The state’s recent decision to limit services through the Medicaid Aged and Disabled (A&D) Waiver affects not only the oldest and poorest Indiana residents, but also the youngest. Beyond immediately capping the number of people who can be served, the decision also imposes a financial burden on local Area Agencies on Aging (AAA) and likely will increase state spending by forcing Medicaid recipients from in-home care to more expensive institutional care.
CICOA Aging & In-Home Solutions, the state’s largest AAA, was notified Dec. 3 by the Division of Aging that a waitlist for services should be implemented effective immediately for the remainder of the fiscal year through June 2010. CICOA is a not-for-profit organization that serves as the single point of entry in Central Indiana for people seeking Medicaid Medical Model Waivers or CHOICE funds.
Medicaid Waivers use federal and matching state dollars to pay for services from qualified providers of attendant or nursing care services, home modifications, assistive technology, etc., and are intended to help people continue to live in their homes and communities rather than in Medicaid-funded facilities. Besides helping people continue to live in their preferred environments, the program often proves to be a more cost effective solution than institutional care.
CHOICE, an acronym for Community and Home Options for Institutional Care for the Elderly and Disabled, is a state-funded program under the Division of Aging that provides support to both the elderly and people of any age with a disability to help them live at home or in community-integrated settings.
Every state has a maximum number of slots for Medicaid Waivers it can grant in a given year, filled on a first-come, first-served basis. To be eligible for Waivers, an individual must meet Medicaid requirements and be at risk of institutionalized care. For children with disabilities under the age of 18, parental income and resources are not counted against financial eligibility. Once the Medicaid Waiver intake process is complete, ongoing case management can be handed off to an independent case manager if the client so chooses.
On average CICOA has been adding 100 or more clients to its in-home services caseload each month. To help bridge the waiting period for Waiver services to begin, CICOA has offered services to clients through state CHOICE funds as a temporary measure. Now that Waiver funds are frozen, clients are unable to move off the CHOICE list. CICOA President and CEO Orion H. Bell IV estimates that the liability for these active care plans exceeds $1 million.
“We are looking for ways to help bridge this shortfall in funding so we can continue to provide these needed services to our clients,” Bell said.
As of December 1, 2009, CICOA had 3,282 clients ranging in age from three months to 105 years. Of those, 2,641 are active Waiver clients. An additional 222 people have care plans submitted to the state and are awaiting Medicaid approval for services to begin.
After learning about the freeze, CICOA case managers were able to submit paperwork on 75 clients before the end of day when the freeze took effect. Another 105 people who had not completed the application process now have been placed on a waitlist. At the current rate of enrollment, Bell estimates that between 600 and 800 people could be on a waitlist by July 1, 2010.
CICOA Aging & In-Home Solutions (cicoa.org) is the premier source of information and access to resources for seniors and persons with disabilities living in Central Indiana. Through a network of agencies, service groups and volunteers, CICOA provides home care services including personal home care, home-delivered meals, home health care, senior transportation services, respite care and caregiver assistance. Annually CICOA provides in-home care management to more than 3,750 clients, delivers more than 515,000 nutritious meals to homes and 33 neighborhood sites, and offers respite care and supplemental services to 1,500 caregivers. CICOA’s Aging & Disability Resource Center handles more than 44,000 calls per year from people seeking assistance with aging and disability issues. CICOA is a leader in community change with its Lifelong Living Communities Initiative designed to make central Indiana the most elder-friendly community in the country.