Waivers for Individuals with Intellectual and/or Developmental Disabilities

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The Division of Disability and Rehabilitative Services (DDRS) Bureau of Developmental Disabilities Services (BDDS) provides services for individuals with developmental disabilities that enable them to live as independently as possible in their communities. BDDS 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. BDDS also monitors the quality of care and the facilities of those who are approved to provide these services in Indiana.

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 developmental and intellectual disabilities. 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 Medicaid waiver program is administered by the Indiana Family and Social Services Administration (FSSA) through the Department of Disability and Rehabilitative Services (DDRS). DDRS oversees two waivers, the Family Supports Waiver (FSW) and the Community Integration and Habilitation Waiver (CIH).
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.
The FSW was created to be the initial point of entry into the Medicaid Waiver system in Indiana. This waiver provides services to individuals of any age who live in their own homes, family homes, or other community settings. The purpose of this waiver is to provide individuals with access to community-based services and supports that are important to them and that are provided in a manner that respects their personal beliefs and customs. Below is a list of the services available through the FSW.

Services available through this waiver are:
- Adult Day Services: Community-based group programs designed to meet the needs of adults through individualized plans of care. These non-residential programs provide health, social, recreational and therapeutic activities; supervision; support services; and, personal care.
- Behavioral Support Services: Training, supervision or assistance in appropriate expression of emotions and desires; acquisition of socially appropriate behaviors; and, the reduction of inappropriate behaviors.
- Day Habilitation: Services provided outside of the 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. This service can be provided on an individual basis or in a group setting.
- Environmental Modifications: Physical adaptations to the home, required by the individual’s plan of care, which are necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Environmental Modifications have a lifetime cap of $15,000. The cost of modification, along with the allowable $500 annual repair are outside of the FSW annual cap.
- Extended Services: Ongoing employment support services which enable an individual to maintain integrated competitive employment in a community setting. Individuals must be employed in a community-based, competitive job that pays at or above minimum wage in order to access this service.
- Facility-Based Support Services: Facility-based group programs designed to meet the needs of participants through individual plans of care. These non-residential programs provide health, social, recreational and therapeutic activities; supervision; support services; and, personal care. They may also include optional or non-work related educational and life skill opportunities. Participants attend on a planned basis.
- Family and Caregiver Training: Services that provide training and education to instruct a parent, other family member, or primary caregiver about the treatments and equipment specified in the PCISP.
- Intensive Behavioral Intervention (IBI)*: A highly specialized, individualized program of instruction and behavioral intervention. The primary goal of IBI is to reduce behaviors such as tantrums and acting out behaviors, and to increase or teach replacement behaviors that have social value for the Individual and that increase access to their community. Program goals are accomplished by the application of research-based interventions. This service is limited to individuals age 21 and over, due to the existing availability of these services on the Medicaid State Plan for individuals under age 21.
- Music Therapy: Services provided for the systematic application of music in the treatment of the physiological and psychosocial aspects of an Individual’s disability and focusing on the acquisition of nonmusical skills and behaviors.
- Occupational Therapy*: Services provided under 460 IAC 6-5-17 by a licensed/certified occupational therapist. This service is limited to individuals age 21 and over, due to the existing availability of these services on the Medicaid State Plan for individuals under age 21.
- Participant Assistance and Care: Staffing and personal assistance in the home. This service can be provided by a trusted friend, neighbor or relative of the family if preferred.
- Personal Emergency Response System: An electronic device which enables certain Individuals who are elderly or have high medical needs 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 phone and programmed to signal a response center, which is staffed by trained professionals, once a “help” button is activated.
- Physical Therapy*: Services provided under 460 IAC by a licensed physical therapist.
- Prevocational Services: Services that prepare a participant for paid or unpaid employment. Prevocational services include teaching concepts such as compliance, attendance, task completion, problem solving and safety. Services are not job-task oriented, but instead, aimed at a generalized result.
- Psychological Therapy*: Services provided under 460 IAC 6-3-56 by a licensed psychologist with an endorsement as a health service provider in psychology, a licensed marriage and family therapist, a licensed clinical social worker, or a licensed mental health counselor.
- Recreational Therapy: Services provided under this article and consisting of a medically approved recreational program to: restore, remediate, or rehabilitate an Individual in order to improve the Individual’s functioning and independence; and, to reduce or eliminate the effects of an Individual’s disability.
- Respite: Services furnished on a short-term basis in order to provide temporary relief to those unpaid persons normally providing care. Respite Care can be provided in the participant’s home or place of residence, in the respite caregiver’s home, in a camp setting, in a DDRS approved day habilitation facility, or in a non-private residential setting (such as a respite home). This service can be provided by a trusted friend, neighbor or relative of the family if preferred.
- Remote Supports: The use of technology to foster independence by providing support and supervision without staff in the home. Newly added to the FS waiver and allowing the first $500 in reimbursement outside the annual FS waiver cap in any service plan year, as well as expanding the allowable age rage to 14-17.
- Specialized Medical Equipment and Supplies: Includes devices, controls or appliances, specified in the plan of care, which enable Individuals to increase their abilities to perform activities of daily living or to perceive, control or communicate with the environment in which they live and without which the Individual would require institutionalization.
- Speech/Language Therapy*: Services provided by a licensed speech pathologist under 460 IAC 6.
- Transportation: Services that enable waiver participants to gain access to non-medical community services and resources, maintain or improve their mobility within the community, increase independence and community participation.
- Workplace Assistance: A range of personal care services and/or supports during paid competitive community employment hours and in a competitive community employment setting to enable waiver participants to accomplish tasks that they would normally do for themselves if they did not have a disability.
* Speech/Language Therapy, Occupational Therapy, Physical Therapy, Intensive Behavioral Intervention, and Psychological Therapy may be added to the waiver budget after private insurance and Medicaid funding have been exhausted or denied for those waiver participants age 21 and over.
The CIH waiver was created to assist those FSW participants who experience emergencies for which that waiver does not provide sufficient supports to ensure the Individual’s health and safety. Situations that might constitute an emergency include: loss of primary caregiver, caregivers over the age of 80, evidence of abuse or neglect in the current home, and an extraordinary health and safety risk. There is no annual waiver service cost cap associated with the CIH waiver.
Additional services available through the CIH are:
- Community Transition: Reasonable, one-time set-up expenses for individuals who make the transition from an institution to their own home in the community. These will not be reimbursable on any subsequent move. The provision of oversight and monitoring within the residential setting of adult waiver participants through off-site electronic surveillance. Also included is stand-by intervention staff prepared for prompt engagement with the participant(s).
- Rent and Food for an Unrelated, Live-in Caregiver: The additional cost a participant incurs for the room and board of an unrelated, live-in caregiver (who has no legal responsibility to support the participant) as provided for in the participant’s Residential Budget. This can be utilized if the participant is receiving Structured Family Caregiving.
- Residential Habilitation and Support: Services that provide up to a full day (24-hours) 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 needed to support participants to live successfully in their homes.
- Structured Family Caregiving: A living arrangement in which a participant lives in the private home of a principal caregiver who may be a non-family member (foster care) or a family member who is not the participant’s spouse, the parent of the participant who is a minor, or the legal guardian of the participant. Necessary support services are provided by the principal caregiver. Only agencies may be Structured Family Caregiving providers.
- Wellness Coordination: The development, maintenance and routine monitoring of the waiver participant’s Wellness Coordination plan and the medical services required to manage his/her health care needs.

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

Step 1. Completing the Waiver Application

To apply for BDDS services there are two options available.

The BDDS Gateway is an online application available 24/7 where individuals and families seeking may submit an application for services. The BDDS Gateway may be accessed at: Bddsgateway.fssa.in.gov.

To learn more about the BDDS Gateway and the online application process, review the resources below:

A paper application (state form 55068) is available for download here. The form may be completed as a fillable pdf or handwritten. The form must be printed, signed and returned to the local BDDS office via fax, mail or in person delivery.

Step 2. The Intake Process

Once you have completed and returned the waiver application packet and all requested documents, an Intake Specialist from your local BDDS 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 Intellectual and/or Developmental Disability (I/DD) eligibility and preliminary Level of Care (LOC).

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

After the application process is complete and LOC is determined, you will be placed on the waiting list for waiver services.
While you are waiting for an open slot, you may:
- Utilize Medicaid State Plan services, if eligible
- Apply for Supplemental Security Insurance (SSI)
- Apply for caregiver supports (respite) as they are available
- Use natural supports for help (e.g. family members, church, neighbors, co-workers and friends)
- Utilize the other resources, such as the Department of Education (if under age 22), the Indiana Centers for Independent Living Services and the Aging and Disability Resource Centers
Contact your local BDDS office immediately and annually to update your address or telephone number.
To better serve Individuals on the FSW waiting lists, DDRS has developed the BDDS Waitlist Web Portal. The Portal will allow you to review and update your contact information and to review the waiver application dates the BDDS has on record. Check the BDDS waiting list online.

Step 4. Beginning Waiver Services

DDRS will mail you a targeting letter when a waiver slot is available.
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.
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)

When you have been offered and have accepted a waiver slot, your local BDDS 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.
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 us.
To notify your local BDDS 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 BDDS office.

My Child Will be Graduating from High School. How Long is the Wait for Waiver Services?

The State of Indiana has reserved a portion of the waiver slots for Eligible Individuals age 18-24 with permanent separation from their educational setting. Qualified/eligible Individuals ages 18 through 24 who have aged out of, graduated from or have permanently separated from their school setting may be able to enter waiver services upon that separation if funded slots are available.

Priority access by reserve capacity category is made available as long as priority waiver slots in the reserve capacity category remain open. Once the priority waiver slots in the reserve capacity category are filled, Individuals meeting the priority access criteria will be placed on the waiting list. They will subsequently be tracked based on their need for a priority waiver slot and offered a waiver slot when:

A newly available priority waiver slot for which they qualify becomes available.
A non-priority waiver slot using the first come, first served criteria for waiver enrollment (date placed on the waiting list) becomes available and the applicant is the first person on the waiting list.

Source: http://www.in.gov/fssa/