The Indiana Family and Social Services Administration (FSSA) is moving forward with changes to the Indiana Attendant Care Program, a Medicaid program vital for over 1,600 children with disabilities. This decision, proceeding despite the significant concerns raised by caregivers, marks a substantial shift in how care is provided to this vulnerable population. This article delves into the planned changes, the worries of families, and the FSSA’s responses, providing a comprehensive overview for those seeking to understand the evolving landscape of attendant care in Indiana.
The core of the change involves transitioning away from the existing attendant care model to Structured Family Caregiving (SFC) on July 1st. Under the current system, family caregivers could be directly compensated for providing attendant care. However, the FSSA has stated that family caregivers will no longer be able to provide attendant care under the traditional model. This shift to SFC means that legally responsible individuals can still provide care, but under a structured, tiered system with different compensation levels and requirements.
This transition has generated considerable anxiety and pushback from families who rely on the Indiana Attendant Care Program. Indiana Families United for Care, a group representing affected families, presented recommendations to Governor Eric Holcomb and the FSSA, urging a 90-day delay to clarify the process and allow families adequate time to find suitable Structured Family Caregiving providers. Their concerns revolved around the clarity of the transition process, communication from the FSSA, and ensuring a smooth changeover to minimize disruption in care for their children.
Despite these appeals, the FSSA has decided to continue with the transition as planned. They have addressed some of the concerns raised by families in a response document and informational webinars. However, key issues remain, particularly around service plan reviews and communication transparency.
Family Concerns and Recommendations Regarding the Indiana Attendant Care Program Shift
Families participating in the Indiana Attendant Care Program have voiced several critical concerns regarding the transition to Structured Family Caregiving. One major point of contention is the alleged practice of FSSA holding approvals for other waiver services “hostage.” Families claim that the agency is reducing or stopping attendant care hours before the July 1st deadline, seemingly to push families into the SFC program.
The FSSA has stated that it initiated service plan reviews in March to ensure requested services align with CMS-approved service definitions and individual needs. These reviews, announced after a significant state Medicaid budget shortfall, involve a more thorough examination by state staff, replacing previous automatic approvals. While the FSSA assures that previously approved services will continue during review, denials can be appealed or modified service plans can be resubmitted, adding complexity and uncertainty for families.
Transparency and communication have also been major focal points of family advocacy. Indiana Families United for Care proposed several recommendations to improve these areas, including:
- Designating an ombudsman: Families requested a dedicated ombudsman to assist families navigating the complexities of the Indiana Attendant Care Program and the transition. However, FSSA stated that ombudsmen are already designated by state statute, implying they cannot create a new designated role.
- Written Notification of Service Denials: Families asked for formal written notification when services are denied, to ensure clear communication and documentation for appeals.
- Publicly Available Waivers and FAQs: The group requested public access to the waivers submitted to the federal government and a comprehensive frequently asked questions (FAQ) section on the Medicaid strategies webpage. FSSA has since posted waivers on their Medicaid strategies page and maintains an FAQ, though the waivers are noted as not yet CMS approved.
Another significant request from families was for clarity on the evaluation process for the Structured Family Caregiving program. Specifically, they sought information on how individuals would be assessed for the three-tiered payment system within SFC. In response, FSSA announced that for individuals transitioning from attendant care, their SFC tier would be determined by their authorized attendant care hours as of May 1st, with assessments aimed for completion by May 30th.
FSSA’s Response and Actions Regarding the Indiana Attendant Care Program Transition
In response to the concerns and recommendations, the FSSA has taken some actions and provided clarifications regarding the Indiana Attendant Care Program transition. While they proceeded with the planned July 1st transition date, they addressed several points raised by families.
The agency clarified its stance on ombudsmen and pointed to existing FAQs on their website. They also made waivers accessible online, albeit noting their pending CMS approval. The determination of SFC tiers based on previous attendant care hours was also announced as a direct response to the need for clarity in the evaluation process.
Furthermore, the FSSA did submit a change request to CMS based on family feedback regarding respite care. This proposed change aims to provide caregivers in the Structured Family Caregiving program with access to respite care from skilled workers, a step up from the currently offered non-skilled respite. Details on this change are expected to be released on the state’s Medicaid strategies webpage.
On the issue of legally responsible individuals providing attendant care, FSSA reiterated that while direct attendant care by legally responsible individuals is being phased out, the Structured Family Caregiving program allows this in a “fiscally responsible way” that aligns with state-approved waivers. They argue that SFC ensures compliance and financial sustainability.
To improve communication, FSSA has initiated webinars for care managers and is now adding webinars specifically for individuals and families affected by the Indiana Attendant Care Program changes. These bi-weekly webinars, scheduled until July 1st, aim to provide ongoing updates and information to Medicaid members under 59 years old on the Aged and Disabled waiver, offering a platform for updates and clarification.
Conclusion: Navigating the Changes to Indiana Attendant Care
The transition from the traditional Indiana Attendant Care Program to Structured Family Caregiving represents a significant shift for families of children with disabilities in Indiana. While the FSSA aims to create a more structured and fiscally responsible system, families have valid concerns about communication, transparency, and potential service disruptions. The ongoing webinars and released information are steps towards addressing these concerns, but continued dialogue and monitoring will be crucial to ensure a smooth and effective transition that prioritizes the needs of vulnerable individuals and their families. Families are encouraged to stay informed through official FSSA channels and advocate for their needs during this period of change.
