Olmstead Data Collection Tool - Medicaid (Aged, Blind and Disabled)
Target population served: Aged, Blind and Disabled
- Please indicate the target population served by your agency:
- Please outline/describe the array of services provided to the aforementioned target population:
- Early/periodic screening diagnosis & treatment for those under age 21
- Family planning services and supplies
- Inpatient hospital services
- Laboratory and x-ray services
- Nurse midwife services
- Nurse practitioners' services
- Nursing facility and home health services for those age 21 and over
- Outpatient hospital services
- Physicians services and medical & surgical services of a dentist
- Rural health clinic and federally qualified health center services
- Case management services
- Chiropractic services
- Christian Science nurses
- Christian Science sanitariums
- Clinical services
- Dental services, including dentures and partials for adults
- Diagnosis services
- Emergency hospital services
- Eyeglasses
- Hospice care
- Inpatient hospital services for those above age 65 in institutions for mental diseases
- Inpatient psychiatric services for those under age 21
- Intermediate care for the mentally retarded
- Medical social worker services
- Nurse anesthetists services
- Nursing facility services for those under age 21
- Occupational therapy
- Optometry services
- Physical therapy
- Podiatry services
- Prescribed drugs
- Preventive services
- Private duty nursing services
- Prosthetic devices
- Psychological services
- Rehabilitative services
- Respiratory care services
- Screening services
- Speech, hearing, and language disorders
- Transportation services
- Please indicate the statutory authority (federal and/or state) of each target population served by your agency.
- Please indicate the total number of consumers (by target population categories) served by your agency:
- Please indicate the funding source and cost (per consumer) of each of these services provided by your agency:
- Please describe how consumer choice is considered in determining the appropriate placement of each consumer served by your agency:
- What data is collected to insure quality services are provided to the target population?
- Please indicate any services that are not provided statewide (list geographic region):
- Please describe any measures taken (for each target population) by your agency to prevent unnecessary instititionalization:
- Case management
- Respite
- Personal attendant care
- Homemaker
- Home modifications
- Adaptive aids and devices
- Assistive technology
- Adult day care
- Home-delivered meals
- Residential-based habilitation
- Group and/or individual habilitation
- Supported employment
- Pre-vocational services
- Personal emergency response systems
- Family/caregiver training
- Supported living services behavior management
- Extended State Plan services of physical therapy
- Speech therapy
- Occupational therapy
- Transportation
- Please describe any measures used to evaluate the current level of care (e.g. deinstitutional efforts) for each consumer served by your agency:
- Please describe any transition services (including any barriers/gaps) provided to the target population by your agency:
- Please list any needs assessments that have been conducted during the previous three (3) years of this target population:
- Please provide a brief summary of the priorities, barriers, and assets identified by a aforementioned needs assessment:
Indiana Medicaid serves individuals age 65 or older if they meet certain financial criteria. Persons eligible for Medicare Part A, also may qualify to have Medicaid pay their Medicare premiums, co-insurance and deductibles as a Qualified Medicare Beneficiary (QMB). In addition, persons categorized as Specified Low-Income Medicare Beneficiaries (SLMB), or a Qualifying Individual-1 (QI-1) due to Medicare part A eligibility and income may qualify to have Medicaid pay their Medicare part B premiums. Medicaid will also pay a small portion of Medicare Part B premiums for Qualified Individuals-2 (QI-2), a Specified Low-Income Medicare Beneficiary (SLMB), a Qualifying Individual (QI) or a Qualified Disabled and Working Individual.
Medicaid also serves blind and disabled Hoosiers who meet certain criteria. To be eligible for services in the blind aid category, one must meet the criteria used by the federal Social Security Administration. Currently, to be eligible in the disabled category, a person must have a physical or mental impairment, disease or loss that appears reasonably certain to continue throughout the lifetime of the individual without significant improvement and that substantially impairs his/her ability to perform labor or to engage in a useful occupation. Effective January 1, 2001, the disability definition will be expanded to allow health care benefits to be available to individuals who have severe medical conditions that are expected to last for four years or more and prohibit the individuals from working. Blind and disabled recipients may also be eligible for the Medicare-related programs described above, if they are eligible for Medicare.
The Indiana Medicaid Program also provides health care services to members of families with children, as well as pregnant women and children under the Hoosier Healthwise programs.
State Medicaid programs are required to provide certain basic services to members in order to qualify for federal matching funds. In addition, states may also receive matching funds for a variety of optional services approved by the federal government. In SFY 1999, Indiana provided 30 of 34 possible optional programs, making the Indiana Medicaid program one of the most comprehensive in the country.
A list of the mandatory and optional services provided by Indiana Medicaid is as follows:
Mandatory services:
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Optional services:
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For the aged, blind and disabled population, additional services are provided based on the individual’s care setting; i.e. institutional or non-institutional. Long term care services include traditional institutional care provided to Medicaid residents in nursing homes, intermediate care facilities for the mentally retarded (ICFs/MR) and group homes, as well as non-traditional care provided in community settings through the Medicaid home and community based services waiver program. Other services delivered through Indiana Medicaid’s long-term care program include home health care to support the medical needs of individuals who continue to reside in the community and hospice services for persons who are terminally ill.
Section 1902(a)(10) of the Social Security Act
Indiana Code 12-14-15-1
Indiana Code 12-15-2
155,000 recipients were served in SFY 1999. Of those, 72,000 were aged, and 83,000 were blind and disabled. 73,000 of those recipients received long-term care services (please see the table on #5 below).
All services are funded through the Indiana Medicaid Program with the state share being 38.9% of the total amount. Expenditures per aged recipient for SFY 1999 were $12,438.
Expenditures per blind and disabled recipient were $12,643. The following table illustrates the recipients and expenditures by long term care setting.
Expenditures by Service for SFY 1999
| Service | Recipients | Expenditures/Recipient |
|---|---|---|
| Nursing Facility | 52,526 | $14,498 |
| ICF/MR Group Homes (Small and Private) | 5,327 | $43,276 |
| ICF/MR Institutions | 1,067 | $61,403 |
| Waiver | 4,536 | $16,901 |
| Hospice | 1,131 | $17,247 |
| Home Health Care | 9,438 | $ 4,948 |
The Division of Disability, Aging and Rehabilitative Services (DDARS) is the federally-designated Placement Authority for persons who are MR/DD. The Bureau of Aging and In-Home Services oversees the determination of appropriate placement for aged and disabled persons who are at risk of institutionalization. The Office of Medicaid Policy and Planning (OMPP) works with DDARS and the Division of Family and Children to determine consumer eligibility for Medicaid and for institutional and waiver program placements. While OMPP is responsibility for overseeing all Medicaid Programs, issues regarding consumer choice are addressed in DDARS and locally by the area agencies on aging and the Bureau of Developmental Disabilities.
Federal and state law requires nursing home residents to be assessed no less than once each calendar quarter. This assessment is used by the federal and state government to identify quality care indicators. It is also used to determine payment levels for Indiana Medicaid-enrolled nursing facilities. This data has been compiled into a factbook produced by OMPP, providing information not only on services, but also on resident characteristics and needs. OMPP audits all Medicaid-enrolled nursing facilities at least once every fifteen months to assure that services billed were appropriate.
All services are provided throughout the State.
The Medicaid home and community based services waiver programs (HCBS) work to prevent unnecessary institutionalization. The goal of the Medicaid home and community based services waiver programs is to establish a framework that will assist states in identifying persons who are in need of institutionalization in the absence of the home and community-based services waiver program and other community supports. It also seeks to provide a cost-effective, flexible care plan for services to allow at-risk persons to remain in the community for as long as possible.
Indiana has five federally-approved, Medicaid home and community based services (HCBS) waiver programs. These include: Aged and Disabled Waiver; Intermediate Care Facility for the Mentally Retarded (ICF/MR) Waiver; Autism Waiver; Medically Fragile Children’s Waiver and Traumatic Brain Injury Waiver.
The HCBS Waiver program includes the following services in addition to the services already available (e.g., physician, hospital, home health, etc.) to all Medicaid recipients:
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The Medicaid HCBS Waiver program is administered by DDARS and overseen by OMPP.
Level of care needs for each resident of a Medicaid-enrolled institution, applicants, and consumers seeking services from the Medicaid HCBS Waiver program are generally reviewed and determined no less than annually by the OMPP or in limited cases by others who have been delegated level of care authority.
Not applicable.
Not directly applicable to OMPP, however, please see responses to # 7 and # 10 above.
Not directly applicable.
