Indiana’s Medicaid Home and Community-Based Services (HCBS) Waiver program provides individualized supports to assist people, of all ages, to 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 needed home and community-based services.
Waivers fund therapeutic and other needed supports and services. HCBS Medicaid waivers make Medicaid funds available as an alternative to institutional care if 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 the 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/IID) level of care waivers:
• Family Supports Waiver
• Community Integration and Habilitation 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 eligibility requirements.
An individual 18 years old or over must qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals who qualify for Social Security benefits will automatically be eligible for Medicaid.
Eligibility for a child under 18 years old, who does not qualify financially for SSI, requires that once targeted for a Waiver, a separate eligibility determination will be made for Medicaid Waiver services. It is best, to wait until your child is targeted and the BDDS Office tells you to apply for Medicaid. (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);
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 part of its 2021 Budget Bill, the Indiana Legislature included a 14% rate increase for direct support professionals (DSP) through the efforts of partners such as The Arc of Indiana and INARF. The intent of these funds is to support the overall goal of increasing the statewide average DSP wage to $15 an hour. Therefore, the rate increase requires an authorized service provider to use at least 95% of the amount of the increase in the reimbursement rate to pay payroll tax liabilities and to increase the wages and benefits paid to eligible direct care staff.
BDDS values the critical supports that direct support professionals provide therefore are moving to obtain approval to implement the rate increase as soon as possible. If approved by Centers for Medicare and Medicaid Services, the increased rates will be implemented and available in their systems to bill beginning July 19, and retroactively effective to July 1, 2021.
To minimize impact on individuals and families that result from the rate increases, BDDS will also increase the annual cap on the Family Support Waiver annual budgets from $17,300 to $19,614 when these are available in state systems beginning July 19, 2021, to ensure no loss in direct service. BDDS will propose this cap be adopted into the Family Support Waiver in a future waiver amendment to continue to offer this cap increase for individuals on this waiver. Providers will be able to bill their July dates of service to claim the increased rates after the system changes are in place and the FSW cap increase is in place.
The focus of this article is on Indiana’s two Medicaid waivers for persons with developmental disabilities: The Family Supports Waiver and the Community Integration and Habilitation (CIH) Waiver. These are the two waivers most individuals with an autism spectrum disorder might qualify for, as autism spectrum disorders are classified as a developmental disability.
Indiana’s Family Supports Medicaid Waiver (FS waiver)
The Family Supports Waiver is the basic entry point to receive waiver services for a child or adult with a developmental disability (which includes autism spectrum disorders). Applications for the Family Supports Waiver are accepted through the Bureau of Developmental Disabilities Field Services Office (BDDS).
The Family Supports Waiver- Fast Facts:
• Limit of an individual’s budget at $17,300 (to be changed to $19,614);
• Provides a newer 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. The local BDDS office will determine who qualifies.
Below are all services that are approved under Indiana’s Family Supports Waiver as of August 1, 2020:
• Adult Day Services
• Behavioral Support Services
• Case Management
• Day Habilitation – (individual and group)
• Environmental Modifications (A new service to FS waiver as of 8/1/20 with a $15,000 lifetime cap and $500 per year service and repair allowance outside of $19,614 yearly cap.)
• Extended Services (ongoing employment support services)
• Facility Based Support
• Family and Caregiver Training
• Intensive Behavioral Intervention
• Music Therapy
• Occupational Therapy
• Participant Assistance and Care
• Personal Emergency Response System
• Physical Therapy
• Prevocational Services
• Psychological Therapy
• Recreational Therapy
• Remote Supports (A new service to FS waiver as of 8/1/20. Available to teens 14- 17 years old and adults to foster developmentally appropriate independence. The first $500, in a service plan year, is outside of $19,614 yearly cap.)
• Specialized Medical Equipment and Supplies
• Speech/Language Therapy
• Transportation Services: Level 1, 2, and 3
• 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:
1. physical or intellectual disability, cerebral palsy, epilepsy, autism, or condition similar to an intellectual disability;
2. the condition is expected to continue indefinitely;
3. the condition had an age of onset prior to age 22; and
4. the individual needs a combination services.
The six major life activity categories are:
4. capacity for independent living;
5. receptive and expressive language; and
There are three ways to access the application for Medicaid waiver services. You can contact your local Bureau of Developmental Disabilities Services (BDDS) Office and request an Application Packet to apply for the Family Supports waiver. To locate your local Bureau of Developmental Disabilities Services (BDDS) Office, visit their website at at https://www.in.gov/fssa/ddrs/4088.htm. The BDDS state office number is another resource for locating your local BDDS Office: 1-800-545-7763.
As of 2/1/21, the BDDS Gateway online application for services is now available. This application available 24/7, can be used to apply for waiver services and/or group home placement. For further information and to access this online application see: https://bddsgateway.fssa.in.gov.
Waiver application forms, for printing off and submitting, may also be found online by following this link: https://www.in.gov/fssa/ddrs/information-for-consumers/forms/. It is important to submit the Application for Developmental Disabilities Services form (State Form 55068): https://forms.in.gov/Download.aspx?id=10691 along with the following two application forms: the Authorization for Disclosure of Personal Health Information form (HIPAA): https://forms.in.gov/Download.aspx?id=9484 and the Confirmation of Diagnosis 54727 form: https://forms.in.gov/Download.aspx?id=10267.
The Application and two other forms must be returned to the local BDDS Office. The Application and other forms can be submitted in person, by mail, or by fax. Other individuals and/or agency representatives can provide help to complete the application. (See “Additional Information” section below.)
Whether you apply online or fill out the paper forms and submit them keep a copy of your dated waiver application. Also request a receipt to confirm the initial application was received. Save this documentation for your records (along with dated notes when you are in contact with the BDDS office).
After the Application is submitted to the local BDDS Office, intake staff from that office will determine eligibility and preliminary Level of Care (LOC). (** Make sure the “Level of Care Screening Instrument” (LOCSI) is administered by the BDDS Office. It must be administered for an eligible individual, age six and above, to be added to the Wait List.)
After a family member is placed on the Medicaid waiver waiting list through the BDDS Office, you can check their status on the waiting list by using the following portal: https://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 (CIH 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 which may 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/IID).
In addition to the same services approved for the FS waiver (see above), the CIH waiver allows for a larger budget for eligible services and may provide the following additional approved services (as of August 1, 2020):
• Community Transition
• Rent and Food for Unrelated Live-In Caregiver
• Residential Habilitation and Support
• Structured Family Caregiving
• Wellness Coordination
Appeals and Statewide Waiver Ombudsman
If you/your family member has been deemed ineligible, you have the right to appeal the decision. Instructions for the appeal will be included in the denial letter. You need to sign the appeal form and fax, scan or mail it to the Office of Appeals and Hearings, according to the instructions in the denial letter.
Matt Rodway is Indiana’s Statewide Waiver Ombudsman. In this role he receives, investigates, and attempts to resolve complaints and concerns made by or on behalf of an individual with a developmental disability who receives Medicaid Waiver services (Family Supports waiver and the Community Integration and Habilitation waiver). Matt Rodway can be reached by email at firstname.lastname@example.org, and by phone at 317-503-1217 or toll free at 800-622-4484; when prompted press 2.
The Bureau of Developmental Disabilities Services provides several Fact Sheets, available in English, Spanish and Burmese that can be accessed from their Developmental Disability Services page at this link: https://www.in.gov/fssa/ddrs/developmental-disability-services/. There is also a very helpful Family Support Waiver Checklist found on this page which guides you through all the steps of applying, and also the steps once an individual is at the top of the waiting list and is “targeted for services”.
For further help 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. Indiana Family to Family is one such organization. To check on Medicaid Waiver information posted by this organization, visit their website at https://www.inf2f.org/ or call 844-323-4636 for assistance.
The Autism Society of Indiana also has Medicaid Waiver information on their website at: https://www.autismsocietyofindiana.org/. Area Support Coordinators are available across the state that will help families understand the waiver process and provide support in navigating the application process. You can contact them at 800-609-8449 or via email at email@example.com.
Arc of Indiana 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 waiver. Check their website for Medicaid Waiver information https://www.arcind.org/ and/or contact the Arc of Indiana at 800-382-9100 and ask to speak with a Family Advocate.
If you have additional questions that cannot be answered by these sources, 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) Medicaid Waiver
Services covered by the Aged and Disabled Waiver may include: Adult Day Services, Adult Family Care, Assisted Living, Attendant Care and Self- Directed Attendant Care, Case Management, Community Transition, Environmental Modifications, Environmental Modification Assessments, Health Care Coordination, Homemaker, Home Delivered Meals, Nutritional Supplements, Personal Emergency Response System, Pest Control, Respite, Specialized Medical Equipment and Supplies, Structured Family Caregiving, Transportation, and Vehicle Modifications.
• Traumatic Brain Injury (TBI) Medicaid Waiver
Services are covered by the TBI Waiver may include: Adult Day Services, Adult Family Care, Assisted Living, Attendant Care, Behavior Management/ Behavior Program and Counseling, Case Management, Community Transition Services, Environmental Modifications, Health Care Coordination, Homemaker Services, 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 1-800-986-3505 to get the contact information for your local AAA.
Wheeler, M. (2021). Indiana’s Medicaid waiver programs: Home and community-based services for adults and children. Retrieved from https://www.iidc.indiana.edu/irca/articles/medicaid-waiver-programs-home-and-community-based-services-for-adults-and-children.html.