Home and Community Based Service (HCBS) Medicaid Waiver
Named after the section of the Social Security Act that authorized it, the 1915c Medicaid Home and Community-Based Waiver Program allows states to design Medicaid funded community-based service programs as alternatives to treatment in long-term care facilities. These HCBS Waivers allow individuals at risk of institutionalization to preserve their independence and ties to family and friends by remaining in their communities. Medicaid HCBS Waivers may serve children, adults, individuals who are elderly, or all ages. Additionally, they serve individuals with certain diseases or conditions, including physical disabilities; mental illness; developmental disabilities; traumatic brain injury; HIV; etc.
SED Waiver: In June 2003, Indiana requested a 1915c Waiver from the Centers for Medicare and Medicaid Services for children age 4 through 21, who are eligible for placement in a state psychiatric hospital due to a primary diagnosis of serious emotional disturbance. This waiver application was based upon the recommendations of a year-long Waiver Task Force consisting of parents, advocates, Family and Social Services Administration Division of Family and Children, Department of Correction, Department of Education/Division of Exceptional Learners, Family and Social Services Administration Office of Medicaid Policy and Planning, providers, Indiana Council of CMHCs, IARCCA, Family and Social Services Administration Division of Mental Health and Addiction, and state hospital youth staff.
Indiana's Waiver for Children with Serious Emotional Disturbance ("SED Waiver") was approved by the Centers for Medicare and Medicaid Services (CMS) effective February 1, 2004. CMS approved a maximum of 50 slots for year one of the waiver and a maximum of 200 slots for years two and three, depending on the availability of the required state match.
Eligibility: The SED Waiver program will eventually be implemented state-wide; however; for the first year of the SED Waiver, services will be available to children in 10 counties (Daviess, Elkhart, Knox, Lake, Marion, Martin, Pike, Randolph, St. Joseph, and Vigo). Children who are Medicaid recipients and are eligible for placement in a state psychiatric hospital will be offered the choice of participation in SED Waiver programming by their local Community Mental Health Center, if the cost of their care is no greater in the community as it would be in the hospital. A child must be eligible for Medicaid to receive services under the SED Waiver. If a child applying for waiver services is not a Medicaid recipient, a Medicaid application will be taken simultaneously by the Community Mental Health Center staff.
Available Services: All waiver program participants will receive "Wraparound Facilitation" services. Wraparound Facilitation includes activities typically performed by a case manager with the addition of other responsibilities, including: eligibility determination activities; managing a budget for services, providing technical assistance to others involved in the child's care; assuring that everyone who has an impact on the success of the plan of care is appropriately involved; and that systemic barriers to services are addressed and resolved.
Other waiver services are:
Respite Care (if the child receives other waiver or intensive treatment/services);
Family Support and Training: and
Independent Skills Training.
Additionally, waiver program participants are eligible to receive regular Medicaid State Plan services.
To Apply: Children/parents/guardians who are residents of the 10 pilot counties may apply at their local Community Mental Health Center. For additional information contact, Beth Fetters, Indiana Family and Social Services Administration Division of Mental Health and Addiction, 402 W. Washington St., Room W353, Indianapolis, IN 46204, lfetters@fssa.state.in.us or 317.232.7939.
