The Indiana Family and Social Services Administration (FSSA) is moving forward with a significant change to the state’s Medicaid program, impacting over 1,600 children with disabilities. This shift involves transitioning from the existing attendant care program to Structured Family Caregiving, raising concerns among caregivers and families across Indiana. This article breaks down the key changes, addresses the concerns raised by families, and outlines what you need to know about the Indiana Attendant Care Program transition.
Understanding the Transition to Structured Family Caregiving
For families relying on Indiana’s Medicaid, a major update is underway. The FSSA has announced that family caregivers will no longer be able to provide attendant care services under the traditional program. Instead, Indiana is transitioning to a Structured Family Caregiving (SFC) model, effective July 1st. This decision means that legally responsible individuals, typically parents, who were previously compensated for providing attendant care will now operate within the SFC framework.
This change is presented by the FSSA as a move towards a more “fiscally responsible way” to deliver care while remaining compliant with state-approved waivers. However, the transition has sparked considerable anxiety and questions from families who depend on these services for their medically complex children.
Family Concerns and Recommendations
Indiana Families United for Care, a group representing affected families, voiced significant concerns regarding this transition. They presented a series of recommendations to Governor Eric Holcomb and the FSSA, urging for greater clarity, improved communication, and a smoother transition process.
Key recommendations from the group included:
- Delay the Transition: Families requested a 90-day delay to allow for better understanding of the new Structured Family Caregiving program and to provide families adequate time to select appropriate Structured Family Caregiving providers.
- Process Clarification: Families sought clearer explanations of the transition process itself, wanting more details on how the new system would function and affect their current care arrangements.
- Improved Communication: A major point of emphasis was the need for better communication from the FSSA to families and stakeholders. They highlighted a lack of transparency and timely updates regarding the program changes.
- Service Approval Concerns: Families reported that approvals for other essential waiver services were being delayed or denied, perceived as being linked to the attendant care hour reductions prior to the official July 1st transition.
- Transparency and Accountability: To enhance transparency, families requested the designation of an ombudsman to act as a point of contact and advocate for families navigating the system. They also asked for written notifications for service denials, public access to waiver documents submitted to the federal government, and readily available FAQs on the Medicaid strategies webpage.
- Evaluation Criteria for Structured Family Caregiving: Families sought clarity on how individuals would be evaluated and placed within the three-tiered payment system of the Structured Family Caregiving program.
FSSA’s Response and Actions
The FSSA has responded to these concerns, outlining their position and planned actions. While they acknowledged the feedback, the agency has decided to proceed with the July 1st transition date as planned.
Here’s a breakdown of FSSA’s responses to the family recommendations:
- No Delay to Transition: The transition to Structured Family Caregiving will proceed on July 1st.
- Service Plan Reviews: FSSA stated that service plan reviews initiated in March are aimed at ensuring service requests align with CMS-approved service definitions and individual needs, not to hold approvals “hostage.” These reviews are attributed to increased state staff involvement and are part of addressing the state’s Medicaid budget shortfall. Previously approved services should continue during the review, and appeal processes are in place for denied services.
- Communication Improvements: FSSA pointed to existing FAQs on their Medicaid strategies webpage and has published the requested waivers on the same page, although these are still awaiting CMS approval. While stating that a designated ombudsman is not possible due to state statutes, FSSA has committed to improving communication through webinars.
- Structured Family Caregiving Tier System: The agency clarified that for individuals transitioning from attendant care to Structured Family Caregiving, their tier placement will be based on the authorized attendant care hours as of May 1st. Assessments for tier placement are underway with a target completion date of May 30th. Informational webinars have been conducted to explain the provider and tier system transition.
- Respite Care Enhancement: In response to family requests, FSSA has submitted a change to CMS to allow caregivers in the Structured Family Caregiving program access to respite care provided by skilled workers, instead of only non-skilled respite currently available.
Implications and Next Steps for Families
The transition to Structured Family Caregiving represents a significant shift for Indiana families utilizing the attendant care program. While the FSSA aims for fiscal responsibility and waiver compliance, families are navigating uncertainty and seeking clarity on how these changes will impact the care of their loved ones.
It’s crucial for families to:
- Stay Informed: FSSA is conducting bi-weekly webinars every other Wednesday until July 1st to provide updates on the transition for Medicaid members under 59 on the Aged and Disabled waiver. These webinars are key resources for understanding the evolving situation.
- Review Service Plans: Understand that service plans are under review to ensure compliance and consistency with individual needs.
- Understand Appeal Processes: Be aware of the appeal options if services are denied or modified during the review process.
- Engage with Resources: Utilize the Medicaid strategies webpage for FAQs and updated information. Participate in webinars to directly address questions and concerns.
- Connect with Advocacy Groups: Organizations like Indiana Families United for Care can provide support, information, and a collective voice for families navigating these changes.
The coming weeks are critical as families prepare for the July 1st transition. Staying informed and actively engaging with available resources will be essential to ensure a smooth transition and continued care for children with disabilities under the Indiana Medicaid program.
