INDIANA MEDICAID WAIVER PROCESS AND PRIVACY POLICY

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.

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:
1.  self-care;
2. learning;
3. self-direction;
4. capacity for independent living;
5. receptive and expressive language; and
6.  mobility.

Indiana’s Medicaid Waiver Programs: Home and  Community-Based Services  for Adults and Children. 

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.)

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).

• 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.

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.