Indiana's Home and Community Based Waivers

Medicaid Waiver services provide individualized supports that help people to live successfully in home and community settings, instead of in institutional settings. This is accomplished by funding therapeutic and other needed supports and services in the home or in other community settings. The Medicaid Waivers make Medicaid funds available as an alternative to institutional care as long as the cost of supporting the individual in the home or community is no more than the cost of caring for the same type of individual within an institutional setting.

Home and Community-Based Waivers were first established in Indiana in 1990. Each of Indiana’s Medicaid Waivers has a fixed number of individuals that can be served in a calendar year. Indiana’s Waiver Program continues to expand and change due to the commitment and belief of many advocates for the citizens of Indiana that quality home and community-based services are a priority.

To be eligible for any of the Medicaid Waivers, an individual must:

Meet Medicaid (also called the Medicaid “State Plan”) income eligibility requirements (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 the assets and resources of the recipient are taken into consideration.); and
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 Foster Care Home in the community; and
The total cost to Medicaid for home-based services cannot exceed the average cost of serving an individual in a long-term care facility.

Currently there are five statewide Medicaid Waiver options for an individual in Indiana. Statewide there are three Medicaid Waivers designated for persons with developmental disabilities and two medical Medicaid Waivers. Each of Indiana’s Medicaid Waivers has a fixed number of individuals that can be served in an approved waiver year.

The three Medicaid Waivers for the developmentally disabled are all accessed through the local Bureau of Developmental Disabilities Services (BDDS) Office in your area. The waiting lists for these three Waivers are kept by the Bureau of Developmental Disabilities Waiver Specialist Supervisor in the Bureau of Developmental Disabilities Central Office. All three Medicaid Waivers for the developmentally disabled must meet ICF/MR Level of Care requirements. ICF/MR Level of Care requires that the disability begins before the age of 22 years and the individual experiences substantial limitations in at least three of the following six areas: self-care, use and understanding of language, learning, mobility, self-direction, and capacity for independent living. Specifically, the three Medicaid Waivers in Indiana for persons with developmental disabilities are:

1. Support Services Waiver. Specific eligibility requirements: diagnosis of a developmental disability and meeting an intermediate care facility level of care (ICF/MR Level of Care). Medicaid eligibility for the Support Services Waiver is based on the disability being expected to last at least 12 months or longer. The individual’s gross income must be below 300% of current maximum Supplemental Security Income benefit. Services offered under this Waiver are allowable up to a maximum of $13,500 a year.

Potential services include: day Services (prevocational services, supported employment follow-along services, day service transportation), adult day services, respite care, crisis intervention, personal emergency response systems and behavior management. Music therapy, physical therapy, occupational therapy, speech/language therapy and psychological therapy are also potential services that may be covered under the Support Services Waiver.

For additional information about the Support Services Waiver, contact the Bureau of Developmental Disabilities Services (BDDS) Central office toll free at 1-800-545-7763 extension 2 or you can check for your county’s local Bureau of Developmental Disabilities (BDDS) District Office listed at the end of this article. You can email your questions to BDDShelp@fssa.in.gov.

2. Autism Waiver. Specific eligibility requirements: the diagnosis of an autism spectrum disorder (including autism, Asperger Syndrome and Pervasive Developmental Disorder Not Otherwise Specified) and meeting an intermediate care facility level of care (ICF/MR Level of Care). The individual’s gross income must be below 300% of current maximum Supplemental Security Income benefit.

Potential services include: respite care, adult day services, personal emergency response systems, environmental modifications, assistive technology, and residential habilitation and support (including residential transportation, health care coordination and training on self-direction, money management, daily living skills, socialization and mobility). The Autism Waiver can cover day services which may include community habilitation and participation services, prevocational services, supported employment follow-along services, and day service transportation. Other potential services that may be covered by the Autism Waiver include music therapy, physical therapy, occupational therapy, speech/language therapy, psychological therapy and applied behavior analysis therapy. The recommended length of treatment for applied behavior analysis therapy is two to three years for children between the ages of two to seven.

For additional information about the Autism Waiver call the Bureau of Developmental Disabilities Services (BDDS) Central office toll free at 1-800-545-7763 extension 2 or you can check for your county’s local Bureau of Developmental Disabilities (BDDS) District Office listed at the end of this article. You can email your questions to BDDShelp@fssa.in.gov.

3. Persons with Developmental Disabilities (DD) Waiver. Specific eligibility requirements: diagnosis of a developmental disability and meeting an intermediate care facility level of care (ICF/MR Level of Care). The individual’s gross income must be below 300% of current maximum supplemental Security Income benefit.

Potential services include: respite care, personal emergency response systems, environmental modifications, medical equipment and supplies and day services which can include community habilitation and participation services, day service transportation, pre-vocational services and supported employment follow-along services. The DD Waiver can also include residential habilitation and support (residential transportation services, health care coordination and other residential services). Music therapy, physical therapy, occupational therapy, speech/language therapy, psychological therapy, and behavior management are also potential services that may be covered under the DD Waiver.

For additional information about the DD Wavier, contact the Bureau of Developmental Disabilities Services (BDDS) Central office toll free at 1-800-545– 7763, extension 2 free or you can check for your county’s local Bureau of Developmental Disabilities (BDDS) District Office listed at the end of this article. You can email your questions to BDDShelp@fssa.in.gov.

Indiana’s two medical Medicaid Waivers are accessed through the local Area Agency on Aging (AAA) for your area. To contact your local AAA, call toll free at 1-800-986-3505. The four medical Waivers are:

Aged and Disabled Waiver. Specific eligibility requirements: diagnosis of a Medicaid defined disability, or being over the age of 65 and meeting nursing facility level of care. The individual’s gross income must be below 300% of the current maximum Supplemental Security Income benefit. Services offered under this Waiver include: case management, homemaker, attendant care, respite care, home modifications, adaptive aids and devices, adult day services, transportation (to and from adult day services only), and home delivered meals. The waiting list is maintained by the Bureau of Aging and In-Home Services. For additional information, call toll free 1-800-545-7763, extension 1 or 1-317-232-7020 within the Indianapolis calling area.
Traumatic Brain Injury Waiver. Specific eligibility requirements: a diagnosis of a traumatic brain injury and meeting nursing facility level of care. The individual’s gross income must be below 150% of the current maximum Supplemental Security Income benefit. Services offered under this Waiver include: case management, homemaker, personal care, respite care, independent living skills training, structured day program, prevocational services, supported employment (for those services determined ineligible through Vocational Rehabilitation), environmental modifications, specialized medical equipment and supplies, personal emergency response systems, adult companion services, residential care, community residential services, speech, hearing and language therapy, physical therapy, occupational therapy, and behavior programming, counseling and training. The waiting list is maintained by the Bureau of Aging and In-Home Services. For additional information, call toll free 1-800-545-7763, extension 1 or 1-317-232-7020 within the Indianapolis calling area.

In Indiana, as of April 2007 there were 9,905 people served on the Autism, DD and Support Services Medicaid Waivers. The waiting lists for the three Developmentally Disabled Waivers are very long. There are also waiting lists for the two medical Medicaid Waivers. As of April 2007 , 13,846 individuals had applied for at least one of Indiana’s five Medicaid Waivers and were not currently receiving any Waiver services.

The number of people that can be served on Medicaid Waiver programs has continued to expand. Regardless, the time on a waiting list can be several years. A person may be eligible for more than one Waiver and should apply for all that are appropriate. Although individuals can only receive one Waiver at a time, some waiting lists are shorter or move faster than others. Efforts continue to be made to expand the number of available slots.

Do not let the length of the waiting lists for these Waiver programs stop you from applying. Applications are prioritized according to the date the application is completed. Applications for all developmentally disabled Medicaid Waivers can be initiated at your local Bureau of Developmental Disabilities Services district office. Applications for the medical Medicaid Waivers can be initiated at your local Area Agency on Aging office regardless of the age of the individual for whom you are applying.

Your local Area Agency on Aging (AAA) should be listed in your phone book or call toll free 1-800-986-3505 to obtain contact information for your local AAA. Ask for the Medicaid Intake Case Manager at your local AAA office. To find the local Bureau of Developmental Disabilities district office for your county, call the state office toll free at 1-800-545-7763, extension 2 or at 1-317-232-7902 within the Indianapolis calling area. All BDDS district offices are listed at the end of this article.

If you think you or a family member needs and qualifies for one of the Waivers (persons with an autism disorder, by definition, can apply for the Autism, DD, and Support Services Waivers), you should persist with the application process even though there is a waiting list. Staff from your local Bureau of Developmental Disability Services office and/or local Area Agency on Aging can be called to mail you the intake application packet. At some point in the process, paperwork is also filled out for Medicaid eligibility at your local Family and Children Services office.

Though Medicaid paperwork must be filled out for any of the Waiver Programs, parental income and resources are disregarded for children less than 18 years of age for all of the Medicaid Waivers. No matter the age of the person with the disability (the recipient), assets and resources of the actual recipient are taken into consideration. Most children under 18 years of age have little or no assets and so it is likely not to affect income eligibility for the majority of the Medicaid Waiver applicants.

In 2007 the Indiana Family and Social Services Administration (FSSA), began two priority Medicaid Waiver programs. As of May 2007, Priority DD (Developmental Disability) Waivers are available to eligible individuals who primary caregiver is 80 years old or older.

As of August 2007, Priority Support Services Waivers are available to eligible young adults 18-24 years old who have left high school. The first group targeted is those who left school after the 2006-2007 school year. Between September 2007- June 2008, other slots will be released to those who have left school and are ages 18-24. Families should contact their local BDDS office to apply for Priority Waiver if either situation scribed applies to them.

Once an individual is granted placement on a Developmental Disabilities, Support Services or Autism Waiver, they will be contacted to complete the Inventory for Client and Agency Planning (ICAP) assessment. This new initiative will expand until all individuals receiving waiver services are participating in the ICAP assessment. Also a Plan of Care (POC) is completed for that individual. The POC, created using the person-centered planning process, lists the specific services and budgeted dollars planned for the waiver recipient to utilize. For a booklet and/or specific information on services funded by each of the Medicaid Waivers, there are some helpful agencies you may want to contact: