INDIANA—Indiana is set to introduce new assessment tools on July 1 to determine eligibility for Medicaid’s home—and community-based services for children and infants. While the Indiana Family and Social Services Administration (FSSA) states that the eligibility criteria remain unchanged, some children currently receiving services may no longer qualify under the new assessments.
The core of the change lies in the “level of care” assessment, which determines if an individual requires a “nursing facility” level of support. Previously, an adult-focused assessment tool was used for all ages. Holly Wimsatt, director of the Bureau of Disabilities Services within FSSA, explained that the new tools are specifically tailored to evaluate children and infants based on typical developmental milestones, leading to more age-appropriate evaluations.
Wimsatt acknowledged that “some individuals, specifically with the new pediatric tools…may not meet the level of care utilizing these tools.” To address potential disqualifications from the Health and Wellness waiver, FSSA has increased the “reserve capacity” for the Family Supports waiver.
Advocates, including Kim Dodson, CEO of The Arc of Indiana, have expressed concerns about the lack of transparency regarding the new tools, requesting access to them for review and evaluation. However, Medicaid officials cited proprietary issues and potential “notable financial issues” as reasons for not sharing the tools directly.
Starting July 1, a statewide vendor will assume responsibility for all levels of care assessments and renewals, aiming to enhance efficiency and consistency across the state. While the vendor will conduct initial assessments for various waivers, any denials will be reviewed by state staff, and an appeal process will remain in place for individuals who wish to challenge the decision.
