What is the Medicaid Waiver?

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The Indiana Medicaid Waiver (sometimes known as the Home and Community-Based Services Waiver) is a state-funded program which pays for supports and services for individuals with disabilities in their family homes or provider-owned communities overseen by the Bureau of Developmental Disabilities Services (BDDS). Medicaid Waivers allow an individual to use traditional Medicaid services, as well as additional services offered through the Medicaid Waiver program. The program began in 1981 in response to the national trend toward providing home and community-based services. In the past, Medicaid paid only for institutionally based long-term care services, such as nursing facilities and group homes. As described by BDDS, the goals of waiver services are to provide the individual with meaningful and necessary services and supports, to respect the individual’s personal beliefs and customs, and to ensure that services are cost effective. Specifically, waivers for individuals with an intellectual/developmental disability assist an individual to:

• Become integrated into the community where he or she lives and works
• Develop social relationships within the person’s home and work communities
• Develop skills to make decisions about how and where the individual wants to live
• Be as independent as possible

There are two types of the Medicaid Waiver available to individuals who qualify in Indiana: The Family Supports Waiver (FSW) and the Community Integration and Habilitation (CIH) Waiver. Both waiver options provide services to participants with an intellectual disability, cerebral palsy, epilepsy, autism, or other condition (other than a sole diagnosis of mental illness) similar to intellectual disability who have substantial functional limitations. Participants may choose to live in their own home, family home, or community setting appropriate to their needs. The difference in waivers depends on the severity of the individual's required supports. To qualify for the Indiana Medicaid Waiver, per Indiana Code IC 12-7-2-61, an individual’s developmental disability diagnosis is required to meet the following conditions:

• Is attributable to:

  • Intellectual/developmental disability, cerebral palsy, epilepsy, or autism, or

  • Any other condition (other than a sole diagnosis of mental illness) found to be closely related to intellectual/developmental disability, because this condition results in similar impairment of general intellectual/developmental functioning or adaptive behavior, or requires treatment or services similar to those required for a person with an intellectual/developmental disability.

• Is manifested before the individual is 22 years of age

• Is likely to continue indefinitely

• Results in substantial functional limitations in at least three of the following areas of major life activities:

  • Self-care

  • Understanding and use of language

  • Learning

  • Mobility

  • Self-direction

  • Capacity for independent living

  • Economic self-sufficiency

Other things to note:

• If applying for the Medicaid Waiver and over the age of 18, you must apply for Social Security Income (SSI) or Social Security Disability Income (SSDI)
• If you are under the age of 18, a separate eligibility assessment is completed, after the application is received.
• For the Family Supports Waiver, funding is limited to $17,300 per year for services.
• For the Community Integration and Habilitation (CIH) Waiver, funding caps are based on the person’s needs and residential setting as determined by DDRS.

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How Do I Apply for the Medicaid Waiver?

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You can apply for the Medicaid Waiver through your local Bureau of Developmental Disability Services (BDDS) office. Obtain the number for your local BDDS office by calling 800-545-7763 or utilize this BDDS District Map to find your local BDDS office.

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What Services are offered through the Medicaid Waiver?

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• Adult Day Services

• Behavioral Therapy

• Case Management (Required)

• Community-Based Habilitation – Group or Individual

• Environmental Modifications

• Extended Services

• Facility-Based Habilitation – Group or Individual

• Music Therapy

• Participant Assistance and Care (FS Waiver Only)

• Personal Emergency Response System

• Prevocational Services

• Recreational Therapy

• Residential Habilitation (CIH Waiver Only)

• Respite

• Structured Family Caregiving (CIH Waiver Only)

• Transportation

• Wellness Coordination (CIH Waiver Only)

• Workplace Assistance

For more information regarding descriptions of each service, please see the most recent DDRS Manual.

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