Indiana’s proposed changes to Medicaid waivers that provide home- and community-based services are expected to take effect in December — including a significant cap on certain therapy services. But, people can still submit comments on the proposed changes until Friday.
Among other things, the Family and Social Services Administration proposed a cap of six hours a month on music and recreational therapy services under the Family Supports and Community Integration and Habilitation (CIH) waivers.
Cathy Robinson, with FSSA, said people are utilizing the services more and in ways that they weren’t intended to be used.
“We do not have a sustainable waiver system,” Robinson said. “These are steps we're having to take to preserve, to the best of our ability, the existing structure until we can move to a place of redesigning and resetting our waivers.”
Robinson said these services aren’t meant to “fill” or "augment" someone’s day. However, advocates said the therapy services often serve as a critical way that people engage with their communities.
Kim Dodson, the Arc of Indiana’s CEO, also said these therapies can be more beneficial and accessible to people with disabilities and their families.
“We hear from families, because there is such a lack of [Direct Support Professionals] in other areas that in order for somebody to live a good life, instead of sitting at home, they have access to some therapies — rather than no therapies or no services,” Dodson said.
Advocates said there’s also a high level of turnover for Direct Support Professionals, which makes it difficult for the person receiving services to build the relationship needed to see the full benefit.
Advocates and providers said this a significant loss in agency for people with disabilities who need those services.
Jim Wiltz, Indiana Association of Behavior Consultants professional liaison and member of the Division of Disability and Rehabilitative Services (DDRS) Advisory Council, said the state proposed the changes with no input from providers or people who receive the services.
“I do find it a little bit disappointing that the whole process kind of got to this point,” Wiltz said. “Now, as an advisory council, there's a lot of talent around this room, a lot of experience, and now we're basically being informed what's basically been decided.”
Wiltz’s organization represents over 600 behavioral consultants, whose services are also being affected by the proposed waiver changes.
“I understand that it's still draft,” Wiltz said. “We've repeatedly asked to have a seat at that table to help you. We're not going to be the decision maker, but we could offer a lot of support, and that has not really happened, and I'm disappointed by that.”
Other providers said there were no recreational or music therapists involved in the decision making process and none in the DDRS advisory council meeting where FSSA outlined the changes.
Advocates and providers said while they continue to reach out for answers and to provide critical insight, they’re also focused on getting people to participate in the current public comment period.
FSSA is accepting public comment on the proposed waiver changes until Aug. 8. The full language of the waiver amendments is available on the agency’s website. People can submit their comments by either mail or email.
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After Aug. 8, the state has to take a minimum of 30 days to review the public comments and feedback they received and potentially make changes based on what it’s heard.
Once the changes are made, FSSA will send the waiver amendment to the Centers for Medicare and Medicaid Services for final approval from the federal government.
Medicaid officials said more changes may be needed to ensure waiver services are financially sustainable.
DDRS Director Kelly Mitchell said Indiana plans to make a number of changes to Medicaid waivers as part of a longer process to ensure financial sustainability.
“We still are moving toward 'waiver reset,' which includes not just a new array of waivers looking differently, but looking at what types of services should be there,” Mitchell said.
Medicaid officials said the caps are being applied to services that have increased in cost and utilization in recent years.
Abigail is our health reporter. Contact them at aruhman@wfyi.org or on Signal at IPBHealthRuhman.65.