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Waiting List Assessment Guidance for County Boards

The Ohio Department of Developmental Disabilities (DODD) has been monitoring the implementation of the new waiting list rule, OAC 5123-9-04, since it went into effect on September 1, 2018. In response to common questions from county boards of developmental disabilities, DODD is issuing the following guidance about the Ohio Assessment for Immediate Need and Current Need, also known as the Waiting List Assessment.

Waiting List Assessment

  • OAC 5123-9-04 asks county boards to conduct assessments and not surveys. It is important that the assessor is as objective as possible and records answers to the assessment questions based on observation, documentation, and evaluation of the person. Ideally, this should be done as a face-to-face conversation with the person present (as well as parents or guardians, if applicable).
  • The responses to questions 1 through 3 on the Waiting List Assessment Tool in isolation do not automatically place someone on the waiting list nor exclude them from placement on the waiting list.
  • Determining what waiver services will be employed to meet a person’s needs is secondary to determining the needs and eligibility for waiver enrollment. A person’s desire to receive a specific waiver service should not be considered when completing the Waiting List Assessment. For example, a person’s desire to use Shared Living services should not be considered until it is established by assessment that the person has a need for an Individual Options Waiver.
  • A request for a new assessment should be accompanied by the indication of a change in circumstance. If it is not, the county board is within its rights to ask what the change is before agreeing to reassess. A disagreement with the outcome should go through due process (the offer of hearing rights).
  • A third party reading the results of the Waiting List Assessment, such as a hearing officer, should be able to identify (1) the person’s assessed needs, (2) which of those needs can be addressed with the use of waiver services, and (3) specifically what community-based alternatives are being used to meet those needs (if applicable).

Current Need

  • “Current need” includes assessed needs which are likely to arise within 12 months from the time of the assessment and can be anticipated to require waiver funding to be met. “Current need” can also include assessed needs that exist, and are being met, at the time of the assessment, if it is foreseeably likely that the means by which the need is currently being met will no longer be available within 12 months, and waiver funding will be necessary to meet it. Therefore, placement on the waiting list may offer the person and the county board time to plan together for the likely occurrence of a significant need that requires waiver enrollment.
  • If an event is happening shortly after the end of the 12-month window for determining a person’s current need, it is acceptable to include it in the assessment being completed at that time to allow for planning.
  • Waiting list placement is an indication that the person needs services; however, the need does not necessarily have to be met by enrollment on a waiver. If the need is met through alternative services or alleviated by other circumstances before waiver enrollment occurs, the person should be removed from the waiting list.
  • There is no requirement that a person must be enrolled on a waiver within 12 months of being placed on the waiting list.
  • The Waiting List Assessment is not intended to consider a person’s or family’s desire for lifestyle changes. However, increasing a person’s independence and community participation are appropriate goals. When confronted with appropriate desired changes, such as a family wanting a person to move into his or her own apartment, the assessor should discuss the feasibility of the desired change happening within the next 12 months. Factors like the person’s independent living skills and what waiver services may be needed to support independent living, abilities to finance the desired change, and the availability of other needed resources should be considered.
  • If the feasibility of the desired change is too remote for it to be considered a current need (likely to occur within 12 months), the county board should make achieving the change a focus of other service coordination.
  • It is also important to recognize there are people whose current needs are being met but who would like to have more services or different service arrangements. Additional service requests or desired changes should be included in the individual service plan so the relationship with the service and support administrator, or SSA, is the vehicle that keeps meaningful planning conversations moving forward in these instances.

Natural Supports

  • Natural supports for adults are different than natural supports for minors (younger than 18 years of age).
  • Family members of adults have no legal obligation to provide natural supports.
  • The determination of where the parental obligations for minor children end and where needs created because of a person’s disability begin is challenging and should be determined case by case. The Waiting List Assessment is designed to focus on the needs of the person and should be helpful in making such a determination; however, family dynamics need to be considered. Waiver services should support parents’ efforts to care for their children, not relieve them of their reasonable responsibilities.
  • When family members express the need for additional supports in order for them to continue providing natural supports, a frank and specific conversation should take place to discuss and plan what care they will provide and what additional support/waiver service is required to maintain the family unit. How soon additional supports will be required must also be determined.
  • Once the level of needed supports has been established, it is necessary to have an open, honest, and straightforward conversation regarding the plan to meet the person’s needs if the natural supports currently in place decrease or become unavailable. This can be a difficult conversation, but one that is important for all involved to understand what is expected.
  • The goal is to meet the needs of the person being assessed.

Alternative Community Resources

  • If potential alternative community-based resources are identified and recommended in the Waiting List Assessment as options to meet a person’s immediate or current needs, the county board should follow up to verify the resources are (1) actually available to the person and (2) successfully meeting the person’s needs. The expectation is that if a potential community resource has been explored and ruled out, the assessment should be updated accordingly and the person would remain on the waiting list. Communication with the family needs to be clear so that the person’s needs are met and the necessity to request a hearing is less likely.

DODD Support

  • Heidi Clarke is available for consultation from a clinical perspective. Contact her at 614-466-6187 or heidi.clarke@dodd.ohio.gov.