Cuyahoga County developmental-disability board warns rising Medicaid waiver match could force cuts to non-waiver services

Amber Gibbs, CEO and president of the Cuyahoga County Board of Developmental Disabilities, told the county Health and Human Services and Aging Committee on Oct. 1 that enrollment and per-person costs for Medicaid home-and-community-based waivers have grown substantially and that the board’s local share of those waivers may require new revenue within one to two years.

Gibbs said the board “serve[s] 15,000 people a year” across the lifespan and that roughly 5,100 people in Cuyahoga County are currently enrolled in one of three state waivers: the Individual Options (IO) waiver, the Level 1 waiver and the SELF waiver. She told the committee that last year the board authorized about $473,000,000 in services in Cuyahoga County and that “in 2025, our waiver match expenditure is projected to be almost $88,000,000,” making the waiver match the board’s single largest expense.

The board’s funding structure makes the county responsible for a local match to capture federal Medicaid dollars; Gibbs said about 60% of waiver costs are federally funded and about 40% come from state and local sources, and that the board’s continuous levy is the primary local revenue source. The board’s dedicated levy is a 3.9-mill continuous levy passed in February 2005, Gibbs said.

Why it matters: The board’s local match is legally required and grows as more people use waiver services or per-person costs rise. Gibbs told council members that if local revenue cannot keep pace with the increase in waiver-match…