Effective March 27, 2024, the Indiana Family and Social Service Administration (FSSA) has chosen not to cover services under its Aged and Disabled (A&D) and Traumatic Brain Injury (TBI) Medicaid waivers until after the application approval date. This decision has raised concerns and sparked discussions about its potential impacts on vulnerable populations in the state. Let’s delve into the details and implications of Indiana FSSA’s delay of coverage.

Medicaid Waiver Program

Medicaid waivers are crucial tools that allow states to tailor their Medicaid programs to meet the specific needs of certain populations. These waivers often cover services beyond what traditional Medicaid programs offer, providing essential support to individuals with disabilities, chronic illnesses, and other specialized needs.  For example, the A&D waiver provided many aged and disabled seniors in need of institutionalized level of care with home and community-based alternatives to institutionalization.


Changes to the Medicaid Waiver Program

Under federal Medicaid law, an individual’s eligibility for Medicaid benefits begins the month the individual submits his or her Medicaid application, if the individual meets all eligibility criteria.  In some instances, the individual’s first month of eligibility can be up to three months prior to the date of application.  However, the FSSA has 45 days to process the Medicaid application (or 90 days if the individual is under 65 and the FSSA needs to make a disability determination).  So, the result of this “system change” is the individual will receive at least two months of retroactive Medicaid coverage upon approval, but ­will not receive coverage for the individual’s home and community-based services for those months.


The following example illustrates this problem:

John lives in an assisted living facility that is a provider under the Medicaid Aged and Disabled Waiver.  He has less than $2,000 in a bank account and $1,500 a month in income.

The assisted living facility charges $6,000 per month privately for the room he resides in, but $943 per month when he has coverage under the Medicaid waiver.

John applies for Medicaid benefits on April 2.  His Medicaid application is approved on May 17, 2024 for an effective date of eligibility of April 1.

Before the “system change,” the assisted living facility could bill Medicaid for John’s care for the months of April and May.

After the “system change,” the first month the assisted living facility can bill is June.  John will owe the private pay rate to the facility for the months of April and May.

John, though, has no ability to pay for these months because he had to spenddown his resources to $2,000 to be eligible for the Medicaid benefit in the first place.

The Indiana FSSA’s decision to not provide coverage for services until after the application approval date means that individuals applying for Medicaid waivers will have to bear the financial burden of these services until their applications are officially approved. Indiana FFSA’s delay in coverage could lead to significant challenges for families already struggling to access necessary care and support.


Implications of Indiana FSSA’s delay in coverage


Financial Hardship:

For many families, the cost of assisted living services can be prohibitive without Medicaid coverage. The Indiana FSSA’s delay in coverage places an added financial strain on these families, potentially forcing them to forgo essential services, accumulate debt to meet their loved one’s needs, or move their loved one to a nursing facility where Medicaid will retroactively cover services.


Healthcare Access:

Delayed coverage could result in delays in accessing vital services, therapies, and support. This delay may exacerbate health conditions, impede individuals’ progress toward their health and wellness goals, and impede their ability to reside in assisted living or other less restrictive long term care options.


Administrative Burden:

Navigating the Medicaid application process is often complex and time-consuming. Error rates in Medicaid application processing are high. Individuals will either further delay receiving needed services or families will have the added burden of out-of-pocket expenses for services while the Medicaid agency corrects mistakes.


Overwhelming Nursing Homes:

This decision may overwhelm nursing homes as families are forced to seek placement in these facilities since it is the only level of care that Medicaid will cover retroactively.


Planning Early Is Key

The Indiana FSSA’s decision not to cover services under its Medicaid waiver until after the application approval date has far-reaching implications for individuals and families relying on these vital services. Hopefully, families and the providers that serve them will convince the FSSA to reconsider this system change.  In the meantime, we at the Stinson Law Firm have developed strategies to assist families to minimize the impact of this poor policy.  Planning early will be more than important than ever.  We encourage families who might find themselves in this situation to contact legal counsel well-before a loved-one’s funds are completely depleted.  Seeking eligibility for the Medicaid waiver while a loved one is still at home will be helpful.  Also having counsel who can ensure that FSSA stays accountable to processing an individual’s Medicaid application timely and correctly will be essential to receiving services promptly.


Planning for Medicaid and navigating the Medicaid application process is complicated and can be daunting.  For expert assistance understanding Indiana Medicaid laws, contact Stinson Law Firm for assistance. Our Indianapolis Medicaid attorneys will guide you through the steps you should take to protect the family members you love.


How our Indianapolis Medicaid Attorneys Can Help


If you live in Indianapolis, IN, and need assistance handling the Medicaid process, the legal team at Stinson Law Firm can help. Our Indianapolis Medicaid Attorneys have helped hundreds of Indianapolis residents get through the Medicaid process. We can guide you through every step of your Medicaid process.

Let our Medicaid attorneys provide you peace of mind with care and compassion.

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