This split-screen comparison image shows why people prefer home healthcare to nursing home care.

Most people prefer living at home rather than in a healthcare facility. However, a money shortage in Indiana’s Aged and Disabled Waiver program is pushing disabled Hoosier seniors into nursing homes. This Article describes Indiana’s home healthcare crisis and the difficult choices it’s forcing families to make.

Indiana’s Home Healthcare System

Congress established the home and community-based services (HCBS) program to help older people “age in place” at home without moving to nursing homes. Although Medicaid usually covers nursing home healthcare costs, the Aged & Disabled (A&D) waiver is an HCBS program that helps patients receive healthcare services at home. The Indiana Family and Social Services Administration (FSSA) manages the state’s A&D waiver program.

FSSA’s Indiana’s Home Healthcare Crisis Announcements

A&D Waiver Spending Increases

The FSSA reported to the Indiana State Budget Committee on December 19, 2023, that its A&D waiver spending had contributed to an unexpected $900 million funding shortage (https://
www.in.gov/sba/budget-committee/live-video/budget-committee-meeting-video-archives/sba-indiana-state-budget-committee-december-19,-2023/
).

COVID-19 Public Health Emergency Complication

While Indiana’s home healthcare crisis began before the COVID-19 public health emergency (PHE), Federal PHE rules magnified the problem. Under those rules, states had to offer Medicaid benefits regardless of applicants’ eligibility (see https://www.kff.org/medicaid/
issue-brief/payment-rates-for-medicaid-home-and-community-based-services-states-responses-to-workforce-challenges/
and https://www.in.gov/fssa/medicaid-strategies/).

FSSA’s Indiana’s Home Healthcare Crisis Recovery Plans

In January, the FSSA published initial plans to solve its money shortage at  www.in.gov/fssa/
files/MedicaidForecastUpdatesandInitiatives.pdf
.

Managed Care

One FSSA strategy published at https://www.in.gov/pathways/home/ included hiring managed-care entities (MCEs) Anthem, Humana, and UnitedHealthcare to manage its nursing home and HCBS Medicaid systems. The plan requires choosing one of the MCEs’ benefits programs, like the tough choice of picking a Medicare Advantage plan.

FSSA’s A&D Waiver Waiting List

Indiana’s home healthcare crisis deepened in April when the FSSA announced it would place all new A&D waiver applicants on a waiting list. Sadly, the list forces disabled seniors’ families to make tough choices. Those who can afford it pay home healthcare costs unaided until they reach the top of the waiting list. However, patients may receive nursing home Medicaid benefits in less than two months.

Murky Plans

Despite requests from Indiana elder law attorneys for the plans’ details, the FSSA has responded slowly and incompletely. We will keep digging until the FSSA answers are questions.

More Information

Find more information about this and other topics at www.hawkinselderlaw.com. You can also call us at 812-268-8777.

About the Authors

Jeff and Jennifer are Trust & Estate Specialty Board Certified Indiana Trust & Estate Lawyers, and active members of the Indiana State Bar Association and the Indiana Chapter of the National Academy of Elder Law Attorneys (NAELA). Jeff is also a member of the Illinois NAELA Chapter, a Fellow of the American College of Trust and Estate Counsel, and a member of the Illinois State Bar Association.

Both Hawkins are admitted to practice law in Indiana, and Jeff Hawkins is admitted to practice law in Illinois.

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