Aging in Place in Your State: Indiana
Indiana is an example of a state that, on the one hand, offers a leaner set of of Medicaid waiver programs for helping elderly and disabled residents continue to live independently; and on the other hand, that supplements those programs with a state-directed fund. This week, we’ll look at what Indiana has to offer for HCBS waivers, as well as at the Hoosier State’s own program that helps residents age in place.
The federal side: Indiana Aged and Disabled Waiver
Indiana’s HCBS (home and community based services) program, the Aged and Disabled Waiver, is fairly straightforward. It’s designed to help people who are “aged, blind, or otherwise disabled” remain in their homes “as an alternative to nursing facility placement.” The state also has a federally funded program for developmentally disabled residents that provides similar services.
To qualify for the aged and disabled waiver, Indiana residents must be age 65 or over and/or have a disability, and either live in their own home (owned or rental) or be transitioning to such a residential setting. They also must have income no greater than 300% of the federal benefit rate, or $2,382 per month for an individual and $3,573 per month for a couple. They also must need a “nursing facility level of care,” as determined by a doctor.
There also is a $2,000 asset cap for applicants, excluding a primary home and some other personal possessions; that cap increases for married applicants, and if only one spouse in a married couple is applying for benefits, the spouse who is not applying may be able to retain more of the couple’s assets and receive at least a portion of his or her spouse’s income without affecting existing caps. It’s also important to remember that Medicaid waiver programs are not entitlement programs; that means that qualifying applicants may find themselves on a waiting list to receive services.
However, once approved for the program, residents can get help in a host of different ways, from adult day and family care to attendant and nursing care, meal delivery, homemaker services, transportation, respite care, attendant care, and several benefits that could bring our company into the picture, including community transition services, vehicle modifications, and modifications to homes and yards.
With a case manager, beneficiaries of Indiana’s Aged and Disabled waiver complete a Person-Centered Individualized Support Plan (PCISP) to determine their needs and what services will best address those needs. If a person is living in an institutional setting but would like to and is able to return to private community housing, the waiver will pay for “community transition services,” which help people move into private housing. To qualify, people must be moving from an institutional setting into “any dwelling, including a house, apartment, condominium, trailer, or other lodging that is owned, leased, or rented by the individual and/or the individual’s guardian or family.”
Covered transition services include “reasonable, one-time setup expanses” like security deposits, essential furnishings, moving expenses, setup fees or deposits for utility services (telephone, electricity, heating, and water), and one-time health and safety assurances like pest eradication, allergen control, or cleaning. Total transition services provided may not not exceed $2,500, and areas like monthly rent, food, appliances, recreational items, television, cable TV access, and movie or game playing consoles are not covered.
Once in a home, residents can also receive environmental and vehicle adaptations listed as part of their PCISP. The vehicle benefit is included in the waiver’s “specialized medical equipment and supplies” category and is therefore included in that category’s overall $15,000 lifetime cap on services provided. Vehicles modified must be the property of the beneficiary or a primary caregiver, be registered and licensed, have appropriate insurance, and be the beneficiary’s primary means of transportation. Allowed modifications include wheelchair/scooter lifts, hoists, and tie-downs; wheelchair/scooter carriers for the roof or back of a vehicle; raised roof and door openings; and power transfer seat bases. The program does not cover lowered-floor van conversions, citizen’s band (CB) radios, cell phones, GPS devices, and the like; or alarm systems, car payments, insurance coverage, emergency road service, routine maintenance and repairs, and costs for registering drivers or vehicle.
Home modifications must “enable the individual to function with greater independence in the home” and be of “direct remedial benefit” to the applicant. Reimbursable activities include installation of ramps and grab bars, widening doorways, modifying existing bathroom facilities, installation of specialized electrical and plumbing systems, adaptive switches and buttons, secure fencing, stair lifts, single-room air conditioners (though not central air conditioning), adaptive door openers and locks, environmental control units like adaptive switches, replacement of glass windows with shatterproof material, and refinishing of areas that have received modifications (painting, doors trim, flooring, etc.). The program also covers maintenance and repair of items installed during the initial request, as well as assessment and inspection. Not allowed are adaptations that are not of direct medical or remedial benefit, that add to total square footage (except where that is necessary, as in adding an extra landing for a ramp), or that were not included in the PCISP or properly pre-approved.
For environmental adaptations, there is a lifetime cap of $15,000 per waiver, with service and repair of prior modifications, up to $500 per year, allowed outside this cap. If this cap has been reached and further needs are identified, case managers will explore other available funding streams for clients, one of which is the state option discussed next.
The state side: Indiana CHOICE
The state of Indiana also runs the Community and Home Options to Institutional Care for the Elderly and Disabled program, or CHOICE. This program has similar goals to the state’s federally funded Aged and Disabled waiver: “to assist individuals in maintaining their independence in their own homes or communities for as long as is safely possible.”
Residents applying for CHOICE must be at least 60 years of age or have a disability. They must be “at risk of losing their independence, usually indicated by difficulties with activities of daily living, such as bathing, dressing, walking, transferring or medications set-ups.” In addition—and this is a crucial distinction—people are not eligible for CHOICE if other funding, such as Medicare or Medicaid, is available to meet their needs. This program is also not an entitlement program, which means residents may encounter waiting lists.
There are no income limits for CHOICE beneficiaries, but the program operates using a cost-sharing formula. This means that applicants with higher incomes may be asked to pay for a portion of the services they receive. There is an asset limit: to receive the maximum benefits, applicants may not have more than $250,000 in assets (an additional $20,000 in countable assets will be excluded from the total). Assets that people retain over that cap will figure into estimates of what portion of the costs of services that applicant can pay for themselves.
Services covered under CHOICE include such offerings as attendant and home health care, meal delivery, chore and homemaker services, skilled nursing, transportation, and home and vehicle modifications. Some (but not all) of the approved home modifications under CHOICE include replacing standard round door knobs or faucets with lever handles, adding grab bars and handrails, installing wheelchair ramps, widening doorways, and securing thresholds of a home. The CHOICE program is run through Indiana’s 16 Area Agencies on Aging, which are divided by regions.
For more information on Indiana’s federal and state offerings, visit the state Family and Social Services Administration at https://www.in.gov/fssa/ or contact one of Indiana’s Area Agencies on Aging; that list is available at https://www.in.gov/fssa/da/area-agencies-on-aging/.