ICFs and HCBS Waivers

As of October 1st, 2021, county boards of developmental disabilities are required to list the following resources for Intermediate Care Facilities or ICFs.

Intermediate Care Facilities (ICF)

ICF is a short way of saying “Intermediate Care Facility”.

An ICF is a place where someone with a disability can choose to live and get the services that help him/her live their life.

An ICF has staff that can help you 24 hours a day. 


Frequently Asked Questions

A waiver is a way that Medicaid can pay for services to keep you in your home so you do not have to move to a long-term care facility or nursing home. Your home is where you choose to live.

Yes, your local County Board of Developmental Disabilities or the County Department of Job and Family Services (ODJFS) representatives can give you information.

You apply for a waiver at your County DJFS Office. Tell your local County Board of Developmental Disabilities that you have applied, and on what date you applied.

You must need the same level of care as people who live in a long-term care facility, and you must meet the income requirements for Medicaid Waivers.

Each County Board of Developmental Disabilities establishes waiting lists when there are not enough resources to meet the needs of everyone requesting service. If you ask for a service that has a waiting list, a County Board will document your request along with the date and time, and place your name on the list if you would accept the services within the next 12 months.

Waiver Services Definitions

Adaptive and Assistive Equipment / Specialized Medical Equipment and Supplies (Level One)

Adaptive and Assistive Equipment (Individual Options, or IO) / Specialized Medical Equipment and Supplies (Level One) are:

  • Devices, controls or appliances that allow people to do daily living activities or to help them communicate;
  • Items necessary for life support and the supplies and equipment necessary for upkeep; and,
  • Durable and non-durable equipment that is not paid for by the Medicaid State Plan.

Adult Day Support

Adult Day Support services are provided separate from any home or facility in which an individual resides, focus on non-work activities, and include five components:

  • Assessment – may be formal or informal, for the purpose of developing an Individual Service Plan (ISP);
  • Personal Care – includes personal hygiene, eating, communication, mobility, toileting, and dressing;
  • Skill Reinforcement – includes implementing behavioral intervention plans, and help with the use of communication and mobility devices;
  • Training in Self Determination – includes developing self-advocacy skills and acquiring skills that enable an individual to become more independent;
  • Recreation and Leisure – includes supports identified in the ISP that are therapeutic, and help to develop and maintain social relationships and family contacts.

Adult Family Living

Adult Family Living (IO only) is personal care and support services provided to an adult by a caregiver who is related to and lives with the individual receiving the services.

Adult Foster Care / Shared Living

Adult Foster Care, now Shared Living (IO only) means personal care and supportive services (e.g., homemaker, chore, and medication oversight to the extent permitted under state law) provided in a private home by an unrelated, principal care provider who lives in the home and whose primary, legal residence is that home. Adult Foster Care is furnished to adults who receive these services in conjunction with residing in the home, and the services, their associated activities, and skill development approximate the rhythm of life that naturally occurs as part of living in the family home.

Clinical/Therapeutic Intervention

Clinical/Therapeutic Intervention (Self-Empowered Life Funding, or SELF, only) includes services that assist unpaid caregivers and/or paid support staff in carrying out individual treatment/support plans; and are necessary to improve the individual’s independence and inclusion in their community. The service includes:

  • Consultation activities that are provided by professionals in psychology, counseling, and behavior management;
  • Development of a home treatment/support plan, training and technical assistance to carry out the plan and delivery of the services;
  • Monitoring plan implementation

Community Inclusion

Community Inclusion (SELF only) includes supports that promote the individual’s participation in his/her community. The service includes opportunities and experiences that focus on socialization and/or therapeutic recreational activities, as well as personal growth in the home and/or community. Community Inclusion also can include peer support activities and organization of self-advocacy events. It is not meant to cover employment-related services. The scope of this service includes:

  • Personal Assistance: Iin the home and/or the community with life activities.
  • Transportation: Including, but not limited to, transportation in a modified vehicle; transportation provided by operators of commercial vehicles, and mileage reimbursement for an amount up to the federal reimbursable mileage rate.

Community Respite

Community Respite (IO only) means services provided to individuals unable to care for themselves that are furnished on a short-term (60-day) basis because of the absence of or need for relief of those persons who normally care for the individuals. Community Respite shall be provided only outside of an individual’s home in a camp, recreation center, or other place where an organized community program or activity occurs.

Environmental Accessibility Adaptations

Environmental Accessibility Adaptations are changes to a home that enable a person to function with greater independence. Examples include:

  • Installing ramps or grab-bars;
  • Widening doorways;
  • Modifying bathrooms to be wheelchair-accessible; and,
  • Installing specialized electrical or plumbing systems to accommodate medical equipment;

Functional Behavioral Assessment

Functional Behavioral Assessment (SELF only) helps to determine why an individual engages in challenging behavior and how the individual’s behavior relates to the environment. Functional behavioral assessments can provide information to identify:

  • Why the individual engages in the behavior;
  • When the individual is most likely to demonstrate the behavior;
  • Situations in which the behavior is least likely to occur

Home-delivered Meals

Home-delivered Meals (IO only) mean the preparation, packaging, and delivery of one or more meals to people who are unable to prepare or get nourishing meals. The waiver will provide up to two meals a day, seven days a week.

Homemaker/Personal Care

Homemaker/Personal Care is provided to help a person with daily living activities such as personal hygiene, dressing and eating. These services include:

  • Basic personal care and grooming, including bathing, hair care, and help with clothing.
  • Help with medications that are usually self-administered when ordered by a doctor.
  • Household services essential to a person’s good health and comfort, such as changing bed linens.
  • Light cleaning in areas of the home used by the person.
  • Preparation of a shopping list, grocery shopping and meal preparation.
  • Laundry.
  • Other neighborhood errands including going to medical appointments or taking short walks.

Informal Respite

Informal Respite (Level One only) can be provided in a person’s home, the home of a friend or family member of the individual or at sites of community activities.

Institutional Respite

Institutional Respite means the care is provided in a Medicaid-certified Intermediate Care Facility for the Mentally Retarded (ICFMR) or a facility licensed by the Ohio Department of Developmental Disabilities.

Interpreter Services

Interpreter Services (IO only) help a person communicate. People who provide this service help the individual who has a disability (for example, an individual who is deaf) to convey a message as well as feelings or attitudes.

Integrated Employment

Integrated Employment (SELF only) includes supports needed by a participant to acquire and maintain a job in the general workforce at or above the state’s minimum wage.  The service also can provide supports needed by an individual to acquire and maintain an internship or apprenticeship of limited duration. The service has two distinct components:

  • Initial Supports to gain employment and
  • Retention supports to stay employed.

The service may include supports for an individual to achieve self-employment through the operation of a business, but will not provide funding for start-up or business operation expenses.

Non-Medical Transportation

Non-Medical Transportation is a service available to enable waiver participants to obtain transportation to access Adult Day Support, Vocational Habilitation, Supported Employment-Enclave and Supported Employment- Community waiver services, as specified by the Individual Service Plan. Non-medical Transportation is available in addition to the Transportation waiver service, used primarily in connection with the provision of Homemaker/Personal Care Services.

Nutrition Service

Nutrition Service (IO only) is used when people need direction to ensure they are eating the right foods to be healthy. A nutritionist can provide a nutrition care plan that could include an outline of foods to be eaten, conversations about the importance of the foods and counseling about the need for proper nutrition. The nutritionist can be used to teach the person with disabilities, their family, guardian, or others who help with meals.

Personal Emergency Response System

A Personal Emergency Response System (Level One only) is an electronic device that an individual with disabilities uses to get help in an emergency. For example, the system may be a portable “help” button connected to a person’s phone that is programmed to send a signal to a response center when the “help” button is activated.

Participant-Directed Goods and Services

Participant-Directed Goods and Services (SELF only) are services, equipment, or supplies not otherwise provided through this waiver or through the Medicaid State Plan that address an identified need on the ISP (including improving and maintaining the individual’s opportunity for membership in the community). Examples include installing ramps or grab-bars, widening doorways, modifying bathrooms to be wheelchair-accessible, and installing specialized electrical or plumbing systems to accommodate medical equipment. The item or service must:

  • Decrease the need for other Medicaid services;
  • Promote inclusion in the community; or
  • Increase the participant’s safety in the home environment.

Providers of this service do not need to become certified.

Participant/Family Stability Assistance

Participant/Family Stability Assistance (SELF only) is a service that enables the individual to understand how best to support the individual in their home and/or to enhance the individual’s ability to direct their own services. The service only can be utilized by the individual or by family members who reside with the individual. Participant/Family Stability Assistance includes counseling and/or training to accommodate the participant’s disability in the home and to access supports offered in the community.

Remote Monitoring

Remote Monitoring (IO only) means the monitoring of an individual in his or her residence by staff using one or more of the following systems: live video feed; live audio feed; motion sensing system; radio frequency identification (RFID); web-based monitoring system; or other device approved by DODD. The system shall include devices to engage in live two-way communication with the individual being monitored.

Remote Monitoring Equipment

Remote Monitoring Equipment (IO only) means the equipment used to operate Remote Monitoring Systems.

Residential Respite

Residential Respite (IO only) means services provided to individuals unable to care for themselves that are furnished on a short-term (90-day) basis due to the absence of or need for relief of those persons who normally provide care for the individuals. Residential Respite can be provided in an ICF/DD; in a licensed facility; or in a residence (if the provider is an agency provider.)

Social Work

Social Work (IO only) helps a person and their family with emotional problems or social needs that will allow them to live in the community. The counselor or social worker may work on problem-solving, help a person to develop self-help or adaptive skills, or arrange for counseling, or other support services to help ease stress that may be caused by such things as work, families or living situations.

Supported Employment

Supported Employment services are intensive, ongoing supports that help people to perform work in a regular employment setting, including self-employment. Supported Employment does not include sheltered work or other vocational services furnished in specialized facilities. There are two types of Supported Employment services:

  • Enclave: Provided to individuals who work as a team at a single work-site (community business or industry) with ongoing support provided by on-site staff.
  • Community: Provided to individuals who work in an integrated community work setting, along side employees without disabilities, and performing same or similar tasks

Support Broker

A Support Broker (SELF only) assists the individual with the individual’s responsibilities regarding participant direction.  A Support Broker is chosen by the individual and may be paid or unpaid. A Support Broker must have at least an associate’s degree or two year of experience providing support to someone with developmental disabilities.

Support Brokers are considered an “agent of the individual.” A Support Broker’s duties include:  assisting the individual with negotiating rates for independent providers (where applicable); helping the individual to select providers; and assisting with communication/coordination between the individual, their Service and Support Administrator, and the Financial Management Services entity.

The following cannot be a Support Broker:

  • County Boards
  • County Board employees
  • SELF waiver providers (and their employees)
  • Contractors/related entities of SELF waiver providers

Legal guardians, as well as family members who reside with the individual, cannot be paid to provide this service, but may provide it on an unpaid basis. Whether paid or unpaid, before becoming a Support Broker, one must attend training established by DODD.


Transportation enables people to access waiver services and travel to community services, activities, and other resources.

Vocational Habilitation

Vocational Habilitation services are services designed to teach and reinforce habilitation concepts related to work, including responsibility, attendance, task completion, problem solving, social interaction, motor skill development, and safety.

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