The Montgomery County Board of Developmental Disabilities Services declared a fiscal emergency in 2023. Since then, the county board has received $31 million in emergency funds. Just this year, $4.4 million in cuts have been made at MCBDDS in order to combat a projected deficit in 2026.
MCBDDS Interim Superintendent Kamarr Gage said his agency is working hard to manage expenses and collaborate with the community to serve people with developmental disabilities and their loved ones.
But the financial challenges faced by the MCBDDS aren’t necessarily unique.
Lifelong services, an increase in clients
Medicaid waivers allow adults and children with disabilities and other chronic conditions to receive care in their homes and communities rather than in long-term care facilities, hospitals and other care spaces.
The federal government pays the largest share of waiver costs, with local and state providing match funds — county boards like MCBDDS pay out roughly 37 cents per dollar for these costs. This mandated match totaled more than $26.5 million last year for Montgomery County.
This is a 95% increase from just five years ago.
Roughly a third of people served by the MCBDDS use a waiver for services. Montgomery County’s waiver enrollment has jumped 178% over the past two decades. Since then, the number of people served by the county board has also increased by more than 166%, according to MCBDDS.
Once a person receives a waiver, they are guaranteed this funding for their lifetime as long as they live in Ohio. The Ohio county that granted the initial waiver funding is responsible for continuing to grant the level of waiver funding they authorized, according to the Ohio Department of Developmental Disabilities.
Other rising expenses
Other expenses have increased exponentially over the past couple of years.
Both agency and independent providers make up the workforce known as direct-support professionals. In 2024, state officials mandated a wage increase for these workers, requiring county DD boards to pay an additional dollar per hour for their wages. This brought the average wage for these workers up to $19 per hour.
For Montgomery County, this wage increase has cost the board roughly $4.5 to $5 million annually.
MCBDDS officials have said the increases in these expenses aren’t necessarily bad — awareness and education about developmental disabilities are both growing, and more families are being served in their communities. Workers who do important work are also earning higher wages, too.
“The way the Medicaid program works is that they expect us to assess our population. They identify those needs, and our Medicaid should grow proportionate to those needs,” Gage said.
Ohio has used a waitlist for Medicaid waivers. Each of Ohio’s county boards of developmental disabilities maintained a list of people in their county seeking waiver funding. People were encouraged to get on the wait list in the event they might need waiver-funded services later, according to the Ohio Department of Developmental Disabilities.
That led to people being on the wait list for years without ever having received waiver-funded services. An Ohio Developmental Disabilities Council survey in 2013 found more than half of respondents, who were on the wait list, reported some area of unmet need: medical care, housing, transportation or just having something to do during the day.
Ohio’s rules for the waiver services changed in 2018. County boards of developmental disabilities are now required to take action within 30 days to address a person’s immediate needs. That may include linking the person with community resources, using local funds, enrolling the person in a waiver and more, according to the state developmental disabilities department.
How other counties compare
Statewide, county DD boards are reporting that Medicaid waiver matches continue to be their largest expense — and that expense is growing.
Summit County, which is comparable to Montgomery County in population, reported $36 million in Medicaid costs in 2024. This was the top expense for the Summit County Board of Developmental Disabilities, which reported $81 million in total expenses. Reported revenue that year lagged behind at $69.8 million.
Summit County in 2023 passed a 6-year replacement levy for its DD board. It slightly raised residents’ annual tax payments by $3.58 per month.
Ohio’s most populous county, Franklin, served 6,000 people with developmental disabilities through waiver services in 2023, the year of its most recent annual report. For those services, Franklin County paid out $84 million.
This is up nearly 10% from services paid out the year before, which totaled $77 million. This funding served 5,523 people that year.
The Franklin County Board of Developmental Disabilities also allocated approximately $9.7 million in 2023 to increase the Medicaid-funded hourly wages for direct support professionals.
The Cuyahoga County Board of Developmental Disabilities in its 2023 annual report said medicaid waiver matches were its top expense, taking up nearly 38% of its reported $152 million in expenses. The board reported a little more than $147 million in revenue that same year.
The year before, CCBDD reported that Medicaid service matches were still its largest expense, making up 32.7% of its $135 million in reported expenses.
Hamilton County Developmental Disabilities Services last year served 3,315 people through waivers. Its top expense at $68 million was services funded in the community, which includes Medicaid waivers.
Funding to MCBDDS
The Ohio Department of Developmental Disabilities ranks counties by their local and state financial support, people with developmental disabilities served, waiver costs and supports, and Medicaid capacity. Its most recent ranking in 2022 for revenue per capita saw Franklin County as fifth-highest in the state, followed by Summit (23rd), Hamilton (38th) and Cuyahoga (46th).
Montgomery County trailed far behind at 78th out of 88 counties.
Montgomery County officials approved a $59 million budget for the county developmental disabilities board for 2025, with recent emergency funds of $9.1 million granted to the department to help it maintain state-required reserve funds next year.
The MCBDDS is funded a little differently than other county boards — most receive a bulk of their local funding through property tax levies that they bring before the public every few years. When these levies approach their expiration, county officials can weigh the option of asking their taxpayers to pay more.
“Folks are aware of the growing needs, but at the end of the day, we are not arbitrarily allowed just to kind of run a levy, ask for more millage, to try and raise that,” Gage said. “We’re part of the bigger collaborative of human services. That’s how our community operates, funding that safety net of services.”
The MCBDDS has a 1-mill, continuing property tax levy that provides $3 million in funding annually. Taxes collected from this levy are based on 1977 property values — the year the levy was established.
MCBDDS COO Andrew Kinder said that the board could ask for county approval to bring the levy back to the ballot in the form of a replacement. If that were to pass, the updated levy would generate an additional $9 million annually.
This isn’t something the MCBDDS is considering for this year.
“It is an option, but it definitely is a strategic collaboration that would need to take place,” Kinder said.
But the county’s board of developmental disabilities is a recipient of funding through the combined Human Services Levy, which generates $138 million in funds each year for agencies like Montgomery County Alcohol, Drug Addiction and Mental Health Services; Public Health - Dayton and Montgomery County; Older Adult Services and Montgomery County Children’s Services. That levy is expected to hit the ballot this fall.
MCBDDS’ allotment of Human Services Levy dollars is roughly $28 million per year — just a little more than what the MCBDDS must pay in waiver matches annually.
To balance out its budget, the MCBDDS has cut back on non-mandated services, but many of these programs provide beneficial services, like mental health support or outlets to connect with other people with disabilities. Gage said that for now, collaboration is a priority.
“Every year, we’ve got a commitment. We’re working with leadership to figure this out,” Gage said. “We will get there, it’s just a matter of time.”
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