Medicaid Waiver – Part 2: What Happens After You Receive the FS Waiver

In the first part of this two-part article (Medicaid Waiver – Part 1: What It Is and How You Acquire It), we discussed the 8 steps you need to take to apply for the Family Services Waiver (FS Waiver). Now let’s take a look at Steps 9 through 13, which cover what happens after you’ve received the Waiver.

Step 9: Choose a Case Manager

The job of your case manager is to guide you through the remaining steps of the process and to manage your FS Waiver funds.

To find an individual case manager with whom you feel comfortable, call the case management companies on the list you received at the 2nd intake interview, to schedule interviews. Choosing the case manager is left up to your discretion. You can contact and schedule interviews with as many of the companies on the list as you want. When you’ve completed those interviews, you’ll select your case manager.

Step 10: Conversation with Your Case Manager

You will then have a conversation with your case manager about the things your child struggles with. Based on that conversation, your case manager will recommend and help you choose the different types of appropriate services available through the Waiver to deal with your child’s needs. Your case manager will also help you manage allocation of the $16,545 budget available per year for these services.

Step 11: Choose Your Child’s Service Providers

The next step is for you to schedule interviews with the available service providers recommended by your case manager, to determine which of those agencies will best serve your child’s needs. If you are not satisfied with the services provided by an agency you initially selected, you can switch to a different agency at any time. You can also change at any time the types of therapies your child receives, because the services provided are meant to grow with the individual. Naturally, a 20-year-old will need different types of assistance than when they were five, 10, or 15 years old.

When you’ve decided on the types of service agencies you want to use and your budget allocation, your case manager will send that information to the state to get everything approved.

Step 12: Upon Case Manager’s Instruction, Apply for Medicaid Disability Insurance

During this process, your case manager will also instruct you when to apply for Medicaid, if your family is not already enrolled in the Medicaid program. Your child needs to be enrolled in the Medicaid program to receive Medicaid disability insurance.

Medicaid disability insurance will also provide additional financial support for your family, but that is a completely different topic about which you can find information here.

Apply for Waiver BEFORE You Apply for Medicaid Insurance

The Medicaid Waiver will waive the standard income-level threshold to qualify for Medicaid if your child has been diagnosed with an autism disability, which is why you need to submit the Waiver and proof of that medical diagnosis before you apply for Medicaid.

If you do not already have Medicaid insurance—and you would not qualify for it because your family earns too much income—do not do anything until after you’re told by your case manager to do it. Otherwise, you’ll be denied and have wasted your time. Again, you’ll need to be patient, because it may be about 12 months after you apply for the Waiver until you are assigned a Medicaid case manager.

Medicaid and Waiver Eligibility Requirements

It is okay if your family already has Medicaid insurance when you apply for the Waiver, because that will not cause any problems when you submit your Waiver application.

If you do not already have Medicaid insurance coverage, you should wait until your case manager tells you to apply, because the Indiana Medicaid agency must already have a record in their system that your child has been approved for the Waiver and that the state has approved Waiver services for your child. Until those two records of approval are in the agency’s system, you will most likely be denied Medicaid coverage.

Remember, if your family’s income level is above the Medicaid maximum income threshold and you apply for Medicaid before submitting your Waiver application and being accepted into that program, you will not be accepted into the Medicaid insurance program.

When Medicaid disability insurance is attached to an approved Waiver, the parent’s income and assets are no longer a qualifying factor. Acceptance into the Medicaid insurance program then becomes based entirely on the fact that your child has autism.

Help is Available from ASI

The Waiver application process can be quite confusing, so be sure to carefully follow the steps outlined in this article, along with your case manager’s instructions. Every Ally at the Autism Society of Indiana has been through the Waiver application process, so you can always find an ASI Ally here who is able and willing to walk you through the process. If you have any questions about the nuances of the Waiver at any point in the process—from application to receiving services and beyond—call your Ally.

The Waiver program is one of the biggest programs available through the state to help people with autism, so we want to make sure every eligible family can access the life-changing services it provides. You can rely on your Ally for all of the information and answers you need!

Remember to remain patient during this step. The Waiver system and the Medicaid insurance system are separate, which can sometimes cause a system-to-system communication or processing delay of a few months. Keep in contact with your case manager to ensure the process is still moving forward. You can also contact your ASI Ally if you are struggling with the process.

Always keep in mind the application process is a monumental marathon, not a sprint. Don’t give up! When the entire process is completed, your child will be eligible for a lifetime of benefits, so your patience will be rewarded year after year.

Step 13: Quarterly Meetings with Your Case Manager and Therapists

After you have been accepted into the Medicaid program and your Waiver services have started, you will have a meeting during every quarter of the year with your case manager and all of the therapists you’ve selected. During this group meeting, you’ll discuss how things are going, whether or not you’re happy with the results, as well as any problems that may exist and adjustments that can be made to correct them. This quarterly meeting is designed to ensure that parents remain in control of the treatment therapies for their children.

All of the behavior service within the Waiver program are scheduled to serve your family’s needs and fit within your lifestyle. Therapists will come to your home when it’s convenient for you, which is one of the major benefits of the program. Another major benefit is that appropriate services will continue as long as your child needs them throughout their entire life. Medicaid disability insurance will also continue throughout your child’s life.

Indiana Waiver Only for Indiana Residents

If you qualify for the Medicaid Waiver in Indiana, your family can move to any city within the state and still use the Waiver. If your family moves out of Indiana, you will need to re-apply for the Waiver all over again, according to the procedural rules of the state in which you settle.

Even though Medicaid is partially funded by the federal government, each individual state designs its own rules for the how the program is implemented and managed under the federal guidelines. Every state has a Waiver program, but they do not cross state lines.

If you qualify for the Waiver in Indiana and then move to another state, you would need to start the application process from the beginning in that state, for both the Medicaid Waiver and disability insurance. If you move to another state and then move back to Indiana, you would need to start the application process from the beginning again.

Application Denied Under Certain Circumstances

If your child has been diagnosed with autism by an approved practitioner (an M.D., psychiatrist or psychologist), it is rare that your applications for the Waiver and Medicare disability insurance will be denied. However, it can happen under certain circumstances.

An example of a circumstance under which an application might be denied is a young adult who has high-functioning autism (HFA). Sometimes an individual with HFA does not have enough need for assistance to qualify for the Waiver. However, individuals with HFA often have some social skill or independent living issues that do require assistance, so this example is not cut and dried. Each case is determined based it its own merits. The person conducting the intake interview is not trying to disqualify you, so very few applications are denied for individuals who have been diagnosed with autism.

We will have publish Medicaid Waiver – Part 3 article, which will discuss the different type of services available via a Family Services Waiver, along with how those services will be useful to your child. You can read this previously published ASI article about Waiver programs: Indiana’s Medicaid Waiver Programs: Home and Community-Based Services for Adults and Children. You can also contact your ASI Ally about any questions you have regarding Waiver services.

Kelly Pence, ASI Autism AllyThanks to Kelly Pence, Autism Society of Indiana Autism Ally, for her contribution to this article. If you have any questions, please contact her at kelly@inautism.org or by calling 800-609-8449 x303.

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