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WHAT ARE MEDICAID WAIVERS?

Medicaid Waivers provide an alternative to nursing home placement.

Medicaid Waivers help people stay in their own home, apartment, assisted living facility or adult foster care home.

Medicaid Waivers help people move out of a nursing home and back to a community setting.

Medicaid Waiver clients must need assistance with  a minimum of 3 activities of daily living such as grooming, dressing, ambulating, toileting or several other qualifiers.

See services tab for a listing of all services available through Medicaid Waivers.

 

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 HOW TO APPLY FOR AGED AND DISABLED (AD) OR TRAUMATIC BRAIN INJURY (TBI) WAIVERS

SWIRCA & More is the single entry point for AD and TBI waivers.  An applicant is assigned a Case Manager who will visit the individual in the privacy of his or her own home to complete an assessment.

The applicant must also apply for Medicaid through the Family and Social Services(FSSA) Document Center if he or she is not already a current medicaid client. For a child under the age of 18, the parental income does not affect the child's financial eligibility for Medicaid.    
See FSSA Medicaid site for application. Contact SWIRCA & More's Aged and Disability Resource Center (ADRC)for further details. 

Spousal impoverishment rules will apply for Medicaid eligibility.  See link for additional information.

The level of care for a Medicaid Waiver client is determined by SWIRCA & More Case Management Dept, a physician's recommendation of home and community-based services and Indiana's Division of Aging.  The level of care required is the same criteria as is necessary for nursing home placement meaning that the individual would be at risk of being placed in a nursing facility without services provided by the Medicaid Waiver.

 

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ELIGIBILITY CRITERIA FOR WAIVERS

AGED AND DISABLED WAIVER (AD)
The child or adult must be aged or disabled; Nursing Facility Level of Care; Medicaid eligible (up to $2022 per month of income); Parental income for children under 18 years of age is disregarded; Spousal impoverishment protection is the same as if a spouse was in a nursing facility.

TRAUMATIC BRAIN INJURY (TBI)
The child or adult must be aged or disabled, Nursing Facility Level of Care; Traumatic Brain Injury; Medicaid eligible (up to $2022 per month of income); Parental income for children under 18 years of age in disregarded.  Indiana defines a traumatic brain injury as a trauma that has occurred as a closed or open head injury by an external event that results in damage to brain tissue, with or without injury to other body organs.

MONEY FOLLOWS THE PERSON (MFP)
The MFP grant was established by the federal government to assist the Family and Social Service Administration (FSSA) in its reform efforts to rebalance Indiana's long term care system to achieve a more appropriate balance between institutional and home and community based options.
The MFP Progran is aimed at implementing a system of appropriate, person-centered, needs-based services for individuals seeking to transition from nursing homes to qualified community based settings.  Advantage Health Solutions, Inc is a health plan contracted with the State of Indiana, FSSA Division of Aging, to provide MFP transitional services.  To qualify for MFP, an individual must be in the nursing home for 90 days and be eligible for Medicaid for at least one day prior to discharge.  Skilled therapy days under Medicare do not count towards the 90 days. Contact SWIRCA & More ADRC if you are interested in making a referral for this program.

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SWIRCA & More | 16 West Virginia Street | Evansville | Indiana | 47710-1742 | Phone: 812-464-7800