FSSA says changes to key eligibility assessment for Medicaid waiver services take effect July 1
Indiana is introducing new tools on July 1 to evaluate if children and infants qualify for home- and community-based services through Medicaid. The Indiana Family and Social Services Administration said the criteria hasn’t changed, but some children may no longer qualify based on the new assessment tools.
Part of the process for receiving Medicaid waiver services is a level of care assessment. It determines whether an individual qualifies for a “nursing facility” level of care based on how much additional support they need.
Holly Wimsatt, director of the Bureau of Disabilities Services within FSSA, said the new tools are tailored to assess children and infants based on typical developmental milestones.
“We may, in full transparency, see some individuals specifically with the new pediatric tools that may not meet level of care utilizing these tools,” Wimsatt said.
Wimsatt said the new tool does not change the eligibility criteria, but instead clarifies it for different age groups. She also said the tool is not a more “rigorous” assessment tool.
“It’s that the assessment tool is designed for use,” Wimsatt said. “Over the years, we’ve been using [the assessment tool] that was designed for adults. There is that possibility that as we use those more appropriate tools that are actually designed for youth some of them will not meet it.”
To accommodate people who no longer qualify for the Health and Wellness waiver, Wimsatt said the agency has increased the “reserve capacity” for the Family Supports waiver.
Advocates said they want clarification on how the new pediatric assessments differ from the assessment process the state was using previously.
Kelly Mitchell, director of the Division of Disability and Rehabilitative Services within FSSA, said the agency would offer examples to show how the tool has been designed to be more age appropriate.
For example, if the assessment if trying to evaluate an individual’s ability to eat on their own, Mitchell said that would look completely different for an adult than for a 1-year-old.
However, Kim Dodson, CEO of the Arc of Indiana, said a set of examples may not be helpful.
“I don’t know if you can make the tool available so that people could look at them,” Dodson said. “That’s the one thing that my team has said, that if they had just a way to just look at the tool.”
Other advocates agreed that they wanted more transparency around the new tool.
Medicaid officials said it may not be possible because the assessment tools are “proprietary”, and sharing it may create a “notable financial issue.”
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Wimsatt also said a statewide vendor will take over level of care assessments and renewals on July 1.
Wimsatt said the state has to complete those evaluations within 11 days of receiving a level of care request. Wimsatt said now, a statewide vendor will help the agency meet that requirement.
“It again, being statewide, we think we will realize — or we know we will realize, some efficiencies there, as well as some added consistency,” Wimsatt said. “No matter where you live in the state, that statewide vendor will be able to address your assessment in a timely manner.”
Wimsatt said the vendor will be responsible for level of care assessments for people on the Health and Wellness, Pathways and Traumatic Brain Injury waivers — but if someone is denied, the state will review the decision.
“Those denials today are reviewed by state staff and will continue to be reviewed by state staff,” Wimsatt said. “If the person is already on a waiver, their services won’t be impacted until that denial goes through. And then there’s that appeal process if they choose to pursue that.”
Wimsatt said it will take the state a week or two to confirm whether the denial was correct or not. She said the change in how the assessment is delivered also doesn’t change the criteria, just how the assessment is delivered.
Abigail is our health reporter. Contact them at aruhman@wfyi.org or on Signal at IPBHealthRuhman.65.
