Family Supports HCBS Waiver (FSW)
The Family Supports HCBS waiver provides limited, non-residential supports to individuals with developmental disabilities who live with their families or in other settings with informal supports.
Individuals must meet HCBS waiver eligibility and Medicaid eligibility guidelines in order to be eligible for a Medicaid HCBS waiver. To be eligible individuals must:
- Be diagnosed as having an intellectual disability prior to the age of 22
- Reside in or transitioning into an HCBS-compliant setting (non-institutionalized)
- Have income no greater than 300% of maximum Supplemental Security Income (SSI) amount (parental income for children under 18 years of age is disregarded)
- Meet “ICF/IID level of care”
What is ICF/IID Level of Care?
To be eligible for intellectual disability services, an individual must meet the required "ICF/IID level of care." Level of care is the minimum need an individual must have to be considered eligible for HCBS waiver services. Level of care is evaluated both when you apply and then at least once a year after that. For the purposes of ICF/IID level of care, a person must have a disability that:
- Results in impairment of functioning similar to that of a person who is intellectually disabled, including autism spectrum disorder, epilepsy, cerebral palsy, or a similar condition (other than mental illness)
- Originates before the person is twenty-two (22) years of age
- Has continued or is expected to continue indefinitely
- Substantially limits a person's ability to function normally in society in three of the six major life areas: self-care, receptive and expressive language, learning, mobility, self-direction, and capacity for independent living
- Requires access to 24-hour assistance, as needed
Available Waiver Services
Eligible individuals may receive authorized waiver services in conjunction with Traditional Medicaid. Authorized waiver services may include:
- Adult Day Services
- Behavioral Support Services
- Case Management
- Community-Based Habilitation- Group
- Community-Based Habilitation- Individual
- Extended Services
- Facility-Based Habilitation-Group
- Facility-Based Habilitation-Individual
- Facility-Based Support Services
- Family & Caregiver Training
- Intensive Behavioral Support
- Music Therapy
- Occupational Therapy
- Participant Assistance and Care
- Personal Emergency Response System
- Physical Therapy
- Prevocational Services
- Psychological Therapy
- Recreational Therapy
- Specialized Medical Equipment & Supplies
- Speech/ Language Therapy
- Transportation Services
- Workplace Assistance
The specific services that meet the needs of the individual member are identified by the member’s case manager. These services are submitted by the state agency for approval and are listed on the member’s Plan of Care (POC)/Notice of Action (NOA).
To apply, first, go to your local Bureau of Developmental Disabilities Services (BDDS) District Office. There are 8 BDDS District Offices throughout the State. It is helpful to apply as soon as you identify a need for waiver services.
You must also apply for Medicaid. You can learn more about applying for Medicaid by going to the Apply for Medicaid webpage.
Families waiting for FSW Waiver services are eligible to receive a small amount of Care Giver Support Services (i.e. Respite) each year. Your local BDDS office can provide information and a listing of providers for this service. Contact your local BDDS office directly to find out how to access Care Giver Support funding while waiting for a waiver slot.
To become a Medicaid provider under the FSW Waiver, a provider must first be certified by the Indiana Family and Social Services Administration, Division of Disability and Rehabilitative Services (FSSA/DDRS). Waiver providers can be certified to provider multiple waiver services. To find out more about the enrollment process, visit the Bureau of Developmental Disabilities (BDDS) Provider Services webpage.
After certification, the provider must enroll as an Indiana Health Coverage Programs (IHCP) provider. Visit the IHCP Become a Provider webpage for more information about that process. Note that some providers also offer nonwaiver services within the IHCP. These providers are issued two unique provider identification numbers for billing purposes - one for waiver billing and one for nonwaiver billing. Providers must submit claims using the provider ID number that corresponds to the services rendered and entered on the claim. The waiver services that can be provided to the FSW Waiver member are limited to those listed on the member’s individualized POC/NOA.
For more information about providing FSW Waiver services see the Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers and the Home and Community-Based Services Billing Guidelines provider reference modules.