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Worthington OH - Home Health FAQs

What is a Medicaid Waiver?

The Medicaid Waiver program began in 1981, in response to the national trend toward providing Home and Community-Based Services (HCBS). In the past, Medicaid paid only for institutionally based long term care services, such as nursing facilities and group homes.

Indiana applies for permission to offer Medicaid Waivers from the Centers” for Medicare and Medicaid Services (CMS). The Medicaid Waivers make use of federal Medicaid funds (plus state matching funds) for Home and Community-Based Services (HCBS’), as an alternative to institutional care, under the condition that the overall cost of supporting people in the home or community is no more than the institutional cost for those people.

The goals of Waiver services are to provide to the person meaningful and necessary services and supports, to respect the person’s personal beliefs and customs, and to ensure that services are cost-effective. Specifically:

Waivers for individuals with a developmental disability assist a person to:

  • Become integrated in the community where he/ she lives and works
  • Develop social relationships in the person’s home and work communities
  • Develop skills to make decisions about how and where the person wants to live
  • Be as independent as possible

DDRS oversees two waiver programs, the Community Integration and Habilitation Waiver andthe Family Supports Waiver.

Community Integration and Habilitation {CIH} Waiver

CIH is a combination of the Autism and the Developmental Disability Waivers and provides services that enable persons to remain in their homes or in community settings and assists transitions from institutions into community settings. This is a needs-based waiver and is designed to provide supports for persons to gain and maintain optimum levels of independence and community integration while allowing flexibility in the provision of those supports.

Family Supports Waiver (FSW)

Formerly the Support Services Waiver, the FSW is designed to provide limited, non-residential supports to persons with developmental disabilities residing with their families, or in other settings with informal supports.

Who can receive waiver services?

To receive a Medicaid Waiver you must meet both the criteria for a developmental disability and ICF/ID-DD level of care. The criteria for a developmental disability is defined in state law and means that a qualifying developmental disability is evident and that it was diagnosed by a medical doctor prior to age 22. ICF/ID-DD Level of Care means that an individual qualifies as deficient in at three of the functional limitations designated in the Code of Federal Regulations.

How do I apply for a Family Supports Waiver?

The Bureau of Developmental Disabilities Services District Offices can provide an application for the Family Supports Waiver as well as assist in researching additional services. Once it has been determined that an individual meets the criteria for a developmental disability, that individual will be placed on the appropriate waiver waiting lists. Once a waiver slot becomes available the individual will be offered a waiver placement.

How do I qualify for the Community Integration and Habilitation Waiver?

This waiver is for an emergency, needs—based placement, only. The Division will only place individuals if they meet very specific criteria, which include:

  • Eligible individuals transitioning to the community from nursing facilities, extensive support needs home, and state Operated facilities;
  • Eligible individuals determined to no longer need/receive active treatment in supervised group living;
  • Eligible individuals transitioning from 100 percent state funded services;
  • Eligible individuals aging out of Department of Education, Department of Child Services,or supervised group living;
  • Eligible individuals requesting to leave a Large Private Intermediate Care Facility for the Intellectually/Developmentally Disabled;
  • Death of a Primary Caregiver where there is no other caregiver available;
  • Caregiver over 80 years of age where there is no other caregiver available;
  • Evidence of abuse or neglect in “the current institutional or supported group living placement; or
  • Extraordinary health and safety risk as reviewed and approved by the Division Director.
What is the difference between Level of Care and Eligibility?

Individuals meeting the state criteria for a developmental disability and meeting the criteria foran lCF/ID-DD level of care determination are eligible to receive waiver services.

The state criterion for developmental disability is as follows:
A mental and/or a physical impairment (other than a sole diagnosis of mental illness) that begins before the age of 22 and is expected to continue indefinitely. An individual must have substantial limitation in at least three (3) of the following areas:

  • Self care
  • Understanding and use of language
  • Learning
  • Mobility
  • Self-direction
  • Capacity for independent living
  • Economic Self-Sufficiency

The criterion for ICF/ID-DD level of care determination is as follows:

A mental and/or a physical impairment (other than a sole diagnosis of mental illness) that begins before the age of 22 and is expected to continue indefinitely. An individual must have substantial limitation in at least three (3) of the following areas:

  • Self care
  • Understanding and use of language
  • Learning
  • Mobility
  • Self-direction
  • Capacity for independent living
I was removed from the wait list for the Developmental Disabilities and/or Autism Waiver. what happens now?

If a person was on the wait list for any of DDRS’ waivers – Autism (AUW), Developmental Disabilities (DD), or Support Services (SSW), and not already on the SSW – he/she was moved to the Family Supports Waiver (FSW) waiting list and will be targeted for the FSW by the earliest application date that he/she has submitted. He/she will not have to re-apply for any waiver, and his/her position on the list will be the same as it was on the AUW, DD, or SSW wait lists.

Why is there a waiting list?

Each year DDRS and the Office of Medicaid Planning and Policy receive a certain number of slots from the federal Centers for Medicaid and Medicare Services based upon the funds available. Unfortunately the demand for waiver slots outpaces the supply of waiver slots and awaiting list is created. DDRS continues to make every effort to reduce the size of the waiting list.

What is the Objective Based Allocation (OBA)?

The Objective Based Allocation (OBA) is the method used by the state to determine the level of supports an individual needs in order to live in a community setting. The OBA is determined by combining the Overall ALGO (determined by the ICAP and ICAP addendum), Age,Employment, and Living Arrangement. For more information on the DEA please refer to training modules that were offered as guidance on the implementation of this new method.

What is an ICAF and ALGO Level?

The Inventory for Client and Agency Planning (ICAP) is one of the most widely used adaptive behavior assessment in the United States. In. Indiana, the ICAP is used to assess individuals with developmental disabilities and provides information about what type of services a person may need for daily living.

The CAP assessment determines an individual’s level of functioning for Broad Independenceand General Maladaptive Factors. The ICAP Addendum, commonly referred to as the Behavior and Health Factors, determines an individual’s level of functioning on behavior and health factors. These two assessments determine an individual’s overall ALGO level which can range from 0-6. ALGOs O & 6 are considered to be the outlines representing those who are the highest on both ends of the functioning Spectrum.

The ALGO level is the overall level determined by combining the scores of the ICAP and ICAP Addendum (Health and Behavior Factors). The ALGO level is combined with Living Arrangement, and age to determine an individual’s OBA. For more information on ICAPs and ALGOS please refer to training modules that were offered as guidance on the implementation of this new method.

What happens if I don’t spend all of my allocation?

An individual should only use the allocation amount they need for services. The allocation amount will not change unless there is a change in living arrangement or age, so the same allocation will be in place in subsequent years, regardless of the prior year’s Spend.

How do I transition to a setting with housemates?

Because the ideal housemate arrangement is three-person, a transition plan may need to be in place for an individual. The transition plan includes a six (6) month window of funding to enable the individual and Team to find suitable living arrangements and housemates. A case manger may request additional support during the search and move in of a housemate via BMR.

Can an OBA be appealed?

Yes, an OBA may be appealed.
The appeal process, which has not changed with the OBA, is located on the back pages of the NOA and is stated below:

The Right to Appeal and Have a Fair Hearing:

If your application or service is denied, you may file an appeal within 30 days of the decision date shown on this notice. The time limit for filing an appeal is extended by two (2) days if this notice is received by mail. Your Home and Community Based Services (HCBS) benefits will continue if you file an appeal within the required time frame of the decision notice. If you appeal and your benefits are continued and you lose the appeal, you may be required to repay assistance paid in your behalf pending the release of the appeal hearing.

How to Request an Appeal:

  1. If you wish to appeal this decision, you may request an appeal within 30 days of the date of this notice. The time limit for filing an appeal is extended by three (3) days if this notice is received by mail. To file an appeal, please sign, date and return the Hearings & Appeals copy of this form to:
    Office of Hearings and Appeals
    MS 04402 W. Washington St. Room E-304
    Indianapolis, IN 46204
    If you are unable to sign, date, and return this form to the above mentioned address, you may have someone assist you in requesting the appeal.
  2. You will be notified in writing by the Indiana Family and Social Services Administration,Hearings and Appeals office of the date, time, and location for the hearing. Prior to, or at the hearing, you have the right to examine the entire contents of your case record maintained by the Case Manager.
  3. You may represent yourself at the hearing or you may authorize a person to represent you, such as an attorney, relative or other spokesperson. At the hearing you will have full opportunity to bring witnesses, establish all pertinent facts and circumstances, advance any arguments with interference and question, or refute any testimony or evidence presented.
What are Day Services and why are they important?

Services that happen during the day include a variety of therapies, employment and pre-employment services, community and facility habilitation and respite (for individuals residing with family). Day Services are considered to be part of a meaningful day and provide community integration and socialization to individuals.

What are the responsibilities of someone receiving BDDS services?

An individual has the following responsibilities when receiving waiver services:

  • To participate in planning your services.
  • To choose your providers for your services.
  • To work on achieving your goals.
  • To keep appointments.
  • To inform your Service Coordinator about any changes that are pertinent to your participation in your program, such as changes in benefits or how you feel about your plan

In addition, by agreeing to receive waiver services individuals are accepting Medicaid dollar sand therefore accepting some additional responsibilities. The primary factor in the Centers for Medicare & Medicaid Services (Federal agency) determining if a state can be approved to provide HCBS waiver services is the state’s commitment to assure participants’ health and welfare. Individuals and their guardians play a significant role in helping the state meet this assurance.

There will be times when a representative of the state will request information or will ask to visit individuals’ homes. These requests and visits are not meant to be intrusive but are necessary to assure that services are being delivered appropriately and whenever possible efforts will be madeto schedule these visits in advance. Specific responsibilities are outlines in the DDR8 Policy for Individual and Guardian responsibilities.

What is a Group Home?

Supervised Group Living (SGL or Group Homes) is another residential option and alternative to waiver placements for eligible individuals with developmental/intellectual disabilities needing services. DDRS has homes licensed around the State serving almost 3,400 individuals. Group homes fall into nine (9) different categories based on an individual’s level of need:

  • Sheltered Living
  • Intensive Training
  • Child Rearing
  • Child Rearing with Special Programs
  • Basic Developmental
  • Developmental Training
  • Small Behavior Management Residence for Children
  • Small Extensive Medical Needs
  • Extensive Support Needs

The residences are governed by state and federal regulations and are monitored by the Indiana State Department of Health. For specific information reference 460 IAC 9.

How do I apply for a group home placement?

An individual should contact their local Bureau of Developmental Disabilities Services District Office. The District Offices can provide the application and provide assistance in findingadditional services the individual may be eligible to receive.

What is a Residential Living Allowance (RLA)?

Federal If the individual is receiving Residential Habilitation Services funded through a State Line or waiver budget and their living expenses exceed their benefits and income, they may be qualified to receive a monthly Residential Living Allowance (RLA) to cover the excess costs of room and board. A RLA budget authorizes the funding of basic residential loving needs of an individual residing in his/her own home (outside of a parent or family home) and is used to support the remainder of an individual’s basic residential living expenses after applying his/her personal income and for benefits. Additional guidelines can be found on the DDRS Policy page.

What is Vac Rehab?

Vocational Rehabilitation Services (VR), a program of the Bureau of Rehabilitation Services(BRS), provides quality individualized services to enhance and support people with disabilities to prepare for, obtain or retain employment. Through active participation in their rehabilitation,people with disabilities achieve a greater level of independence in their work place and living environments.VR Statewide Location Map. DDRS also encourages every individual who applies for BBDS services to apply for VR services.

What is the Employment First Initiative?

Employment First Initiative is a partnership between Vocational Rehabilitation Services and BDDS to emphasize the importance of community integrated employment for individuals with developmental disabilities. Efforts are underway to engage individuals currently in service, on wait lists for services, and applying for services to connect them with VR Counselors in their areas. Demonstration projects around the State are also being developed to strategist ways to bring greater attention to employment opportunities for individuals with developmental disabilities.

What are SSI and SSDI?

The purpose of these programs is to identify people who have disabilities that preclude the ability to work, or for children, preclude the ability to fully participate in learning activities.Supplemental Security Income (SSI) is financed through general tax revenues. It is based on the need of financial aid and can be referred to as a “need-based program”. The benefits are payable to adults and children who: are disabled or blind, have limited income and resources, and meet the living requirements. The amount a person receives monthly depends on where the person lives, what he or she owes and the amount of monthly income brought in.

Social Security Disability Insurance (SSDI) is funded by social security trust fund and FICA taxes. Receiving SSDI is based on prior work under social security. It is for individuals who are considered “insured” because of their contributions to the social security trust fund. Benefits are payable to: blind or disabled workers, widow(er)s, adults disabled since childhood, to individuals with a physical or mental condition which prevents them from working for at least 12 months ora disabling condition likely to lead to your death. The individual must also be younger than 65and have worked five (5) out of the last 10 years. The amount of monthly disability benefit received is based on the social security earnings record of the insured worker.

Vocational Rehabilitation Services (VRS) vs. Waiver

Vocational Rehabilitation Services (VR) provides comprehensive, coordinated, effective, efficient and accountable services needed by eligible individuals with disabilities to prepare for,enter, engage in and retain employment consistent with each individual’s strengths, resources,priorities, concerns, abilities, capabilities and informed choice.

Developmental Disability (lCF/ID-DD) level of care waivers are for children and adults with a developmental disability, and assist a person to: become involved in the community where he/she lives and works; develop social relationships in the person’s home and work communities;develop skills to make decisions about how and where the person wants to live; and be as independent as possible. An individual can receive VRS without a waiver.

What is the function of a Service Coordinator, Case Manager, and Direct Support Professional?

A Service Coordinator is a single point of contact to coordinate all services, provide financialcase management and advocacy support, identify resources in the community, and coordinate transitions.

A Case Manager assists individuals in obtaining the supports they need to live as independently as possible in their community, by finding and coordinating the available resources and services to meet the person’s needs. Case managers also help to plan, monitor and evaluate the person’s services, and assist with the process and necessary paperwork. This service coordination, or case management, is often provided by the direct services agency, but may also be provided by the person’s family or an advocate, or by a private case manager (such as with Medicaid Waiver services).

Direct Support Professional (or Direct Care Professional/Direct Care Staff) is a person, an agent,or employee of a provider entity who provides hands-on services to an individual while providing any of the following services including, but not limited to: respite, adult foster care,adult day services, supported employment, structured day program, residential based habilitation,transportation, health. care coordination, occupational therapy, physical therapy, speech therapy,or behavior management.

What is Person Centered Planning, Individualized Support Plan (ISP), and Notice of Action (NOA)?

Person Centered Flaming is a process that allows an individual and/or the individual’s legal representative, if applicable, to direct the planning and. allocation of resources to meet the Individual’s life goals; achieves understanding of how an individual: learns; makes decisions;and is and can be productive; discovers what the individual likes and dislikes; and empowers an individual and the individual’s family to create a life plan and corresponding Individualized Support Plan (ISP) for the Individual that: is based on the Individual’s preferences, dreams, and needs; encourages and supports the Individual’s long term hopes and dreams; is supported by a short term plan that is based on reasonable costs, given the Individual’s support needs; includes Individual responsibility; and includes a range of supports, including funded, community, and natural supports.

Person Individualized. Support Plan (ISP) is a plan that establishes supports and strategies, based upon the person centered planning process, intended to accomplish the Individual’s long term and short term outcomes by accommodating the financial and human resources offered to the Individual through paid Provider services or volunteer services, or both, as designed and agreed upon by the Individualized. Support Team.

Notice of Action (NOA) Specifies for the provider the service, number of hours and duration they’re authorized to provide and able to bill for the participant.

What is the difference between Residential Habilitation and Support (RHS), Community Based Habilitation—Individual (CHIO), Respite?

Residential Habilitation and Support Services (RHS) provide up to a full day (24-hour basis) of services and/or supports which are designed to ensure the health, safety and welfare of the participant, and assist in the acquisition, improvement, and retention of skills necessary to support participants to live successfully in their own homes.

Community Based Habilitation-Individual (CHIO) are services outside of the individual’s home that support learning and assistance in the areas of: Self-care, sensory/motor development,socialization, daily living skills, communication, community living, and social skills.

Community based activities are intended to build relationships and natural supports. Respite provides services to individuals unable to care for themselves that are furnished on a short-term basis because of the absence or need for relief of those persons normally providing care.

Respite Care can be provided in the individual’s home or place of residence, in the caregiver’s home, camp settings, or in a non-private residential setting (such as a respite home).

What is a Self Advocate and why is it important to individuals with Disabilities?

Self-advocates are people with disabilities who speak up for themselves and others. It means that although people with disabilities may ask others for support, they have the right to make decisions about their own lives without unnecessary influence or control by others. Self-advocates are people who know and understand their rights, take responsibility for their own lives, and fight against discrimination and stereotypes. The self-advocacy movement is about making sure that people with disabilities are treated as equals, with the right to the same choices,responsibilities, and chances as everybody else. It is about people with disabilities coming together to achieve the goals of living the life they want, with the supports they need, to live, learn, work and be involved in their community. By having group meetings and holding conferences, self-advocates work together to help improve their own lives and the lives of others.

What are Natural Supports?

Natural Supports are supports that occur naturally within the individual’s environment. These are not paid supports, but are supports typically available to all community members. Natural supports should be developed, utilized and enhanced whenever possible. Purchased services should supplement, not supplant, the natural supports. Some examples of natural supports are the family members, church, neighbors, co-workers, and friends.