There are a variety of residential services currently in Butler County.  The majority of individuals receiving residential services in Butler County reside in Intermediate Care Facilities for the Mentally Retarded and Developmental Disabled (ICF/MR).  However, throughout the 1990’s the trend and funding has been geared more toward placement into community residential settings.

Residential Facilities

There are five ICF/MR's in Butler County.  These facilities range in size from seven to 119 individuals receiving services.  Butler County also has five facilities identified as Residential Facility Wavier homes.  These are traditional group home settings that range in size from four to six people living together. 

Throughout the years in the 1980's and 1990's, and through the present time, the State of Ohio has seen a dramatic shift in how residential services are provided to individuals.  Facility and group home placements have seen a dramatic decline in being the focus of the kind of service people want.  However, these types of placements continue to be not only an option, but a need for individuals, and the facilities and group homes are generally at maximum capacity.  

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Supported Living

The State of Ohio began an option of providing residential services in the community for individuals instead of the more structured facility or group home setting.  These types of placements were identified as Supported Living.  In essence, it provides whatever kind of support or service a person needs in their family home or in a home in the community.

Supported Living services are generally described as giving the individual what they want or need, and nothing else; whereas a facility placement already has existing services for a large variety of people that not everyone may need.  Supported Living services personalizes the development of an individual's service needs.  The county board is required to monitor and assure each individual's health and safety. 

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What Is A Waiver

The Home and Community Based Waiver Programs are based on the framework of Support Living.  The benefit of Waiver Programs for the state and local governments is that it draws down additional federal dollars for use in serving individuals.

The waiver program is a program that provides funding for residential services to people who choose to live in the community and receive services rather than live in an institutional setting such as an intermediate care facility for the mentally retarded and developmentally disabled.

The waiver program is funded from Federal, State and Local monies.  This program is important for states because with waivers the federal government will pay for approximately 60% of the cost of the service, rather than the state or local county governments being responsible for 100% of the cost of services.  

The Ohio Department of Job and Family Services in conjunction with the Ohio Department of Mental Retardation and Developmental Disabilities request a certain number of "waiver slots" for the entire State of Ohio.  Waivers are then allocated to County Boards by the Ohio Department of Mental Retardation and Developmental Disabilities, based on the population of the county and that counties’ ability to provide the "matching" 40% of the cost of services.  Hence, there are only a certain number of waivers in the state that may be used for individuals who have a developmental disability.

People on a waiver can get the same kind of service as Supported Living (ie: 24 hour staffing per day, a few hours per week, help to handle their money, grocery shopping, doctors appointments, medications, cooking, transportation, equipment, home renovations, etc.)  The county board is authorized to determine what level of support a person needs through their Medicaid waiver; however, individuals and their families are an active participant in developing their plans and services.  .

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Waiver Eligibility 

	Financial - cannot exceed financial savings or monthly income of over $1,500
	Level of Care- must meet 1 to 3 substantial functional limitations, based on the age of the individual per the Ohio Administrative Code. (Such as: self help, communication, self direction, capacity for economic self sufficiency, etc.)
	Must be eligible for County Board Services, and be a resident of the State of Ohio

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Waiver Benefits 

For the person on the waiver program, there are more choices about where they live, whom they live with, and who will provide their direct services.  Being on a waiver automatically qualifies the individual for a monthly Medicaid Card and stops any existing ‘spend down’ for Medicaid. Waiver programs also assist county and state governments financially by helping with the cost of services.

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Types Of Waivers 

Currently in the State of Ohio there are two types of Waiver Programs that serve individuals with mental retardation or other developmental disabilities.  These are the Individual Options (IO) Waiver and the Residential Facility Waiver (RFW).  Both of these programs are in the process of major transition as the State of Ohio is undergoing a significant change with Medicaid reform.  These two waivers provide very similar services.  However, one major difference between the IO waiver and the RFW waiver is that the financial support and services for the IO Waiver are committed to the person.  Whereas the financial support and services for the RFW waiver are committed to the building the person lives in.

NEW WAIVER

On May 1, 2003 the federal government approved a new waiver program for the State of Ohio.  This waiver has been in the planning process for 3 years.  Its focus is to provide limited services to maintain individuals within their family homes and/or provide the families with increased respite services.  It may also assist individuals who reside in the community and need limited supports to maintain their independence.  County Boards who bill CAFS (Medicaid) for their Adults Services program will also see an increase in their CAFS reimbursement when individuals are placed on the Level 1 Waiver.

	A person can get services in their family home or in their own home
	Services could include: recreational/leisure activities, taking to the doctor, helping with bathing, training on skills, transportation, banking, etc.
	There is a funding cost cap of $5,000 per year, per person.....this equals approximately 5 hours of service per week, OR 20 hours of service per month OR 240 hours of service per year...however the person wants or needs to use the hours of staff time
	There is an additional $8,000, one time, cost cap for emergency service needs. Which is approximately 450 hours of staffing over a 3 year time frame
	There is an additional $6,000, one time, cost cap for home renovations or equipment needs that can be utilized over a 3 year time frame

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Priorities for who receives a Waiver

The County Board must follow guidelines outlined in Waiting List law and rule. This means that the Board must provide waiver services to people in the order listed below when funding is available: 

	Emergencies
	Court Order
	For individuals who are 22 years old and over, and are already receiving Supported Living services or Family Resources which is paid for by 100% state and local dollars
	Individuals who are 22 and over and work in a county board day activity or vocational program
	Individuals who are 22 and over who reside with care givers that are aged 60 or more
	Children under the age of 22 who have intensive needs (determined by the county board– only 13 waiver slots available to Butler County )
	Individuals who are 22 and over that have intensive needs (determined by the county board)
	People living in an ICF/MR facility that want to move to the community. (These individuals are identified and approved by the ODMRDD. The Department will pay any matching dollars for these individuals. Only 75 individuals will be selected in the State of Ohio )
	Individuals who have been on previous waiting lists for a waiver, based on chronological order

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Recommendations

With the advent of Medicaid redesign and new waivers being available in the State of Ohio, the Butler County Board of Mental Retardation and Developmental Disabilities has estimated that they may commit to serving up to approximately 150 new individuals on waivers through the years of 2002 - 2004.  The number of individuals will be based on the county board's ability to provide the "matching" dollars for the federal funds which are necessary.

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This page was last updated on January 14, 2005

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