Medicaid Waiver – Part 3: Choose Your FS Waiver Services
This is the third part of our Medicaid Waiver series of articles. The previous articles are: Medicaid Waiver – Part 1: What It Is and How You Acquire It and Medicaid Waiver – Part 2: What Happens After You Receive the FS Waiver
When a family qualifies for the Medicaid Family Support Waiver (FS Waiver), they receive an annual budget every year of $16,545 for services. The organizational framework in which the Waiver funding operates is a layered bureaucratic structure that flows down from the State of Indiana (IN.gov) to the Family and Social Services Administration (FSSA) to the Division of Disability and Rehabilitative Services (DDRS) to the FS Waiver service providers.
A case management company is required as the first service provider FS Waiver recipients select, because a case manager needs to oversee all of the other appropriate service selections and manage the family’s Waiver budget. The family can choose the case management company from the list of qualified providers they receive at their second intake interview, as well as the individual case manager with whom they want to work.
After the family selects their case manager, they can choose the additional Medicaid Waiver services that will best meet their needs from the table in Section 10.2 (page 87) of the DDRS Waiver Manual (PDF). In addition to the types of services available through the FS Waiver (those marked in the FSW Waiver Type column on the left), the table includes the cost per unit of each service (per hour, day, or month), along with the maximum amount of units allowed per day, month, or lifetime.
Popular Services for Individuals on the Spectrum
The DDRS Waiver Manual lists dozens of services that are available to FS Waiver families. Below are a few of the services that tend to be most popular, quite useful, and easily accessible for families caring for an individual with autism. For more information about any of the services available, you can consult with your case manager. An ASI Ally can also provide you with info about these services from a user’s perspective.
Respite care provides for a caretaker to come into your home to care for a person with autism, so that the daily caregiver can take a break. This is a commonly used service with lots of options available. Respite care is one of the lower-cost services, with no maximum limit.
Participant Assistance and Care (PAC) services are similar to respite care. PAC services also provide for someone to come to your home and care for an individual with autism, but the main difference is that PAC services have some specific goals attached to them. Some of those goals are to help individuals acquire and/or improve daily living skills, social skills outside of the home, and independent living skills.
Behavior consultation brings a qualified Master’s level behaviorist into your home, at a time that is convenient to your schedule, to observe an individual with autism. After the observation period, the behaviorist will discuss with your family the behaviors that need to be worked on and then create a plan for improving those behaviors. The behaviorist will then work on the plan, with the person with autism, each time he or she visits your home. The behaviorist will also work closely with the caregiver, to make sure the behavior interventions are being used properly, during and between visits, to continually improve the targeted behaviors.
Recreation therapy is usually focused on fun and engaging activities that are new to the person on the spectrum, who may previously not have been willing to or had the opportunity to participate in a particular activity. These activities also frequently take place in locations or environments that are new to the individual. Examples of potential activities include visits to the library, going to a movie theater, exercising at a YMCA, and working in interactive situations with peers in the community.
Music therapy involves a Bachelor’s level music therapist who will use music in a variety of ways to help the individual with autism deal with issues such as anxiety, coping skills, concentration, attention span, and fine motor skills. Music therapy can also provide an outlet for emotions and behaviors. For individuals who respond well to music, music therapy can be very useful.
Therapeutic Horseback Riding
Therapeutic horseback riding is conducted at a horse riding center with horses trained to work with people who have disabilities. The instructors are also trained for this specific type of service. This type of therapy has been found to help people with anxiety and other issues. It is also a good way for individuals on the spectrum to interact with others in a setting outside of their normal environment.
Individuals with autism can enroll in a Waiver-approved day camp to enjoy the unique fun activities that a camp setting can provide. Check with your case manager or an ASI Ally for the location of the approved day camps in Indiana.
Vocational Rehabilitation / Pre-Vocational
Vocational rehabilitation (VR) becomes an important service when an individual with autism is transitioning out of school and into the next phase of their life. Pre-vocational services can help an individual prepare for employment or volunteer activities.
The Choice is Yours
After you choose your case manager and allocate a small portion your annual FS Waiver budget to that service provider, the remainder of your budget can be spent on any of the eligible services listed above or included in the DDRS Waiver Manual. When you choose the services you want, your case manager will provide you with a list of the providers of those services in your area, You can then interview the available professionals to decide who you feel comfortable with and will best meet your needs.
If you are not happy with a provider you chose, you can change to a different provider. You can also switch to another type of service if you feel you’re not satisfied with it, or the individual with autism is not responding to it, or you feel the service has been effective to the point where you no longer need it.
You don’t need to wait a specific amount of time to make a change of service type or provider—you can make a change at any time by contacting your case manager.
Services Grow as an Individual Grows
An important aspect of the services provided through the FS Waiver is that the services adapt to individuals as they grow. The services that are appropriate for a young child won’t necessarily be appropriate when they are a teenager or an adult.
Medicaid Insurance Coverage Overlaps the FS Waiver Budget
Along with the annual budget for services, the FS Waiver provides Medicaid insurance for the individual with autism. This insurance covers doctor’s appointments, prescription medication, and other medical needs in line with a traditional Medicaid policy, such as physical therapy, occupational therapy, speech therapy, and psychological therapy. Even though these types of therapies are listed as being available through your FS Waiver budget, because they are covered by Medicaid insurance most people spend their Waiver budget on other services not already covered by insurance.
Check with Your Case Manager
The DDRS Waiver Manual, and its table of FS Waiver services in Chapter 10.2 (shown below), can be confusing and intimidating, so check with your case manager to make sure you understand all of the information you’ll need to make your choices about service providers and budget allocations. As always, an ASI Ally can also help you understand your options and provide first-hand knowledge about how the services operate and how they can help your family.
Thanks to Kelly Pence, Autism Society of Indiana Autism Ally, for her contribution to this article. If you have any questions, please contact her at firstname.lastname@example.org or by calling 800-609-8449 x303.
Medicaid Waiver Services Table
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