Medicaid Waivers: Indiana’s Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers
What are Medicaid Waivers?Waivers are a part of the federally and state funded Medicaid program that provides for reasonable and necessary medical care for persons meeting eligibility requirements. Waivers provide funding for children and adults with disabilities to receive support and services in the home and community rather than in an institutional setting. Indiana has two different types of home and community-based waiver programs, medical and developmental. The type of waiver for children and adults whose needs are primarily medical in nature is called the Nursing Facility Level of Care (NFLOC) or Medical Model Waiver. There are two Indiana Medicaid Waivers that use NFLOC as part of eligibility – the Health and Wellness Waiver (H&W) (formerly the Aged & Disabled or A&D Waiver) and the Traumatic Brain Injury Waiver (TBI).
How is Eligibility Determined?To be eligible for the H&W or TBI Waiver, an individual must meet NFLOC, meaning the person has a skilled need and/or the individual is experiencing a medical condition that is causing the need for assistance with their activities of daily living (ADL). The level of care need is determined by the Level of Care Assessment Representative (LCAR) vendor, currently Maximus, using an assessment that determines if the person meets NFLOC based upon their skilled needs and medical condition(s) that impact their ADLs. To be eligible for the TBI Waiver, a person must also have a diagnosis of traumatic brain injury. If an individual does not meet NFLOC criteria, then they can be evaluated by BDS to see if they meet ICF/ID LOC criteria, meaning they meet the level of care for admission to an Intermediate Care Facility for those with an intellectual disability. If ICF/ID LOC is met, then the individual will meet criteria for the TBI Waiver. Age is not an eligibility determinant for the TBI Waiver; H&W is for individuals 59 and younger. Family income and assets are NOT considered when determining Medicaid eligibility for a child under the age of eighteen who is applying for a waiver.
How do I Apply for a Waiver?If you think your family member may be eligible for a Nursing Facility Level of Care Waiver, you can apply by calling the local Area Agency on Aging (AAA) to start an application. See the state map at the link under the "Where to Get More Information" section of this fact sheet below or call 1-800-713-9023 to identify your local office. You can also contact Maximus by calling 833-597-2777 or completing the contact form at https://www.inlcar.com/en/home. Once Maximus has completed and approved the NFLOC assessment, the individual will be referred to the local AAA for options counseling for Medicaid waivers and other program offerings. You may apply for one or both of the waivers, as appropriate. If there are no slots available on the waiver, the applicant will be placed on a waiting list.
How Long is the Waiting List?There is currently a waiting list for the H&W and TBI Waivers. Waiting lists change often. For up to date information about H&W waitlist information, visit https://www.in.gov/fssa/ddars/resources/individuals/hcbs-waiver-waiting-list-information/.
What Do I Need to Do to Stay on the Waiting List?You will need to update your local AAA whenever your contact information, including phone or address, changes. If you move to a different area of the state, contact your local AAA to update your contact information. As long as you remain in Indiana you will not have to reapply. It is advisable to contact the AAA office once a year to update and confirm your contact information. Keep a copy of your dated waiver application and any other correspondence with your AAA office for your own records.
What other Community-Based Services are Available?Indiana's Area Agencies on Aging (AAA) provide case management, information, and referrals to various services for persons who are elderly or physically disabled. There are other programs and services for which you might be eligible. Additionally, you may be eligible for more than one type of waiver. You can apply for all waivers for which you may be eligible. Keep in mind, while you may be eligible for more than one type of waiver, only one waiver can be utilized at a time. To learn about the other types of home and community-based waivers in Indiana, please refer to our fact sheet on Indiana’s Family Supports Waiver & Community Integration Habilitation Waivers.
Where to Get More Information:The local AAA office can answer questions about NFLOC waivers. To find the AAA nearest you, visit: https://www.in.gov/fssa/da/area-agencies-on-aging/ (map available at https://www.in.gov/fssa/ddars/files/bba/AAA_Map.pdf) or call toll free 1-800-713-9023.
The Division of Disability, Aging & Rehabilitative Services (DDARS) is a part of the Family & Social Services Administration. DDARS administers the Nursing Facility Level of Care Waivers and other community- based services for people who are elderly and/or have disabilities. DDARS Website: www.in.gov/fssa/ddars/ Family and Social Services Administration (FSSA) has a webpage with additional FAQs, checklists, and webinars: https://www.in.gov/fssa/ddars/bds/medicaid-hcbs-waivers/ Note: Upon receipt of the waiver, a service plan aligning with the participant’s needs and level of care will be developed by the care manager and participant. The participant has the right to choose all providers who render care, including the care management company. Additional Community Resources:
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Programs and systems change often. It is important to ensure that you are using the most current information. Please check https://www.inf2f.org/fact-sheets.html for the most recent edition.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
This fact sheet was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $96,750 with 89% percent financed with nongovernmental sources. The contents are those of INF2F and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
