Medicaid Waivers
Section 1915(c) of the Social Security Act permits States to offer, under a waiver of statutory requirements, an array of home and community-based services that an individual needs to avoid institutionalization.
Eligibility for all waiver programs requires:
- The recipient must meet Medicaid guidelines.
- The recipient would require institutionalization in the absence of the waiver and/or other home-based services.
- The total Medicaid cost of serving the recipient(s) on the waiver (waiver cost plus other Medicaid services), cannot exceed the total cost to Medicaid for serving the recipient(s) in an appropriate institutional setting(s).
Indiana administers five (5) home and community-based waivers.
Two (2) of the waivers assist individuals who meet nursing facility level of care and they are:
- Aged and Disabled Waiver
The Aged and Disabled Waiver (A&D) is designed to provide an alternative to nursing facility admission for Medicaid eligible persons over the age of sixty-five (65), and persons of all ages with disabilities by providing supports to complement and supplement informal supports for persons who require care in a nursing facility if waiver services were not available. Individuals on this waiver must meet nursing facility level of care. The services available through this waiver are designed to assist participants with remaining in their own homes and communities, as well as to assist individuals residing in nursing facilities to return to community settings, be it their own homes or other congregate community settings such as assisted living.
- Traumatic Brain Injury Waiver
The Traumatic Brain Injury (TBI) Waiver assists Medicaid eligible individuals of any age who have experienced an external insult resulting in a traumatic brain injury, and who requires services ordinarily only available in a nursing facility. Individuals on this waiver must meet nursing facility level of care. This waiver is designed to provide supports such as personal assistance, limited habilitation services, and respite care, as well as limited environmental modifications.
Three (3) of the waivers assist individuals who meet Intermediate Care Facility for the Mentally Retarded (ICF-MR) level of care and they are:
- Autism Waiver
The Autism Waiver provides community supports to Medicaid eligible individuals with Autism, including Autism Spectrum Disorder. Individuals on this waiver must meet ICF-MR level of care. This waiver is designed to provide services for individuals living with family, or in other community settings, in order for individuals to gain and maintain optimum levels of self determination and community integration while allowing flexibility in the provision of those supports.
- Developmental Disabilities Waiver
The Developmental Disabilities (DD) Waiver provides services to Medicaid eligible individuals with developmental disabilities. Individuals on this waiver must meet ICF-MR level of care. The services available through this waiver are designed to assist individuals with remaining in their own homes or in community settings, and assists those individuals who transition from state operated facilities or other institutions to community settings. This waiver is designed to provide support for individuals to gain and maintain optimum levels of self determination and community integration while allowing flexibility in the provision of those supports.
- Support Services Waiver
The Support Services (SSW) Waiver provides support to Medicaid eligible individuals with developmental disabilities. Individuals on this waiver must meet ICF-MR level of care. These individuals may be residing with their families, or in other settings with informal supports.
Should you have any questions about the Medicaid Waiver programs listed above please email Questions@fssa.in.gov.
- Medicaid Waiver Actions
- 450B.pdf - Physician Certification for Long-Term Care Services (instructions included)
- HCBS0003.pdf (1.3 megabytes) - Statement for Freedom of Choice
- HCBS0005.pdf - Notice of Action & Your Appeal Rights as an HCBS Waiver Recipient
- HCBS0007.pdf (1.2 megabytes) - Transmittal for Medicaid Level of Care Eligibility
Applications for Medicaid Waiver services can be initiated statewide at all Area Agency on Aging (AAA) offices, local Vocational Rehabilitation (VR) offices, and Bureau of Developmental Disabilities Services (BDDS) field offices.
