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 obligations, the board would likely have to reduce or eliminate non-waiver programs that are locally funded, such as some early-intervention and family-support programs.

Key details and context

- Waiver counts and costs: Gibbs said the county serves roughly 5,100 people on waivers. She described a divergence among waivers: the IO waiver currently has no hard annual cap and can result in very large per-person costs, while Level 1 and SELF waivers have statutory cost caps of about $62,000 for an adult and $41,000 for a child. Gibbs noted that the IO average cost has risen and at one point she cited an average IO cost of about $146,000 per year.

- Fiscal pressure and timeline: Gibbs said the board’s waiver-match spending is growing faster than other budget lines and projected that “in 2028, we won't be able to pay all of our bills” under current revenue assumptions. She told committee members the board expects it will need an additional revenue source within one to two years to sustain current service levels if trends continue.

- Scope of services and limits: Gibbs described that waivers fund medically necessary home-and-community supports — personal care, community access, transportation for work or activities, employment supports and home modifications — but do not cover housing costs such as rent or utilities. She said waiver eligibility is determined using a state-required standardized needs assessment in the Ohio Administrative Code and emphasized that county boards must first look to local resources before enrolling someone on a waiver.

- Demographics and reach: Gibbs said the county board serves a more diverse population than the general county population and that about half of people open to services are under age 22. She said the board has worked to identify zip codes with lower-than-expected service uptake and has targeted outreach through daycares, preschools, physicians and mailings.

- Workforce and provider capacity: Gibbs said Cuyahoga County has “at least 6 or 700 agency providers and we have a thousand independent providers.” She described statewide wage increases for direct support professionals after the last state budget, which raised average wages from roughly $11 an hour to about $18–$19 an hour, and mentioned local efforts such as Direct Support Professional University (DSPU) and an Employment Collaborative to recruit and credential new workers.

- Training, appeals and compliance: Gibbs described a multi-month onboarding and training program for Service and Support Administrators (SSAs), including state-required modules, shadowing, annual training and continuing professional development requirements. She said families receive copies of the waiver assessment and due-process rights and that appeals are “not very frequent,” estimating appeals at “less than 25 percent” of cases and saying the board’s decisions are upheld in the vast majority of appeals.

Public comment and committee follow-up

Ebony Spano, who identified herself as “a mother and the executive director of grama and move mama's organizing voter economics,” used the public-comment period to request “a public audit of every waiver, including the IO and the self waiver and a racial, zip code breakdown of the recipients for all of those who are on this waiver and their age groups.” Spano also asked whether families are informed when an assessment occurs; Gibbs said families receive a copy of the assessment and are given due-process rights and state hearing options.

Gibbs told the committee that the board collects zip-code data and offered to share it with the committee chair. Multiple council members asked follow-up questions about the board’s timeline for needing additional revenue and about which local programs could face reductions if revenue does not keep pace with waiver-match growth.

Formal committee actions

The committee approved a motion excusing Councilman Sweeney’s absence (moved by Conwell, seconded by Casselberry; voice vote, passed). The committee also approved the minutes from the Sept. 17, 2025 meeting (moved by Schlepper, seconded by Casselberry; voice vote, passed). There was no legislation referred to the committee at this meeting.

Ending

Gibbs offered to return for additional briefings and to provide the committee chair with the board’s zip-code breakdown of people served. Committee members indicated they would continue to watch the board’s fiscal projections and explore possible options for addressing the projected revenue gap.