ODDS director outlines Oregon home- and community-based services, waivers and work ahead

The Oregon Office of Developmental Disability Services (ODDS) on Feb. 6 gave the Senate Committee on Human Services a broad informational briefing on Medicaid-funded home- and community-based services (HCBS), eligibility criteria, historical shifts away from institutional care and current implementation priorities.

"We currently serve approximately 38,000 individuals across the state of Oregon with intellectual and developmental disabilities," Dana Hittle, interim director of ODDS, told the committee. Hittle said roughly 25,000 of those individuals are adults and about 12,500 are children; about 28,000 receive services beyond case management. The data she cited were current as of January 2025.

Hittle reviewed the history and legal framework for HCBS, citing the U.S. Supreme Court's Olmstead decision and the 2014 HCBS Settings Rule, and described Oregon's long-term shift from large institutions to community-based settings. She said Oregon was an early adopter of the 1915(c) waiver and later implemented the 1915(k) Community First Choice (the "K plan"), which expanded access to in-home services and carries a higher federal match.

Hittle walked the committee through the state's HCBS authorities and service array, including attendant care, skills training, community transportation, employment supports (including supported employment in partnership with vocational rehabilitation and education), community nursing, and case management. She emphasized person-centered planning, dignity of risk and individualized limitations: if a right (for example, a lock on a bedroom door or access to certain food) is limited, it must be documented as an individual-based limitation, assessed, consented to by the individual or guardian and reviewed annually.

Among current implementation issues, Hittle said ODDS is reviewing the Oregon Needs Assessment (ONA) and completing the final phase of a rate-structure implementation. She said ODDS has launched a life-course redesign of the Individual Support Plan to document individuals' goals and coordinate paid and unpaid supports.

Hittle also described work underway related to the Stabilization and Crisis Unit (SACU). She said ODDS has contracted an external firm to convene work groups that will include people receiving services, families, advocates, providers, SACU staff, legislators and tribal representatives. "There have been no decisions made at the state level about what SACU would be restructured to look like," she said, and added there is no anticipation of layoffs for SACU staff, but the agency needs to study options for meeting complex needs in community settings.

On a possible moratorium on new 24-hour residential placements, Hittle said Medicaid (CMS) had not yet approved the modification; ODDS will publish a frequently asked questions document if the modification is approved. She described an exceptions process ODDS plans to use if a moratorium is put in place; exceptions criteria would include lack of capacity in rural/frontier areas, providers meeting complex needs, individual choice and culturally and linguistically responsive services.

Committee members asked about eligibility rules, whether children with behavioral needs must also have an IDD diagnosis to qualify for certain children's waivers (Hittle said in most cases they do meet IDD criteria, but medically involved/medically fragile waivers rely on clinical criteria and not always an IDD diagnosis), and about case management continuity and workforce turnover. Hittle acknowledged turnover in the case management workforce and said she would provide committee data on case manager continuity that had been requested.

The hearing also included testimony from two people who receive services. Ten-year-old Lena described school, early intervention and future goals; Portland resident Zoe described her supported employment experience with Portland Parks & Recreation, where she works as a camp counselor and preschool assistant and said, "I love being with the little kids and making them smile. I'm proud of it." Committee members thanked both Lena and Zoe for speaking.

Hittle closed by saying ODDS will focus on equitable access, trauma-awareness, transparency, ONA accuracy, completing rate-structure implementation, the life-course ISP redesign and expanding the service array in response to changing needs. She said ODDS will convene and begin work with its contractor immediately on SACU-related work groups.

The committee adjourned after the informational session; no formal committee votes were taken during the ODDS briefing.