At my house, we are always looking for resources we can tap into to help make our foster care, adoption or special needs journey an easier one. And one thing I’d like to discuss today is the Medicaid Waiver.
Now…many people are under the impression that Medicaid (which offers medical coverage up until the age of 18, and is often the insurance for kids in foster care) and Medicaid Waiver are the same thing…but I am here to make sure everyone understands: they are definitely NOT the same.
Waiver requires a separate application process and provides support above and beyond that of regular Medicaid. It goes well-beyond the age of 18. An applicant does not have to be on Medicaid in order to apply (in fact, if they do NOT have it at the time of their Waiver application, they will also receive Medicaid coverage if they are granted Medicaid Waiver). And the type of Waiver a child receives is dependent up on his/her diagnosis.
I have one thing I MUST be clear about: not every child in foster care (or adopted from foster care) will qualify for Medicaid Waiver. But if he/she has any type of diagnosis listed in the descriptions below, I encourage families to go through the application process…or at the very least, read the information below.
So here’s just a little bit about each type of Waiver and how to begin the application process.
First off: there are four different kinds of Medicaid Waivers in Indiana; two are Developmental Disabilities Waivers, and two are Skilled Nursing Care Waivers.
The Developmental Disabilities Waivers are the Family Supports Waiver (FSW) and the Community Integration and Habilitation Waiver (CIH).
Individuals applying for the FSW or the CIH must have an intellectual or developmental disability, or a related condition, that was diagnosed before age 22, and is expected to continue indefinitely and meets the level of care that would otherwise be provided in an Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF/IIDD).
In order to meet level of care, an individual must have substantial functional limitations in at least three of the following six categories:
- Use and Understanding of Language
- Capacity for Independent Living
The income and resources of an adult or child (under 18) receiving waiver services ARE considered in determining financial eligibility. Parental income and resources for children under 18 are NOT considered unless they are seeking Medicaid coverage prior to having a waiver.
The FSW hs a capped annual budget for services of $17,300. The annual budget for the CIH Waiver is based on several things, for instance the individual’s level of need and living situation.
FSW & CIH Medicaid Waiver Service Examples:
- Extended Employment Services
- Behavior Management Participant Assistance and Care (FSW)
- Community Habilitation
- Adult Day Services
- Residential Habilitation (CIH)
- Case Management
- Family and Caregiver Training
- Therapies, including Music and Recreation Therapy
To apply for a Developmental Disabilities Waiver, you can obtain the number for your local Bureau of Developmental Disabilities Services (BDDS) office by calling 800-545-7763. Or you can apply online at https://bddsgateway.fssa.in.gov/.
And now for the Skilled Nursing Care Waivers are Aged and Disabled Waiver (A&D) and Traumatic Brain Injury (TBI) Waiver.
The Aged and Disabled Waiver provides services to Medicaid-eligible persons age 65 and older and persons of all ages who have a substantial disability who would otherwise be admitted to a nursing facility.
The Traumatic Brain Injury Waiver provides services to individuals who have a diagnosis of traumatic brain injury who would otherwise be admitted to a nursing facility or, if diagnosed before age 22, an intermediate care facility for individuals with an intellectual or developmental disability.
In order to be eligible for the A&D or TBI Waiver (for those diagnosed at age 22 or older) an individual must have substantial functional limitations in at least one skilled care need or three of the Activities of Daily Living, such as needing assistance with eating, dressing, mobility, toileting, etc.
The income and resources of an adult or child (under 18) receiving waiver services ARE considered in determining financial eligibility; parental income and resources for children under 18 are NOT considered. Medicaid financial eligibility for individuals receiving the A&D is based on 300% of the Supplemental Security Income (SSI) maximum. Those on the TBI Waiver can receive a maximum of 150% of SSI.
A & D Waiver Service Examples:
- Adult Day Services
- Assisted Living Attendant Care
- Home-delivered Meals
- Specialized Medical Equipment & Supplies
TBI Waiver Service Examples:
- Adult Day Services
- Assisted Living Attendant Care
- Behavior Management
- Residential-Based Habilitation
- Supported Employment
To apply for a Skilled Nursing Care Waiver, you can find the number for your local Area Agency on Aging by calling 800-986-3505. Or you can apply online at https://bddsgateway.fssa.in.gov/.
And now…just a little bit more info to make things easier for you, especially if you’re applying online. You will need (at a minimum) the following information, and you should probably ensure you have all of this at your fingertips before you begin…because once you begin, there is no saving the application and finishing it later. If you stop working on your application for more than 15 minutes, then the system will timeout and you will need to start over. So here’s what you need to get started:
- The applicant’s name
- Social security number
- Date of birth
- Applicant’s current physical address
- Mailing address if it is different from the current physical address
- Applicant’s contact information such as phone and/or email
- The age the applicant was diagnosed with a developmental or intellectual disability
- Brief description of how the disability affects applicant’s daily life
If the applicant is a minor or is an adult that has someone who has been legally designated to help make decisions with/for them the following information will be required:
- Name of legal guardian or legal representative
- Relationship to applicant
- Address of legal guardian or legal representative
- Contact information such as phone and/or email of legal guardian or legal representative
And just a tip: the Bureau of Developmental Disabilities (BDDS) will also ask for some additional info that you are not required to answer, however, your answers can help to improve the services and supports your child received. (They do not use your answers to make decisions about eligibility or access to services.) These questions include:
- If the applicant currently has Medicaid and the number
- Marital Status
- Education information
- Race/Ethnicity information
- Preferred Language
- If the applicant has ever been assessed by Vocational Rehabilitation
A signature from the individual and/or legal guardian/representative will be required at the end of the application, which will serve as signature to pursue BDDS services. At ANY point in the process, you can choose to decline services or stop the application process.
After completion of the application, you’ll receive a confirmation message that it was received, and you’ll be given information on the next steps. And you will be able to download a copy of your application to keep for your personal records.
For any additional questions about the process, or with questions as you go along with the process, you can contact your district BDDS office. To find your district office go to https://www.in.gov/fssa/ddrs/files/BDDS.pdf.
I hope that clears up some misunderstanding about Medicaid Waiver and will encourage those who have a right to additional services to pursue them!