Review of changes to Indiana’s Medicaid Waiver Program

by Brenda Darrol, family leadership specialist

Family Voices Indiana recognizes that the changes to the DD waiver system are complex and many families are still struggling to understand them. We are planning to get to "the heart of the matter" in a series of blog posts about the developmental waivers.

We're beginning with an explanation of why these changes occurred, and a general overview of the changes. We will  examine some of these issues more closely in the future.

Medicaid Waivers allow individuals with developmental disabilities to receive meaningful and necessary services and supports while living in their home and community. Indiana’s Division of Disability and Rehabilitative Services (DDRS) notes that “waivers may assist an individual to be a part of the community where he/she lives and works, develop social relationships in the person’s home and work communities, develop skills to make decisions about how and where the person wants to live, and to be as independent as possible.” Waivers are funded by Medicaid, a mix of federal and state matching funds; they are a critical
funding source for programs and services for individuals with developmental disabilities.

Section 144 of the 2012/13 Indiana State Budget directed the Division of Disability and Rehabilitative Services to develop a plan to reduce the per capita and aggregate costs of Indiana’s waiver program. After meeting with stakeholder groups, individuals with disabilities, families, and providers, DDRS
produced the 144 Report.
Indiana applied to the Center for Medicare and Medicaid Services (CMS) with proposed changes to its Medicaid Waiver programs and received approval.

Three themes emerged from the 144 Report:

“Increasing employment: Lower the unemployment rate of individuals with developmental disabilities – whether receiving services or not.” Individuals may be directed to other state services like Vocational Rehabilitation. Employment is a broad term and doesn’t necessarily mean paid work. It might be volunteer work that increases skills and relationships.

“Preserving the family unit: Keeping the family unit together longer may be the single most important contributor to long-term sustainability for the DDRS waiver program.”

“Supporting individuals with high-cost/high needs: Serve this population in a more cost-effective and appropriate manner – the percentage of wavier spend on this population is disproportionate to the actual number of individuals that comprise the population.”

You can view our joint training with ASK on the Section 144 report here.

In order to reduce the number of individuals on all waiver waiting lists and to more quickly provide services to families, DRRS made the following changes, effective September 1, 2012:

There are now just two developmental disability-based waivers through the Bureau of Developmental Disabilities Services (BDDS):

• Family Support Waiver (FSW)
• Community Integration and Habilitation Waiver (CIH)

Consumers who were already receiving services through the Autism Waiver or the Developmental Disabilities Waiver will continue to receive their services through the newly-named Community Integration and Habilitation Waiver.

Families who were already receiving services through the Support Service Waiver will continue to receive their services through the newly-named Family Support Waiver.

The Family Support Waiver’s yearly cap increased from $13,500 to $16,250. Case management is added as a waiver service and the cost is now included when planning the budget for services. Participant Assistance and Care (PAC) is a new service that may be accessed under the FSW. PAC is staffing for personal assistance and care in the home.

The Community Integration and Habilitation Waiver will include a new transportation option, and budgets for some individuals will be adjusted at the next annual meeting for their 2013 budget. Case management has been added as a waiver service.

The state now maintains only one wait list for developmental disability-based Medicaid Waivers. Families on the former DD, Autism, and Support Service Wavier waiting lists have been moved to the Family Support Waiver Waiting list using the earliest date they applied for any type of waiver.

The Family Support Waiver will be the point of entry into waiver services; however, the FSW is not a “stepping stone” to the more comprehensive Community Integration and Habilitation Waiver. Individuals will remain on the FSW unless they meet the new needs-based-only criteria for CIH:
the criteria include emergency situations such as: loss of a primary caregiver where there is no other caregiver available; caregivers over the age of 80; evidence of abuse or neglect in current institutional or home placement; and extraordinary health & safety risk.
Other priority criteria for CIH waiver include:
eligible individuals transitioning to the community from a nursing facility, extensive support needs homes, and state operated facilities; eligible individuals determined to no longer need/receive active treatment in Supported Group Living; eligible individuals transitioning from 100% state funded services,
eligible individuals aging out of Department Of Education, Division of Child Services, or Supported Group Living placements, eligible individuals requesting to leave a Large Private Intermediate Care Facility/Intellectual Disability.

DDRS will assess individuals currently living in group homes in the same manner as those living in waiver settings to determine how many individuals with lower Algo scores live in Group Homes, which may not be the best placement. If you have a loved one in a group home, ask about the ICAP assessment
and make sure it, along with the DDP and other measures, is an accurate reflection of your child’s needs.

Providers may voluntarily transition their group homes into waiver settings.

Instead of one state-wide case management company, FSSA approved four companies to provide case management as a waiver service. Families receiving waiver services may choose from Advocacy Links, LLC, The Columbus Organization, Indiana Professional Management Group, or Unity of Indiana. More case management providers may be available in the future.

Families have several web-based state resources for up-to-date Waiver information:

FSSA maintains a Waiting List Web Portal to check an individual’s status on the waiting list. You may also update your contact information. www.in.gov/fssa/ddrs/4328.htm

FSSA posts information and updates on new Medicaid Waiver enrollments here: http://in.gov/fssa/ddrs/3347.htm

You can sign up to receive email updates from DDRS https://public.govdelivery.com/accounts/INSTATE/subscriber/new

And, Family Voices Indiana strives to keep families updated via our blog and listserv.

If you have questions about Medicaid Waivers, please contact us at 317.944.8982.