Dementia is a loss of cognitive functioning, whether it be thinking, remembering, or reasoning.  It is not a specific disease, but a group of conditions characterized by impairment to an individual’s brain functions.  When an individual’s dementia becomes so severe that it interferers with daily functioning, he or she will typically need assistance to compensate for his or her loss of ability to manage his or her daily life.

Fortunately, Indiana has many Medicaid covered home and community based alternatives to institutionalization for individuals who need assistance because of dementia.  Under Indiana’s Aged and Disabled Medicaid Waiver, an individual can obtain financial help for home care, assisted living care, adult day care, and adult family care among other services.

What is the Indiana Aged and Disabled Waiver?

The Aged and Disabled (A&D) Waiver allows individuals who are aged, blind, or disabled to remain in their home as an alternative to nursing facility placement. Home and community-based services (HCBS) are provided through the A&D Waiver to supplement informal supports for people who would require care in a nursing facility if HCBS or other supports were not available.

To qualify for the Aged and Disabled Waiver, an individual must first pass a medical screen conducted by the individual’s local Area Aging Agency and meet “nursing facility level of care” criteria.  The individual must then have income and assets below program limits.  An elder law attorney can assist with the medical screen process and establish a legal plan to protect assets and bring income and assets below program limits.

To meet the medical criteria for the Aged and Disabled Waiver, an individual must need “nursing facility level of care.”  This determination is made by an individual’s local Area Agency on Aging (AAA).

The statutory definition of “nursing facility level of care” requires the person have one of the following:

  • An unstable, complex medical condition, which requires direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain
  • Need for direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, central intravenous access (I.V.)
  • Need for direct assistance for special routines or prescribed treatments from others, such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen
  • Need for medical observation and physician assessment due to a changing, unstable physical condition
  • Other substantial medical conditions.

Dementia typically falls in the “other substantial medical conditions” category.  When discussing an individual’s condition with the AAA, it is important to highlight how the individual’s dementia interferes with his or her daily life. Most individuals will require 24 hour supervision for their safety.  However, the dementia may just as likely affect their daily physical functioning.  For example, just because the individual has the physical ability to dress, bathe, or eat does not mean that they do not need assistance with these functions.  Often individual’s with dementia will need someone to cue them to complete these tasks.

Applying for the Indiana Medicaid Waiver

The first step is to apply for a Medicaid waiver.

The Area Agency on Aging that services the area in which the applicant resides conducts an assessment to determine the recipient’s care needs—e.g., how much help the Medicaid recipient needs with activities of daily living such as bathing, dressing, eating, and moving. Once the assessment is complete, the state draws up a budget, and the recipient can use the allotted funds to pay for goods or services related to care, including paying a caregiver. The assessment process can take weeks; so, the applicant should begin as soon as the need for services arises.

The next step is to apply for Medicaid benefits.

For individuals who have assets or income in excess of eligibility limits, a legal plan to preserve assets and overcome the income limit will need to be implemented prior to the application for benefits.  An elder law attorney can provide assistance in creating and implementing such a plan.

Other Home Care Services and items under Indiana Medicaid Aged and Disabled Waiver

Home care services that Medicaid may pay under the Aged and Disabled Waiver include the following:

  • In-home health care
  • Personal care services, such as help bathing, eating, and moving
  • Home care services, including help with household chores like shopping or laundry
  • Caregiver support
  • Minor modifications to the home to make it accessible
  • Medical equipment
  • Respite Care

Besides home care services, the Aged and Disabled Waiver also covers the following alternatives to nursing home care:

  • Adult Day Care
  • Adult Family Care
  • Assisted Living Care

 

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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