Indiana’s Medicaid Waiver Programs: Home and
Community-Based Services for Adults and Children
Contributed by Marci Wheeler, M.S.W.
The Indiana Medicaid Home and Community Based Services (HCBS) Waiver program provides individualized supports to assist people, of all ages, live successfully in home and community settings. In the past, Medicaid only paid for long-term care services in an institutional setting, such as nursing facilities and group homes. The waiver program "waives" the necessity of admission into an institution in order for Medicaid to pay for the needed home and community-based services.
Waivers fund therapeutic and other needed supports and services. The HCBS Medicaid waivers make Medicaid funds available as an alternative to institutional care as long as supporting the individual, in the home and/or a community setting is no more than the cost of care within an institutional setting.
Currently there are five statewide Medicaid waiver options for an individual in Indiana. One of those waivers however, is closed and no longer accepting new applicants. The Psychiatric Residential Treatment Facility (PRTF) transition waiver is for children and youth with serious emotional disturbances or serious mental illness who transitioned from the prior Community Alternative to PRTF Grant. As of October 1, 2012, no additional children can apply for or receive waiver services through the PRTF Transition Waiver. The other four Medicaid waiver programs are accepting applications and new individuals.
There are two Medicaid waivers designated for people with developmental disabilities. These are also referred to as Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID) level of care waivers:
• Community Integration and Habilitation Waiver (formerly Developmental Disabilities Waiver and Autism Waiver)
• Family Supports Waiver (formerly Support Services Waiver)
There are also two Medicaid waivers for those whose needs are primarily medical. These are often referred to as Nursing Facility level of care waivers:
• Aged and Disabled Waiver
• Traumatic Brain Injury Waiver
Each of Indiana’s Medicaid Waivers has a fixed number of Individuals that can be served in an approved waiver year. To be eligible for any of the Medicaid waivers, an individual must:
1. Meet Medicaid (also called the Medicaid “State Plan”) income eligibility requirements. This amount adjusts annually based on any changes to SSI and is calculated at 300% of the maximum SSI monthly benefit amount (note: As a result of Senate Bill 30 passed in 1991, parental income and resources are disregarded for children under 18 years for all of Indiana’s Medicaid Waivers; although assets and income in the child’s name are counted); and
2. Meet the criteria required for admission to a long-term care facility even though the
person lives, and will continue to live, in their family home, his/her own home, or a licensed Care Home in the community; and
3. The total cost to Medicaid for home-based services cannot exceed the average cost of serving an individual in a long-term care facility.
Indiana’s Waiver Program continues to expand and change due to the commitment and belief of the state and its many advocates that quality home and community-based services are a priority. As September 2012, there were many changes made to the Medicaid Waivers for persons with developmental disabilities.
This articles focus is on Indiana’s two Medicaid Waivers for persons with developmental disabilities: the Family Supports Waiver and the Community Integration and Habilitation Medicaid Waiver. These are the two waivers most persons with an autism spectrum disorder might qualify for according to the level of care criteria.
Indiana’s Family Supports Medicaid Waiver (FSW)
The Family Supports Medicaid Waiver is the basic entry point to receive waiver services for a child or adult with a developmental disability (which includes an autism spectrum disorder and/or autism, Asperger Syndrome and PDD/NOS). Applications for the Family Supports Waiver (FSW) are accepted through the Bureau of Developmental Disabilities Field Services Office (BDDS).
On September 1, 2012, The Family Supports Waiver replaced the Support Services Waiver. All individuals who received services under the Support Services Waiver as of 9/1/12 now receive services under the Family Supports Waiver.
The Family Supports Waiver- Fast Facts:
• Limit of an individual’s budget at $16,250;
• Provides a new service called Participant Assistance and Care which provides another level of support for the individual in their own home or in the family home;
• Provides Case Management as a distinct activity to waiver participants; and
• Allows eligible individuals ages 18 through 24, who have aged out, graduated, or permanently exited from their school setting, to enter waiver services without waiting, if funded slots are available.
Below are all services that are covered under Indiana’s Family Supports Waiver:
• Case Management
• Adult Day Services
• Prevocational Services
• Supported Employment Follow-Along
• Occupational Therapy
• Physical Therapy
• Psychological Therapy
• Speech/Language Therapy
• Behavioral Support Services
• Community-Based Habilitation – Group
• Community-Based Habilitation – Individual
• Facility-Based Habilitation – Group
• Facility-Based Habilitation – Individual
• Facility-Based Support Services
• Family and Caregiver Training
• Intensive Behavioral Intervention
• Music Therapy
• Participant Assistance and Care
• Personal Emergency Response System
• Recreational Therapy
• Specialized Medical Equipment and Supplies
• Workplace Assistance
Level of Care Eligibility Criteria: Bureau of Developmental Disabilities Services (BDDS)
To be eligible for BDDS programs, an individual must be found to have substantial functional limitations in three or more of six major life activities AND meet all of the following four basic conditions. They include:
• physical or intellectual disability, cerebral palsy, epilepsy, autism, or condition similar to an intellectual disability;
• the condition is expected to continue indefinitely;
• the condition had an age of onset prior to age 22; and
• the individual needs a combination services.
The six major life activity categories are:
• capacity for independent living;
• receptive and expressive language; and
Contact your local Bureau of Developmental Disabilities Services (BDDS) Office and request an Application Packet to apply for the FSW. To locate your local Bureau of Developmental Disabilities Services (BDDS) Office, visit their website at http://www.in.gov/fssa/files/BDDS.pdf. The BDDS state office number is another resource for locating your local BDDS Office: (800) 545-7763.
The Application and all documents requested must be returned to the local BDDS Office. The Application can be submitted in person, by mail, or by fax. Other individuals and/or agency representatives can provide assistance to complete the application.
After the Application is submitted to the local BDDS Office, intake staff from that office will determine eligibility and preliminary Level of Care (LOC). The eligible individual is then added to the Wait List.
After a family member is placed on the Medicaid waiver waiting list though the BDDS Office, you can check their status on the waiting list by using the following portal: http://www.in.gov/fssa/ddrs/4328.htm. To access the information, a consumer or guardian will need to provide the following information: Last four digits of social security number or Dart-ID; first and last name; date of birth, and requestor’s name if not the consumer or guardian.
Once the information is verified, a second page will appear, which will include: Consumer’s address and phone number; Guardian contact information (if applicable); Consumer’s waiver application date(s) and BDDS District Office contact information.
If the consumer or guardian discovers that any of the information is incorrect, they will be able to click on the “Help Desk” link, and an e-mail will be sent to the appropriate people to update and track the information.
* You should contact your local BDDS Office immediately if you have a change in address, telephone number and/or any other contact information.
Community Integration and Habilitation Medicaid Waiver
The Community Integration and Habilitation Waiver is to be used as a "needs based" waiver ONLY for people who meet specific criteria. To move from the Family Supports Waiver onto the CIH waiver, an individual must meet specific eligibility/priority criteria.
Effective September 1, 2012 there is no longer an Autism Waiver or a Developmental Disabilities Waiver (DD Waiver). For those on the DD Waiver, the name changed, as of September 1st, to the Community Integration and Habilitation Waiver (CIH). Those on the Autism Waiver were also transferred to the Community Integration and Habilitation Waiver (CIH).
For those on the Community Integration and Habilitation Medicaid Waiver (CIH) as of 9/1/12:
• Case Management was added as a Waiver service to the CIH Waiver.
• For those with Adult Foster Care services through the CIH Waiver, the name of the service changed to Structured Family Caregiving.
To move onto the CIH waiver, an individual must meet specific priority criteria, which include:
• Death of primary caregiver and no other caregiver available;
• Caregiver over 80 years of age and no other caregiver available;
• Evidence of abuse or neglect in the current placement;
• Extraordinary health and safety risk;
• Eligible individuals transitioning to the community from a nursing facility, extensive support needs homes or state operated facilities;
• Eligible individuals determined to no longer need active treatment in a group home;
• Eligible individuals transitioning from 100% state funded services;
• Eligible individuals aging out of Department of Education, Department of Child Services or supported group living; and
• Eligible individuals requesting to leave a Large Private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID).
Updates to Medicaid Waivers Waiting List Status as of 9/1/12
As of September 1, 2012, ALL on the waiting list for DD and/or Autism Waivers (now combined into CIH Waiver) and Support Services Waiver (now called Family Supports Waiver) were put on the waiting list for Family Supports Waiver according to their earliest application date.
The Division of Developmental Disability and Rehabilitative Services (DDRS) understands that there are individuals who have been waiting for years for Medicaid waivers and who are near the top of the Autism or DD Waiver waiting lists. They want to work with individuals who are in this situation on a case by case basis to determine how they should be served through the FSW or the CIH Waiver.
Waiver Service Case Management: Providers as of 9/1/12
These programs are approved to provide case management as a waiver service as of 9/1/12:
• Advocacy Links, LLC,(574) 229-5065;
• Columbus Medical Services, Inc./The Columbus Organization, (610) 592-0292;
• Indiana Professional Management Group, Inc. (IPMG), (317) 585-5944; and
• Unity of Indiana, (317) 458-0113.
If you/your family member has been deemed ineligible, you have the right to appeal the decision within 33 calendar days of the date of the notice. Instructions about this process can be found at http://www.in.gov/fssa/ddrs/4312.htm.
For further help in understanding Indiana’s two Medicaid Waivers for children and adults with developmental disabilities, and/or assistance in applying for the Family Supports Medicaid Waiver, contact an advocacy organization. Family Voices Indiana is one such organization. To check on Waiver changes posted by FV, visit their website at http://www.fvindiana.org or call (317)944-8982 for assistance.
Arc of Indiana (http://www.arcind.org/) can also be helpful with these types of questions and information. For further help in understanding Indiana’s Medicaid Waivers and/or assistance in applying for the Family Supports Medicaid Waiver, contact the Arc of Indiana at (800) 382-9100 and ask to speak with a Family Advocate.
For the current Division of Disability and Rehabilitative Services 2012 Waiver Manual, please see: http://www.in.gov/fssa/files/DDRS_Waiver_Manual_Fall_2012.pdf. If you have additional questions that cannot be answered by this manual or this article, you can also contact the Bureau of Developmental Disabilities Helpline: BDDSHelp.BDDSHelp@fssa.IN.gov.
Medical Medicaid Waivers
There are two Medicaid waivers that are sometimes referred to a Nursing Facility Waivers. These are waivers that are for children and adults whose primary needs are medical. Some individuals with an autism spectrum disorder may be eligible for one of these two waivers due to chronic medical needs that meet the requirements for a nursing home level of care. As mentioned previously these two waivers are:
• Aged and Disabled (A&D) Waiver
As of July 1, 2013 services covered by the Aged and Disabled Waiver include Adult Day Services, Attendant Care, Case Management, Homemaker, Respite, Adult Family Care, Assisted Living, Community Transition, Environmental Modifications, Health Care Coordination, Home Delivered Meals, Nutritional Supplements, Personal Emergency Response System, Pest Control, Specialized Medical Equipment
and Supplies, Transportation, and Vehicle Modifications. Newly added as of July 1, 2013 are Environmental Modification Assessment and Structured Family Caregiving.
• Traumatic Brain Injury (TBI) Waiver
As of January 1, 2013, the following services are covered by the TBI Waiver: Adult Day Services, Adult Foster Care, Assisted Living, Attendant Care Service, Behavior Management/ Behavior Program and Counseling, Case Management, Community Transition Services, Environmental Modifications, Health Care Coordination, Homemaker, Home Delivered Meals, Nutritional Supplements, Personal Emergency Response Systems Pest Control, Residential Based Habilitation, Respite Care, Specialized Medical Equipment & Supplies, Structured Day Program, Supported Employment, Transportation and Vehicle Modifications.
More information and applications for the A&D and TBI Medicaid Waivers can be obtained by contacting your local Agency on Aging (AAA) office regardless of the age of the individual for whom you are applying. Your local AAA should be listed in your phone book or call toll free (800) 986-3505 to get the contact information for your local AAA. Ask for the Medicaid Intake Case Manager at your local AAA office.