ASSISTED LIVING WAIVER CHANGES

Major changes are underway in the Indiana Medicaid program that helps disabled Hoosiers pay for the cost of assisted living care.  There are about 2,500 Hoosiers who pay for their assisted living costs with assistance from Medicaid.  These folks need nursing home level of care and have countable resources of $2,000 or less.  They pay about $735 each month for room and board, and Medicaid pays the facility one of three rates, depending upon how much care the resident receives.

Most assisted living providers in Indiana are located in a senior living facility that has independent living, assisted living, and nursing home care.  These facilities will no longer be able to participate in the assisted living waiver program for new residents as of May 8, 2017.  Current residents will be allowed to stay in place until March of 2019.

This change will reduce the number of assisted living residents on the waiver program by about 75%.  The State is working on replacement waiver programs.

This change is required by the Home and Community Based Services rules adopted by CMS.  The goal is to move the waiver program to more independent living areas and out of institutional care where residents do not have as many freedoms as most of us enjoy.

This change will require new facilities to give residents more rights, such as:

  • The freedom to have visitors at any hour
  • The right to have food as they want to instead of rigid meal times
  • The right to lock their door
  • The right to have privacy in their sleeping area
  • The right to choose a roommate, if a roommate is needed

These changes will be difficult for many Hoosiers that will be denied assisted living care as the State transitions to move residents to less restrictive settings.  We are hopeful these changes will improve the way services are provided to Hoosiers who need nursing home care but can live in a less restrictive environment.

ALERT: Seema Verma, CMS Administrator, and Dr. Thomas E. Price, Secretary of Health and Human Services, mailed a letter on March 14, 2017, to all of the Governors.  This letter included the following:

“CMS has worked with our state partners and other stakeholders to implement provisions of the final regulation defining a home and community-based setting.  In recognition of the significance of the reform efforts underway, CMS will work toward providing additional time for states to comply with the January 16, 2014, Home and Community-Based Services (HCBS) rule.  Additionally, we will be examining ways in which we can improve our engagement with states on the implementation of the HCBS rule, including greater state involvement in the process of assessing compliance of specific settings.”

What does this mean?  Institutions may be able to continue to participate in the waiver program for assisted living in Indiana.  We will post a new article as soon as we hear more about this.

Respectfully submitted,
Keith P. Huffman
March 2017

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