The Montgomery County Board of Developmental Disabilities faces a $8.9 million budget shortfall and says it will need to cut programs and staff amid increased demand and services mandated by the state.
The board had planned to cut 62 full time staff and eliminate many services in its 2025 budget. But Montgomery County commissioners and the Human Services Levy Council responded with $5 million in emergency funds from the human services levy.
County Commissioner Judy Dodge said the emergency money is meant to hold the board over until they find a way to make the original budget work.
“There's no question about it. Your heart goes out to these families that have these children or family members that have developmental disabilities,” Dodge said. “We were able to also discuss with the Human Services Levy Council to give (the board) some sort of breathing room.”
Montgomery County Board of Developmental Disabilities Services Superintendent Pamela Combs said the agency will still have to eliminate, phase out and reduce a number of programs and seven full time employees.
“It's legacy programming that's been in place for decades,” Combs said. “I am hopeful and I am fighting for the funding because it is needed to maintain critical services for people with developmental disabilities.”
Spiking demand
Since 2009, demand for developmental disabilities services has doubled.
Awareness around identifying developmental disabilities has increased, Combs said, creating more demand for their resources. And, as the average lifespan lengthens, so do the needs of people with disabilities.
In 2023, the board announced a fiscal emergency. It calculated an $18 million yearly budget shortfall.
“We knew back in 2019 this is where we would be financially in 2025,” Combs said. “All that information has been shared multiple times, but there didn't seem to be planning in place to help get us to where we needed to be financially.”
Since then, the board has cut costs by allowing staff to work from home, selling property and limiting services its not mandated to provide.
Searching for funding
Combs said the board has pushed for a larger allocation of county funding, a new levy or an update to the existing developmental disabilities levy.
“The responsibility for funding for a DD board in Ohio falls on the commissioners,” Combs said. “They appoint five of our seven board members. They approve our annual budget. They provide the allocations for all of our spending. They're the only entity that can allow us to go on a ballot for a levy.”
Multiple one-time levy allocations and $17 million in American Rescue Plan Act dollars have thus far offset the board’s rising costs.
Dodge said the hope for the $5 million from the human services levy is that it will allow the board to find more funding elsewhere.
“It's only to help, and it's to get them to basically to work at getting more funding from the state and federal government,” Dodge said.
Dodge emphasized the board’s independence.
“We do appoint several of their board members, but they hire their own staff, their own director and all that,” Dodge said. “So, I just want to make it perfectly clear that this is not our agency, but we do work with them.”
Mandated Services
Nearly half of the board’s spending is for services that the state mandates for people with disabilities, through Medicaid waivers. Those pay for things like home aides, shared living and transportation.
Medicaid pays about two thirds of those costs, the county board covers the remaining third.
“If you were to ask either the state or the federal government for additional funds, you would be asking them to alleviate the local funding obligation,” said Adam Herman, CEO of the Ohio Association of County Boards of Developmental Disabilities.
He said typically that only occurs when the county has demonstrated it has done everything possible to find local funding. Usually, by voting on a levy.
“That means it has gone to the voters repeatedly and the voters have said no, and there's no more money to be had at the local level,” Herman said. “This has not occurred in Montgomery County.”
Advocacy at the state level garnered an increase in average hourly wage for providers of waiver covered disability services, from $13.75 to $19 an hour.
“We went to the legislature around this time two years ago and said, 'We are at a breaking point,'” Herman said. “Our system is about to collapse because no one wants to work in our system because the rate that the state pays is not enough.”
Herman said the county boards absorbed 20% of that wage increase. The state incurred the other 80%.
“So the state of Ohio has already put a ton of money into DD services in Ohio,” Herman said. “This was all accounted for when the fiscal projections were run and we knew there might be a county here or there that would need to either make changes in their program or go back to the voters."
Budget breakdown
The Montgomery County board budgeted around $58 million in 2024. It's mainly funded by the county’s shared human services levy.
The board shares that levy funding with departments like Job and Family Services, Human Services Planning and Development, and Alcohol, Drug Addiction & Mental Health Services. It’s allocated by the county commissioners and human services levy council.
And, according to the board, its portion from that levy has remained constant since 2009. The county’s developmental disabilities levy — which generates about $3 million a year — hasn’t been updated since 1977.
The funding structure of Montgomery County’s developmental disabilities board is unique, Herman said.
Commissioner Dodge said the county is looking to the developmental disabilities board to further privatize non-mandated services.
"(Medicaid) will not pay for services that are social services for these individuals with developmental disabilities,” Dodge said. “So what DDS is going to have to do is get outside companies or agencies. Then they can ask for the waiver and get paid and it wouldn't come back on DDS to pay them.”
Ohio’s care model doesn’t support privatization of those services, Herman said.
"At the end of the day, the funding for those services, whether they are provided by the county board directly or provided by a private entity in contract to the county board, they would still have to be paid for by the county," Herman said.
The Montgomery County board was unable to find outside providers for many of the non-mandated services, Combs said, and the county is uniquely prepared to offer them.
Those include things like early intervention, mental health resources and recreation programs.
“A lot of those just will not be able to be replaced,” Combs said. “I believe that people are aware of the need for services. I think it's just been recently that people have understood how tight and challenging our funding has been. We've tried to communicate that, but it just seems with these cuts that it's bringing it to the forefront.”