Medical Model Waiver Programs

The Family and Social Services Administration (FSSA) Division of Aging (DA) provides funding and supports to children and adults with medical needs through the Medical Model Waivers, which include the Aged and Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI). These waivers enable individuals to live as independently as possible in their communities. The DA assists individuals in receiving community supports and residential services using a person-centered plan to help determine which services are needed and who can best provide them. The DA also monitors the quality of care and the facilities of those who are approved to provide these services in Indiana.

What is Indiana's Medical Model waiver program?

Indiana’s Medicaid waiver program began in 1981, in response to the national trend toward providing home- and community-based services. In the past, Medicaid paid only for institutional-based, long-term care services, such as nursing facilities and group homes. Under the Waiver program, it now pays to provide community-based services to people with disabilities who meet specific criteria. Those services are provided in a person-centered manner and are designed to respect the Individual's personal beliefs and customs. Specifically, the Waiver program is meant to assist a person in:

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

In Indiana, the Medical Model waivers are administered by the Indiana Family and Social Services Administration (FSSA) through the Division of Aging (DA). The DA oversees two waivers, the Aged & Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI).

Will the waiver provide all necessary services and supports to meet my needs?

The Indiana Home and Community Based Services is intended to afford an individual to reside in a community setting, rather than residing in a facility setting. The supports available under the waiver are intended to provide educational, rehabilitative, or therapy services aimed at improving an individual’s independence or functioning level. Other forms of supports are available throughout the State of Indiana. The IPMG Case Manager will work with you and the support team to identify any potential resources available to help alleviate the identified needs. IPMG maintains a database of nearly 1000 community resources which Case Managers can reference to identify potential and appropriate resources to meet the individual’s needs. Additionally, Case Managers will refer individuals to seek assistance from Social Security, Public Housing Assistance, Food Stamp Program, etc.

What is the Aged & Disabled Waiver (A&D)?

The A&D waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. Individuals meeting Nursing Facility Level of Care and Medicaid eligibility requirements must meet at least one of the following criteria to receive services through the A&D waiver: 

  • Age 65 or older, or
  • Have a substantial physical disability


The A&D waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other support was not available. A&D waiver services can be used to help individuals remain in their own homes, and can also assist individuals living in nursing facilities to return to community settings such as their own homes, apartments, assisted living or Adult Family Care.

Services available through the A&D waiver are:

  • Adult day services: Community-based group programs designed to meet the needs of adults with impairments through individual service plans. These structured, comprehensive, nonresidential programs provide health, social, recreational, and therapeutic activities, supervision, support services, and personal care.

  • Adult family care: A comprehensive service in which a participant resides with an unrelated caregiver so the participant may receive personal assistance. AFC is designed to provide options for alternative long-term care to individuals who meet nursing facility level of care and whose needs can be met in a home-like environment.

  • Assisted living: Personal care and services, homemaker services, chores, attendant care and companion services, medication oversight (to the extent permitted under State law), and therapeutic social and recreational programming provided in a home-like environment in a residential facility that is licensed by the Indiana State Department of Health (ISDH), in conjunction with residing in the facility. 

  • Case management: A comprehensive service comprising a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual’s service plan. 

  • Community transition: Reasonable setup expenses for individuals who make the transition from an institution to their own home when the person is directly responsible for his or her own living expenses in the community. Community transition services will not be reimbursable on any subsequent move.

  • Environmental modification: Minor physical adaptations to the home, as required by the individual’s service plan, that are necessary to ensure the health, welfare, and safety of the individual, enabling the individual to function with greater independence in the home, and without which the individual would require institutionalization.  

  • Environmental modification assessment: Will assess the home for minor physical adaptations to the home, which, as indicated by individual’s service plan, are necessary to ensure the health, welfare, and safety of the individual and enable the individual to function with greater independence in the home, and without which the individual would require institutionalization.
     
  • Healthcare coordination: Includes medical coordination provided by an RN to manage the healthcare of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan.
     
  • Home-delivered meals: A home-delivered meal is a nutritionally balanced meal. This service is essential in preventing institutionalization, because the absence of proper nutrition in individuals with frail and disabling conditions presents a severe risk to health. No more than two meals per day will be reimbursed under the waiver. 
     
  • Homemaker: Direct and practical assistance consisting of household tasks and related activities. Homemaker services help the individual remain in a clean, safe, and healthy home environment. Homemaker services are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual.
     
  • Nutritional supplements: Liquid supplements, such as Boost or Ensure, to maintain an individual’s health in order to remain in the community
     
  • Personal emergency response system (PERS): An electronic device that enables certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person’s telephone and programmed to signal a response center once a “help” button is activated. The response center is staffed 24 hours a day, seven days per week by trained professionals. 
     
  • Pest control: Designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease to humans, or annoys humans, and is causing or is expected to cause more harm than is reasonable to accept. Pests include insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice.
     
  • Respite: Services that are provided temporarily or periodically in the absence of the usual caregiver.
     
  • Specialized medical equipment and supplies: Medically prescribed items required by the individual’s service plan, which are necessary to assure the health, welfare, and safety of the individual; which enable the individual to function with greater independence in the home; and without which the individual would require institutionalization.
     
  • Structured-day program: Assistance with acquisition; retention; or improvement in self-help, socialization, and adaptive skills that takes place in a nonresidential setting, separate from the home in which the individual resides. 
     
  • Transportation: Non Medical Transportation services are services offered to enable individuals served under the waiver to gain access to waiver and other community services, activities, and resources, specified by the service plan. 
     
  • Vehicle modification: The addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to safely transport in a motor vehicle. Vehicle modifications, as specified in the service plan, may be authorized when necessary to increase an individual’s ability to function in a home and community-based setting and to ensure accessibility of the individual with mobility impairments. 

What is the Traumatic Brain Injury Waiver (TBI)?

The TBI Waiver provides home and community-based services to individuals who, but for the provision of such services, would require institutional care.

Indiana defines a traumatic brain injury as a trauma that has occurred as a closed - or open - head injury caused by an external event that results in damage to brain tissue, with or without injury to other body organs. Traumatic brain injury means a sudden insult or damage to brain function, not of a degenerative or congenital nature. The insult or damage may produce an altered state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical functioning resulting in partial or total disability not including birth trauma related injury.

Individuals meeting Nursing Facility Level of Care and Medicaid eligibility requirements must meet at least one of the following criteria to receive services through the TBI waiver:

  • Have a diagnosis of Traumatic Brain Injury, or
  • Meet intermediate care facility requirements for individuals with intellectual disabilities
     

Services available through the TBI waiver are:

  • Adult day services: Community-based group programs designed to meet the needs of adults with impairments through individual service plans. These structured, comprehensive, nonresidential programs provide health, social, recreational, and therapeutic activities, supervision, support services, and personal care.
     
  • Adult family care: A comprehensive service in which a participant resides with an unrelated caregiver so the participant may receive personal assistance. AFC is designed to provide options for alternative long-term care to individuals who meet nursing facility level of care and whose needs can be met in a home-like environment.
     
  • Assisted living: Personal care and services, homemaker services, chores, attendant care and companion services, medication oversight (to the extent permitted under State law), and therapeutic social and recreational programming provided in a home-like environment in a residential facility that is licensed by the Indiana State Department of Health (ISDH), in conjunction with residing in the facility. 
     
  • Attendant care: Hands-on assistance for aging adults and persons with disabilities. These services are provided to allow aging adults or persons with disabilities to remain in their own homes and to carry out functions of daily living, self-care, and mobility. 
     
  • Behavior management/behavior program and counseling: Training, supervision, or assistance in appropriate expression of emotions and desires, assertiveness, acquisition of socially appropriate behaviors, and the reduction of inappropriate behaviors.
     
  • Case management: A comprehensive service comprising a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual’s service plan. 
     
  • Community transition: Reasonable setup expenses for individuals who make the transition from an institution to their own home when the person is directly responsible for his or her own living expenses in the community. Community transition services will not be reimbursable on any subsequent move.
     
  • Environmental modification: Minor physical adaptations to the home, as required by the individual’s service plan, that are necessary to ensure the health, welfare, and safety of the individual, enabling the individual to function with greater independence in the home, and without which the individual would require institutionalization.
     
  • Healthcare coordination: Includes medical coordination provided by an RN to manage the healthcare of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan.
     
  • Home-delivered meals: A home-delivered meal is a nutritionally balanced meal. This service is essential in preventing institutionalization, because the absence of proper nutrition in individuals with frail and disabling conditions presents a severe risk to health. No more than two meals per day will be reimbursed under the waiver. 
     
  • Homemaker: Direct and practical assistance consisting of household tasks and related activities. Homemaker services help the individual remain in a clean, safe, and healthy home environment. Homemaker services are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual.
     
  • Nutritional supplements: Liquid supplements, such as Boost or Ensure, to maintain an individual’s health in order to remain in the community
     
  • Personal emergency response system (PERS): An electronic device that enables certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person’s telephone and programmed to signal a response center once a “help” button is activated. The response center is staffed 24 hours a day, seven days per week by trained professionals. 
     
  • Pest control: Designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease to humans, or annoys humans, and is causing or is expected to cause more harm than is reasonable to accept. Pests include insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. 
     
  • Residential-based habilitation: Provides training to regain skills that were lost secondary to the traumatic brain injury (TBI).
     
  • Respite: Services that are provided temporarily or periodically in the absence of the usual caregiver. 
     
  • Specialized medical equipment and supplies: Medically prescribed items required by the individual’s service plan, which are necessary to assure the health, welfare, and safety of the individual; which enable the individual to function with greater independence in the home; and without which the individual would require institutionalization. 
     
  • Structured-day program: Assistance with acquisition; retention; or improvement in self-help, socialization, and adaptive skills that takes place in a nonresidential setting, separate from the home in which the individual resides. 
     
  • Supported employment: Paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. Supported employment is conducted in a variety of settings, particularly worksites where persons without disabilities are employed. Supported employment includes activities needed to sustain paid work by individuals receiving waiver services, including supervision and training.
     
  • Transportation: Non Medical Transportation services are services offered to enable individuals served under the waiver to gain access to waiver and other community services, activities, and resources, specified by the service plan. 
     
  • Vehicle modification: The addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to safely transport in a motor vehicle. Vehicle modifications, as specified in the service plan, may be authorized when necessary to increase an individual’s ability to function in a home and community-based setting and to ensure accessibility of the individual with mobility impairments. 


To apply for a Division of Aging waiver within the state of Indiana, please follow the steps listed below.

Step 1. Completing the Waiver Application


  1. Contact your local Area Agency on Aging (AAA) office to request an application packet.
  2. Complete and return the packet and all documents requested to the AAA office.

Step 2. The Intake Process


  1. Once you have completed and returned the waiver application packet and all requested documents, an Intake Specialist from your local AAA office will contact you to complete the assessment for a preliminary Level of Care (LOC) using the information and documents you provide. This part of the process determines eligibility and preliminary Level of Care (LOC).

Step 3. Application Process Complete...Now What?


  1. After the application process is complete and LOC is determined, you will be placed on the waiting list for waiver services.
  2. While you are waiting for an open slot, you may:
  3. Contact your local AAA office immediately and annually to update your address or telephone number.

Step 4. Beginning Waiver Services


  1. AAA will contact you when a waiver slot is available.
  2. Once you have confirmed that you still want to receive services, an Intake Specialist will contact you and complete a current LOC. If you do not currently meet LOC, you will not be able to utilize the available waiver slot.
  3. If Medicaid eligibility was previously denied, you will need to take your targeting letter to your local Division of Family Resources (DFR) to reapply.

Step 5. Choosing your Case Management Company (CMCO)


  1. When you have been offered and have accepted a waiver slot, your local AAA will provide you with a “Pick List,” or list of all certified CMCOs that offer services in your county. Your choice of CMCO is an important one, as the company you choose will be your partner and your guide as you navigate the complexities of the waiver system and help you to move along the path to a more self-determined life. You will have the opportunity to interview any or all companies, and to choose the one that you feel will best represent you.
  2. To arrange to interview with an IPMG Case Management Professional to learn more about our services, you may call Customer Service at 866-672-4764, or email them.
  3. To notify your local AAA office that you have chosen IPMG to provide your case management services, you can fax your pick list directly to them. You can also fax it to us at 866-551-1963 and we will provide it to the AAA office.

Source: http://member.indianamedicaid.com