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Agencies supporting those with developmental disabilities in Lawrence, Washington and Perry counties face financial hardship after levy failures
By: Amanda Pirani
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LAWRENCE COUNTY, Ohio (WOUB/Report for America) — When Ashley Blair’s daughter was a year old, she stopped speaking.
“She wasn’t even saying mom and dad, she had completely quit talking,” she said. “So we knew she was on the spectrum. Way too young to diagnose, but we knew she was.”
Blair said the region doesn’t have many resources for children with special needs. But a program called Early Intervention helped bring therapy and treatment directly to her daughter at home.
“I don’t think she would have made the progress that she made in the amount of time that she did without their resources,” Blair said.
Early Intervention helps children with developmental disabilities and delays until they reach preschool. But funding for the program and others like it could soon be at risk.
That’s because the agency that administers them, the Lawrence County Board of Developmental Disabilities, will go without its primary source of funding this year after voters rejected its levy with 54.19% of the vote.
Lawrence County Board of Developmental Disabilities Superintendent Julie Monroe said the board will be able to operate as normal for one year, before facing a significant financial crisis.
“There’s no other mechanism that we have to get the kind of funding that we need to serve people throughout the lifespan that we’re required to do,” she said.
It’s not the only disability board facing tough decisions after elections last year. In Washington and Perry counties, the boards of developmental disabilities also saw their funding levies fail on the ballot.
Monroe said these levies are typically supported by voters, because they protect a vulnerable population. But in a moment where some are pushing to abolish Ohio’s property taxes altogether, she worries new levies may no longer be a reliable means of funding.
“The voters, they’re done with passing levies,” she said. “We’re not just seeing that in this county. We’re seeing it in other counties across the state. So this is a huge issue.”
What are county boards of developmental disabilities?
In 1967, the state legislature established the current county board system. It was formed largely because of the advocacy of families who wanted to create schools for their relatives with disabilities.
At the time, public school systems could legally turn away students for having a disability.
The boards also created local services as an alternative to caring for people in state-run institutions, which many now consider inhumane.
However, as federal and state laws have evolved to better protect those with disabilities, and the public’s understanding of disabilities has grown, those county systems now provide a much greater range of services to a larger population of residents.
Today, they’re responsible for developmental disabilities services mandated under state and federal law, like early intervention and home-based care, as well as community programs like schools. But funding for many county boards hasn’t increased in over a decade.
Lawrence County relies on a levy still based on 2006 property values. In Washington County, the board tried to replace a levy from 2003, while Perry County’s funding is divided among levies from 2002, 2004 and 2015 property values.
“It’s similar to living on the same paycheck for a decade or more while your household grows,” said Caley Boyden, superintendent of Perry County’s Board of Developmental Disabilities. “Eventually, you either need additional income to keep up, or you’re forced to make cuts to essential expenses.”
How are county boards funded?
The funding for county boards of developmental disabilities is complex but comes down to three streams of revenue: local levies, the state and the federal government. The greatest portion of funding is local.
In Lawrence, Washington and Perry counties, levies provide 50% or more of their income — making ballot failures a significant financial challenge.
Monroe, the Lawrence County board superintendent, said it’s important for voters to understand that county boards of developmental disabilities have no other legal mechanism to fund their services.
“People say, ‘Well do fundraisers or get grants’ but you’re talking about millions of dollars needed,” she said.
She added that there aren’t necessarily grants designed for county board services, and that even if such a grant was earned, it would only provide one-time funds.
Ohio uniquely relies on localized support for health and human services programs, a practice rooted in the state’s culture of home rule.
That’s according to Dylan Armstrong, a policy fellow with Ohio think tank The Center for Community Solutions. With that local control also comes a significant financial responsibility.
“The general thesis … is, with us being a home rule state, and the counties and local governments having so much discretion over laws, rules and what they can control, that the funding should also be coming from the local level,” he said.
Support from the state and federal government largely comes in the form of funds for one of county boards’ largest responsibilities, known as the home-and-community-based services waiver program.
When community resources and conventional Medicaid coverage cannot provide what someone with a disability needs to live safely and independently, they are eligible for care under a waiver.
A Medicaid waiver might cover services like nursing, home-delivered meals and personal care. While this care is typically provided for adults, there are also some children eligible for waiver care.
County boards have reported significant increases in the cost for Medicaid waiver services, but say the amount of funding they receive hasn’t changed.
“That’s where we’ve been hit the hardest,” said Tiffany Neill, superintendent of the Washington County Board of Developmental Disabilities. “We have seen a 156% increase in our waiver match that we have to pay.”
That waiver match refers to the federal-state split when it comes to funding for Medicaid programs. Medicaid services are paid in part by the state government, and then a match is paid by the federal government. The split can fluctuate each year, sitting at about 35-65 between the state and federal government right now.
When it comes to home-and-community-based waiver services, the state’s portion is further divided between county boards and the state, with boards paying about 45% using local levy funds. Waiver funds allocated in the state’s budget are the primary way in which county boards receive state funding.
However, waitlists for waiver care are often long, and county boards cannot leave an individual without care necessary to maintain their health and safety. While county boards can sometimes connect individuals to outside resources, they are often left to absorb costs of essential services not covered by the Medicaid waiver program.
“Here in Washington County, we serve roughly 400 people through our case managers,” said Neill. “However, only roughly two hundred of those are on waivers and get some type of funding, whether that’s in a home or day program.”
Without funding, county boards forced to cut services for those with disabilities
Monroe said she doesn’t judge voters for their choice — but she worries about how it will affect the residents she serves.
The Lawrence County board’s community programs, such as the Open Door School and Early Intervention, will remain open for a year after local school districts and Lawrence County Educational Service Center intervened to provide support.
The Open Door School provides services and education to 56 students with developmental disabilities. Those students were referred to the school by public school districts who said they could not meet the students’ complex needs.
Open Door will remain open until 2027, providing more transition time for its students and local school districts.
The programs were originally slated to end in 2026 as a result of the levy failure.
Monroe said the board’s family support program, which provided special equipment, medical supplies and respite to family caregivers, has already been terminated. The agency has also frozen new enrollment to its waiver services and eliminated two staff positions.
In Washington County, the future of the Ewing School, another local school for those with developmental disabilities, remains to be seen. The board has considered a partnership with the Ohio Valley Educational Service Center but is still exploring all of its available options.
The county’s early intervention team will also see a reduction in staff from nine people to five.
That program is coordinated by the state but administered by county boards. Neill said it’s a critical resource because it can help children improve their long-term abilities before they reach school age.
“We have to hit those young kiddos within those early years to essentially change the trajectory of their disability or delay,” she said.
In Perry County, the failure of an additional levy will have less immediate consequences. The board plans not to fill vacant positions after some expected retirements take place.
But Boyden, the board’s superintendent, said cuts may be a matter of time.
“The unfortunate reality is that additional cuts will eventually be necessary if we cannot secure additional levy funding from property taxes, unless Ohio establishes an alternative funding source for county boards of DD,” she wrote in an email statement.
County boards concerned by future of funding levies
Neill said the Washington board has received approval from the county commissioners to try passing a levy again in May. She’s nervous about the outcome.
“Our concern for May is the fact that our property owners will be getting their property tax bill in April, and they’re going to go and make a vote in May,” she said.
Neill said the board will be performing increased outreach in precincts that voted against the levy in November in the hopes of addressing voter concerns.
Monroe said significant increases in property taxes have left voters wary and unsupportive of levies. Like Neill, she worries any future increases on the ballot would fail again.
“Our field understands that this is a state issue,” Monroe said. “There’s counties that haven’t gotten there yet, but they’re on the way, and there’s going to have to be changes made on the state level in what we’re responsible to fund, because we should be able to provide an early intervention program without worrying about cutting it.”
Across southeast Ohio, more than 30 local levies failed for a variety of public services, from police protection to street repairs. Seventy passed with only a 10% margin.
Armstrong, the policy fellow with The Center for Community Solutions, said the pain county boards and voters are feeling may come back to a state emphasis on local control and funding.
“We’ve continued to see the trend of the funding received by local governments through the state to kind of maybe stay the same, go down a little bit,” he said. “But as we know and as we’ve all experienced, the cost of goods and services have continued to increase. So, it’s … natural that additional revenues would be needed … I don’t think there’s enough voter education to get through the passions that we are witnessing with regards to property taxes. ”
Monroe said the state is aware of the Lawrence County board’s financial status and will be working with the board to determine a future funding plan.
She emphasized that it’s critical the board find a way to continue operations, because people rely on the agency to live healthy and safe lives.
“Someone living alone that has cerebral palsy, that has scoliosis in a wheelchair, you can’t just pull providers out of their home,” she said. “Someone has to take care of that person.”
Amanda Pirani is WOUB’s Report for America Journalist covering Economic Livelihood. For more information about Report for America, you can click here.