Indiana Medicaid Waivers

There are multiple ways Medicaid offers coverage for those in need of long term care services. Waivers allow individuals who need such services to receive them wherever they like, as opposed to only covering long term care in a nursing facility. Medicaid therefore pays for Home and Community-Based Services (HCBS) by waiving the need to be institutionalized through programs approving certain individuals for coverage. Both adults and children may be eligible for the waiver program. While these are not comprehensive health insurance plans, they do offer a necessary number of services to eligible individuals.

Waiver programs are administered by the Office of Medicaid Policy and Planning, in conjunction with the Division of Aging, the Division of Mental Health and Addiction, and the Division of Disability and Rehabilitative Services. The program works by each division defining care and setting standards for each service and provider to follow, and certifies provider applicants in order to give these services. There are five different waivers through Indiana Medicaid, including:

 

Nursing Facility Level of Care Waivers

This category of waivers is designed to help children and adults whose needs are mostly medical maintain a quality of life that is safe while at home. Encouraging as much independence as possible, these assistance services provide medical care in a person’s home so they may continue a normal life and not endanger themselves.

Aged and Disabled Waiver (A&D)

For individuals who are aged, blind, or disabled, this waiver creates an alternative to living in a nursing home and allows them to receive care in a more comfortable environment. Children and adults alike may benefit from this program, as there is no age requirement to be eligible for this waiver. To qualify for the program, individuals must be aged or disabled, meet Nursing Facility Level of Care, and be eligible for Medicaid based on an income at 300% of the SSI limit. Income for parents of children under 18 is disregarded, and spousal impoverishment is the same as if a spouse was in a nursing facility.

The A&D waiver provides services through supports who help individuals get the care they need and are unable to provide themselves. Services include:

  • Adult Day Service
  • Adult Foster Care
  • Assisted Living
  • Attendant Care
  • Case management
  • Community transition
  • Environmental modifications
  • Health care coordination
  • Homemaking
  • Meal delivery
  • Nutritional supplements
  • Personal Emergency Response System
  • Pest control
  • Respite
  • Self Directed Attendant Care
  • Specialized medical equipment and supplies
  • Transportation
  • Vehicle modifications

 

Traumatic Brain Injury Waiver (TBI)

The TBI waiver offers care for individuals of any age who have experienced an external insult causing a traumatic brain injury, and rely on the type of care that is typically only offered through an institution. In order to qualify for the TBI waiver program, Indiana residents must be aged or disabled, have medical proof of a Traumatic Brain Injury, meet Nursing Facility Level of Care, and have Medicaid-eligible income at or below 300% of the maximum SSI benefit.

Persons with such injuries can receive services such as personal assistance and physical therapy to help acclimate them to living without the help of a nursing facility. These services include:

  • Adult Day Services
  • Adult Foster Care
  • Attendant Care
  • Behavior management and counseling
  • Case management
  • Community transition
  • Environmental modifications
  • Health care coordination
  • Homemaking
  • Meal delivery
  • Nutritional supplements
  • Occupational therapy
  • Personal Emergency Response System
  • Pest control
  • Physical therapy
  • Residential-based habilitations
  • Respite
  • Specialized medical equipment and supplies
  • Speech-language therapy
  • Structured day program
  • Supported employment
  • Transportation
  • Vehicle modifications

 

Eligibility Guidelines for Nursing Facility Waiver

 

Intellectual Disability (ICF-ID) level of care waivers

This category of waivers help individuals with an intellectual disability to gain important skills such as cultivating social relationships, and becoming involved in the community where they live and work. They also help children and adults develop skills  to make social decisions regarding how and where they want to live as well as creating an independent lifestyle.

To qualify for an ICF/ID Waiver, you must qualify for intellectual disability services, diagnosed with an intellectual disability, meet ICF/ID level of care, and have income less than or equal to 300 percent of SSI. Parental income for children under 18 years old is not considered.

 

Community Integration and Habilitation Waiver (CIH)

Formerly the Developmental Disabilities Waiver and Autism Waiver, this program provides medical care that allows people to live in their homes or in community settings. Additionally, it assists such persons who transition from institutions of any sort, whether state-run or otherwise, into a community setting. This is extremely beneficial to qualifying individuals, as they can improve their abilities to communicate, be part of a community, and gain confidence in such traits. Services include:

  • Adult Day Care
  • Behavioral support services and crisis assistance
  • Case management
  • Community-based habilitation (group and individual)
  • Community transition services
  • Electronic monitoring
  • Environmental modifications
  • Facility-based habilitation (group and individual)
  • Facility-based support services
  • Family and caretaker training
  • Intensive behavior intervention
  • Music therapy
  • Occupational, physical, and speech/language therapy
  • Personal Emergency Response System
  • Prevocational services
  • Recreational therapy
  • Rent and food for unrelated live-in caregiver
  • Residential habilitation and support
  • Respite
  • Specialized medical equipment and supplies
  • Structured family caregiving
  • Supported Employment Follow Along
  • Transportation
  • Workplace Assistance

 
Family Supports Waiver (FSW)

Formerly known as the Support Services Waiver, this program offers visiting supports to assist individuals with developmental disabilities who live with their families or in other settings with informal supports. Services covered by the FSW include:

  • Adults Day Care
  • Behavioral support services
  • Case management
  • Community-based habilitation (group and individual)
  • Facility-based habilitation (group and individual)
  • Facility-based support services
  • Family and caretaker training
  • Music therapy
  • Occupational, physical, and speech/language therapy
  • Prevocational services
  • Recreational therapy
  • Respite
  • Specialized medical equipment and supplies
  • Supported Employment Follow Along
  • Workplace Assistance

 

Eligibility Guidelines for ICF/ID Waiver

 

How to Apply

 

Nursing Facilities: Visit your local Area Agency on Aging to apply for a Nursing Facilities level of care waiver. You can locate a center near you by searching the FSSA website.

ICF/ID: Locate the nearest Bureau of Developmental Disabilities Services (BDDS) District Office, and apply for a waiver there. There are 8 locations throughout the state of Indiana.

 

Resources

Indiana Medicaid: Waivers

Apply for Medicaid

Contact Indiana Medicaid

317-713-9627 or 800-457-4584

 

 

 

Sources:

 

1. Indiana Medicaid. “Nursing Facility Waivers”. http://member.indianamedicaid.com/programs–benefits/medicaid-programs/waivers/nursing-facility-waivers.aspx.

2. Indiana Medicaid. “ICF/ID Waivers”. http://member.indianamedicaid.com/programs–benefits/medicaid-programs/waivers/icfmr-waivers.aspx.