Navigating Caregiving: Understanding the Health and Wellness Waiver
Overview of Medicaid Waivers
Medicaid Waivers are flexibilities given to states by the federal government to expand Medicaid coverage. This allows states to design programs that provide home and community-based services (HCBS) to eligible individuals. These services are meant to help people with disabilities and seniors live independently in their own homes or communities rather than in institutions like nursing homes.
One key feature of some Medicaid Waivers is the ability to pay family members for providing care to a loved one. This can be a great benefit for families, as it helps them keep their loved ones at home while also providing financial support. However, it's important to note that not all waivers allow this, and there are often eligibility requirements and limits on how much family members can be paid.
Understanding the Health and Wellness Waiver in Indiana
Until recently, Indiana offered the Aged and Disabled Waiver (A&D Waiver) to help Medicaid recipients with disabilities and seniors receive care in their homes or communities. This program was a Medicaid Waiver, a federal program that gives states flexibility in designing healthcare coverage. The A&D Waiver specifically focused on providing home and community-based services (HCBS) as an alternative to nursing facilities.
However, a significant change took effect on July 1st, 2024. The A&D Waiver transitioned to a new program called the Health and Wellness Waiver (H&W Waiver) for individuals under 65. This shift aims to better reflect the program's focus on maintaining overall well-being and independence for those with complex medical needs. While the core function of providing HCBS remains, the name change signifies a renewed approach to supporting this population within the Medicaid program.
Qualifying for the Health and Wellness Waiver
Age and Medical Coverage:
Age: You must be under 65 years old. On July 1, 2024, the H&W replaced the Aged and Disabled Waiver for this age group.
Medicaid: You must be enrolled in and meet eligibility requirements for Indiana Medicaid.
Level of Care:
Nursing Home Level of Care: A core requirement is needing a level of care that would qualify you for placement in a nursing home. This doesn't necessarily mean you need to be in a nursing home, but that the level of assistance you require is significant. A healthcare professional will assess your needs to determine if you meet this criteria.
Additional Resources on Qualifying:
There are additional resources available to help you learn more about the H&W Waiver:
Indiana Medicaid Website: The Indiana Medicaid website provides an overview of the program, including eligibility requirements: https://www.in.gov/medicaid/members/home-and-community-based-services/aged-and-disabled-waiver/
Area Agency on Aging (AAA): Your local AAA can offer guidance on the application process and answer specific questions about your situation. You can find contact information for your local AAA online.
Navigating the Application Process
The application process for the Indiana Health and Wellness Waiver (H&W) is still being established as of June 11, 2024, since it officially replaced the Aged and Disabled Waiver (A&D Waiver) on July 1st, 2024. This is good news, as the A&D Waiver previously had a waitlist for individuals under 65. We can expect the H&W application process to be similar to the A&D Waiver process, but with potential streamlining and improvements.
Here's what you can likely expect:
Contact your local Area Agency on Aging (AAA): They'll be able to guide you through the application process and answer any questions you have.
Eligibility determination: You'll need to meet specific criteria, including being under 65, enrolled in Indiana Medicaid, and requiring a level of care that would qualify for a nursing home.
Functional assessment: A healthcare professional will likely assess your needs to determine if you meet the nursing home level of care criteria.
Service plan development: Once approved, a plan will be developed outlining the specific HCBS you'll receive.
Waitlist vs. No Waitlist:
The A&D Waiver had a waitlist for individuals under 65 due to high demand and limited resources. Since the H&W is a new program, it's unlikely there will be a waitlist initially. However, depending on program popularity and funding, a waitlist could develop in the future.
Stay Informed:
Contact your local AAA for the most up-to-date information on the application process.
Check the Indiana Medicaid website for updates on the H&W program: https://www.in.gov/medicaid/members/home-and-community-based-services/aged-and-disabled-waiver/
Indiana Resources
Reminder that as of July 1, 2024, Indiana's Aged and Disabled Waiver transitioned to the Health and Wellness Waiver. Parents of minor children and spouses can no longer be paid caregivers under the Attendant Care Program with the Health & Wellness Waiver. Most parents will be switching over to Structured Family Caregiving Indiana.
Additional Indiana Resources:
Indiana Medicaid Waivers
Paid.care as Indiana’s #1 Highest Paying Health & Wellness Waiver Provider for Structured Family Care
Additional National Resources
National Family Caregiver Support Program: Provides valuable resources and support for caregivers across the United States. They offer a national helpline, information on local caregiving resources, and educational materials.
Eldercare Locator: A helpful online tool that connects users with local resources for aging adults and their caregivers. This can be a valuable resource for finding legal assistance, support groups, and other caregiving services in your area.
