Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Indiana

HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN INDIANAFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Susan M. GoldensonThe Urban InstituteThe Lewin GroupFebruary 26, 2001 HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN INDIANAFinal ReportPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Jane Tilly and Susan M. GoldensonThe Urban InstituteThe Lewin GroupFebruary 26, 2001 This research was supported by Health Care Financing AdministrationContract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor tothe Lewin Group. The opinions expressed in the report are those of the authors anddo not necessarily reflect the position of the Health Care Financing Administrationor the Urban Institute. 217807Table of ContentsINTRODUCTION.........................................................................................................................................................................1THE LONG-TERM CARE SYSTEM IN INDIANA...........................................................................................................2ADMINISTRATIVE STRUCTURE.........................................................................................................................................4ACCESSING THE SYSTEM.....................................................................................................................................................5ELIGIBILITY CRITERIA AND ASSESSMENT................................................................................................................6CASE MANAGEMENT AND SERVICE PLANNING......................................................................................................6SERVICES.......................................................................................................................................................................................7CONSUMER DIRECTION........................................................................................................................................................9COST CONTAINMENT............................................................................................................................................................10QUALITY ASSURANCE..........................................................................................................................................................11FEDERALISM ISSUES.............................................................................................................................................................13ISSUES FOR THE FUTURE....................................................................................................................................................14 Final Report1217807INTRODUCTIONIndiana, a mid-western state with about 6 million people in 1999,1 provides homeand community services to about 2,300 beneficiaries through its Aged/Disabled Medicaidwaiver and an additional 10,000 persons with disabilities through its state-fundedCommunity and Home Options to Institutional Care for the Elderly (CHOICE) program.The Medicaid waiver and the CHOICE program rely on an agency-based model forprovision of home care services; with CHOICE providing a particularly flexible set ofservices. The state also funds two small programs that provide supplemental payments topeople in board and care homes.Medicaid’s role in Indiana’s home and community services system has grownsince the mid-1990s because the state views these services as a mechanism for reducinglong-run cost growth in the institutional sector. The state received HCFA approval for atotal of 12,500 waiver slots in 2003. The state made this request so it could begin tomove people off the waiver waiting list but state funds are currently not available to usethe newly approved slots. The increased slots will be used should the state shift moneyfrom its institutions to its home and community services sector. To date, the state haslimited the number of slots it will fund to 2,500.This paper analyzes the home and community-based service system for olderpeople and younger adults with physical disabilities in Indiana, focusing on the stateadministrative structure for home and community-based services, eligibility andassessment, services covered by Medicaid and other programs, cost containment andquality assurance. This report also summarizes government officials’ and keystakeholders’ opinions about how well the Medicaid and state-funded programs work.Information wa