver again. Being removed from the waiver is called disenrollment.
Sometimes, if a person has not used services under their waiver for more than 90 days, or about three months, the Ohio Department of Developmental Disabilities or the county board of developmental disabilities will request to have that person disenrolled. However, county boards of developmental disabilities have to do things in a specific way, according to Ohio law.
Ohio Administrative Code (OAC) 5101:3-40-01(E)(8) says that the county board must assess a person’s current need for services on the IO waiver if they haven’t used any services in one month. They have to do this within 15 days after the end of the month when the person didn’t use any services. The board then has to discuss the person’s needs with the person and his or her representative. After this discussion, if this board decides no waiver services are needed, they can then recommend the person for disenrollment.
Challenging the decision
Even after the recommendation is made, the decision is not final. The board has to give the person written notice of his or her right to a state Medicaid hearing to challenge the proposed disenrollment. In order to keep IO waiver services throughout the appeal process, it is important to request a hearing within 15 days of the board’s decision. The person can still appeal after 15 days and up to 90 days, but the services will be terminated until the appeal process is finished.
It is important that the county board of developmental disabilities follows all the steps above. If they do not follow each step exactly, the person on the waiver should argue that they cannot be disenrolled until all the steps are followed correctly.
Other reasons for disenrollment
A county board of developmental disabilities or the Ohio Department of Developmental Disabilities (DODD) can also recommend disenrollment from an IO waiver for other reasons. Those reasons include:
- The person is admitted to a nursing facility;
- The person is admitted to an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID);
- >The person is incarcerated;
- There is a significant change in the person’s condition.
However, in all of these situations, OAC 5123:2-9-01(H)(2) says the county board must evaluate the person’s current needs and circumstances and then make a recommendation to the Ohio Department of Developmental Disabilities. Their recommendation may include disenrollment, but disenrollment is not required.
For more information about Medicaid waivers, see the Medicaid page on our website: disabilityrightsohio.org/medicaid.
Looking for a new job? Disability Rights Ohio now has a Job Openings page on our website. Check back for more opportunities as they become available.
Student gets opportunity to finish vocational program
A student who initially was denied the opportunity to complete his final year in a vocational program will now be able to attend the program and will receive additional compensatory services.
The student and his family moved to a new school district while the student, who has developmental and intellectual disabilities, was in the process of completing his final year of his vocational program. The career center the student attended was not part of the new school district, and the new district refused his request to allow him to finish the program at the career center, even though they did not offer a similar program in their district. The parent contacted DRO for assistance in resolving the issue.
A DRO attorney filed a due process complaint on behalf of the student and successfully negotiated for the student to return to the vocational school with provisions for compensatory services.
Client receives service dog with help from DRO
An individual who uses a wheelchair for his disability had submitted a request to the local housing authority for approval to have a service dog to help with retrieval and mobility. However, the client was on a very short timeline because the non-profit organization that offered to supply the dog had set a deadline to receive consent from the housing authority for the service dog. If consent was not given by the deadline, the dog would be offered to another person. The dog was already trained and the client had already bonded with the dog. He contacted DRO to see if they could assist him.
A DRO staff attorney spoke with the client and the source about the matter and negotiated with the deputy director of the local housing authority for a successful resolution. The client was very grateful as he believed that he would have missed this opportunity to receive his service animal without DRO’s intervention.
Housing authority pays to move client into fully accessible home
An individual who had been approved for a wheelchair was denied when she requested a ramp to be installed to enter and exit her home. This denial caused her healthcare provider to refuse to pay for her wheelchair. The local housing authority instead offered her a housing voucher, which wouldn’t resolve her issues because she couldn’t look for other housing or pay for moving. She contacted DRO to receive assistance in getting a ramp for her home and her wheelchair.
A staff attorney reviewed her case and sent a formal request for reasonable accommodations, explaining that their offer of a housing voucher wouldn’t work for the client. The attorney negotiated on behalf of the client for the housing authority to pay the client’s moving expenses and move the client and her son into a much newer, fully accessible house. She is very happy in her fully accessible home.
DRO advises client on request for accommodation at work
An individual who has a physical disability and uses a power chair was denied a request to work from home on a day when extreme weather conditions would have made it dangerous for him to get to work. He was instead made to take a personal day. The client contacted DRO to receive assistance to be able to work from home the next time poor weather makes it dangerous to travel to his office.
A staff attorney provided advice to the client on how to request the accommodation. Ultimately, the client’s doctor recommended the client resign due to exacerbated health issues caused by the stress of his job. When the client applied for unemployment compensation, his former employer challenged his claim, and the attorney advised him on how to proceed to successfully receive unemployment compensation. Also during this time, the former employer was undergoing a Rehabilitative Services Administration review and the client provided input to RSA. The employer lost their RSA funding.
Woman gets information needed to represent herself at state hearing
A client was notified her home healthcare hours were going to be decreased. She filed an appeal within 15 days of the reduction notice, but in the meantime her care hours were reduced. She contacted DRO for assistance in maintaining her waiver hours until her hearing.
A DRO attorney assisted the client with contacting the Bureau of State Hearings (BSH) to receive a continuation of benefits until the hearing, as well as requesting the hearing be conducted by phone and a new hearing date set so that her aide could be present at the hearing. The attorney advised the client about evidence and testimony to present at the hearing and also provided Disability Rights Ohio’s Medicaid FAQ’s. The attorney later spoke with the BSH on behalf of the client to confirm that the hearing would be conducted by phone, provide information to support the request to reschedule the hearing, and ensure the continuation of her benefits. All of these issues were resolved in favor of the client, who now has the information she needs to represent herself at the hearing.
We believe people with disabilities should be allowed to participate in the community and have a say in how they live, just like people who live without a disability. There is always more to do, but we need your help.
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