Waiver
Overview
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 (HCBS) that an
individual needs to avoid institutionalization. Eligibility for all
waiver programs requires the following:
- The recipient would require institutionalization in the absence
of the waiver or other home-based services.
- The total Medicaid cost of serving the recipients on the waiver
(waiver cost plus other Medicaid services) cannot exceed the total
cost to Medicaid that would have been incurred for serving the
recipients in an appropriate institutional setting had the waiver
not been granted. (Note: Services to individual waiver recipients
may cost more than the services in institutional settings. The
total cost of the waiver programs or the average per
capita cost of services to an individual cannot exceed the
equivalent institutional level-of-care costs if waiver did not
exist.)
HCBS Waivers in Indiana
Indiana administers five HCBS waivers and two demonstration
grant waivers through the Indiana
Family and Social Service Administration (FSSA) Division
of Disability and Rehabilitative Services (DDRS), the Division of
Mental Health and Addiction (DMHA), and the Division of Aging (DA). HCBS
waivers and demonstration grants are funded with state and federal
dollars and are approved by the Centers for
Medicare & Medicaid Services (CMS) for a specified
time.
The following waivers, administered by the Division of Aging,
assist individuals who meet nursing facility level of care:
- Aged and Disabled (A&D) Waiver
- Traumatic Brain Injury (TBI) Waiver
The following waivers, administered by the Division of
Disability and Rehabilitative Services, assist individuals who meet
intermediate care facility for the mentally retarded (ICF/MR) level
of care:
- Autism (AU) Waiver
- Developmental Disabilities (DD) Waiver
- Support Services (SS) Waiver
The following demonstration grant waivers help individuals
transition from and/or avoid placement in institutional settings.
Once the demonstration period is complete, and CMS authorizes the
programs, these demonstration grants could transition to HCBS
1915(c) waivers:
- Money Follows the Person (MFP) Demonstration Grant
- Community Alternative to Psychiatric Residential Treatment
Facility (CA-PRTF) Demonstration Grant
Within each HCBS waiver program, there are specific services
that can be accessed to meet individual needs. These services are
submitted by the recipient's case manager to the state agency for
approval and are listed on the individual's Plan of Care
(POC)/Notice of Action (NOA).
Enrolling as a Waiver Provider
Before enrolling as a Medicaid provider, a waiver provider must
be certified by the FSSA Division that administers the waiver.
Waiver providers can be certified to provide multiple waiver
services. Please contact the appropriate division to learn how to
become a certified waiver provider. After certification, the
provider follows the enrollment process for the IHCP.
Note: A provider may qualify for a Medicaid provider number and
a waiver provider number. When a provider is enrolled with Medicaid
and waiver provider identification numbers, Medicaid services must
be billed using the Medicaid provider number, and the waiver
services must be billed using the waiver provider number.
More Information
For more information about HCBS waivers in Indiana, please see
the HCBS Waiver
Provider Manual.