In the early 1980s a growing national trend moved away from institutional care for the elderly and persons with disabilities in favor of providing home and community-based services. In response, a new Medicaid program “waived” the federal requirement that services be provided in an institution. This allowed Medicaid recipients to receive non-traditional in-home and community-based services, so long as the cost was comparable.
Indiana began offering Medicaid Waivers in 1986 using federal and matching state dollars and today has two categories of waivers. The first, known as Medical Model Waivers, are for children and adults with medical needs and includes the Aged and Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI). The second category, known as Developmental Disabilities Waivers, are for children and adults with intellectual or other developmental disabilities and includes the Autism Waiver, the Developmental Disabilities Waiver, and the Support Services Waiver.
Waivers are used to pay for services from qualified providers of attendant or nursing care services, home modifications (ramps), lifts for vehicles, residential and employment supports, etc., and are intended to help people with disabilities continue to live in their homes and communities instead of being moved to institutional care.
Every state has a maximum number of slots for Medicaid Waivers it can grant in a given year, filled on a first-come, first-served basis. Clients must meet eligibility requirements each year to continue receiving Medicaid and Waiver services.
Around the same time that Indiana began offering Medicaid Waivers, it also developed the CHOICE program. CHOICE, an acronym for Community and Home Options for Institutional Care for the Elderly and Disabled, is a state-funded program under the Division of Aging that provides support to both the elderly and people of any age with a disability to help them live at home or in community-integrated settings.
CICOA’s Unique Role
In Central Indiana, CICOA is the single point of entry for people seeking Medicaid Medical Model Waivers or CHOICE funds. Access to Medicaid Waivers depends on the type of waiver sought and the individual’s eligibility for services. Medical Model Waivers are administered by the Area Agencies on Aging, which means that access to waiver services are initiated through CICOA’s case management program. Developmental Disability Waivers are initiated through the local Bureau of Developmental Disability Services.
To be eligible for Medical Model Waivers, the individual must meet Medicaid requirements and be at risk of institutionalized care. A CICOA case manager will visit the potential client and determine whether the individual is eligible to receive services based on income, level of impairment and the availability of funds. For children with disabilities under the age of 18, parental income and resources are NOT counted when determining financial eligibility.
Once the Medicaid Waiver intake process is complete, ongoing case management can be provided through CICOA or handed off to an independent case manager, if the client so chooses.