As a courtesy to professionals who are referring patients/clients, CICOA makes available the Professional Intake Form. Please use the guidelines below to ensure that you are making the most appropriate referral for your patients/clients.

  1. CICOA serves the following counties: Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby
  2. CICOA completes assessments for Medicaid (Aged & Disabled and Traumatic Brain Injury) Waivers, CHOICE, Pre-Admission Screenings for Nursing Facility Placement, and Home-Delivered Meals.
  3. Medicaid Waiver eligibility requires the need for direct assistance with at least three(3) Activities of Daily Living, which include bathing, dressing, toileting, medication reminders/administration, ambulation, and transferring. In addition, the individual must be Medicaid eligible under Medicaid Waiver guidelines.
  4. CHOICE eligibility requires the need for direct assistance with at least two(2) Activities of Daily Living. There are financial criteria(monthly income and total assets) that must be met based on household size. The individual must be willing to apply for Medicaid, even if the application will result in a denial.
  5. Home-Delivered Meals through CICOA’s Meals & More program are available to individuals age 60 and over who are homebound and who may have a regular diet. At this time, this program does not offer special diets.
  6. Individuals needing assistance with the Instrumental Activities of Daily Living, which include meal preparation, housekeeping, and transportation, must also meet the criteria for Medicaid Waiver or CHOICE services, as there is no current funding to assist with these needs.
  7. Individuals have the right to refuse any and all services.
  8. CICOA does not make referrals for Physical Therapy, Occupational Therapy, Speech Therapy, or medical testing.
  9. Please fill out the Professional Intake Form completely.
  10. Please notify the client/patient or family member that the referral to CICOA has been made.