The Arc of Indiana Blog

The Indiana Family and Social Services Administration (FSSA) recently made changes to the Developmental Disabilities (DD) Medicaid Waiver.  Two changes were made to the waiver that directly affects people with developmental disabilities and their ability to work.  FSSA felt strongly that these changes needed to be made, despite The Arc’s concerns.  The changes include a one-year time limit on prevocational services (a facility based program for people that are not in sheltered work) and an 18 month limit on supported employment follow-along.  

It is important to note that changes to the DD Waiver will not affect state payments for those in sheltered work.  That continues as it always has.  The key to being in sheltered work versus prevocational is the ability of the person to be earning above 50% minimum wage (sheltered work) or earning below 50% minimum wage (prevocational services).

FSSA had two concerns regarding prevocational services funded through the DD waiver. They felt it was an audit exception for Medicaid to pay for prevocational services in a never-ending way.  Their interpretation of the service - which is reimbursed at a level nearly twice that of other day services - is that the higher payment was established to provide more intensive services to prepare someone for work.   Therefore, in their minds, it was appropriate to require a time limit for this service - after a year the person would either be ready for work or would move to another day service.  FSSA felt that by not imposing a time limit they could be liable to pay back the federal government, which they could not afford to do.

On this issue the state was willing to look at a paid work program, but they could not go along with Medicaid paying for the service on an open-ended basis.  They agreed to work with us over the next 90 days to find alternatives that would keep folks served.

Regarding Supported Employment Follow Along (SEFA), FSSA felt after 18 months of support at a rate of about $38 an hour for follow along, people could transition to a new service of Work Place Assistance, at a lower rate of $24 an hour.  This was to recognize that people should need less intense support after they begin mastering a job. 

Both The Arc of Indiana and INARF worked to exclude these changes to the DD Waiver, but FSSA felt they had to keep them in.  However, FSSA officials have agreed to work with us on both of these issues, as they understand why we have concerns.

In addition to the two changes we are specifically concerned about, we should also note that the DD waiver now includes a new service, Facility Based Support.  This new service was requested at the sessions FSSA held to solicit input on changes to the DD waiver.  It is not intended to be a replacement for any other service, but rather is intended to provide a “safe haven” for someone who needs a place to go between services or a job.  This service would provide supervision, but would provide work related or rehabilitation services.   

On October 1, 2009 we sent out a joint memo to all INARF and ICEArc members (the executive directors of our chapters), laying out our plan to work on this and sharing our great concern regarding changes to the waiver that impact employment.    

We established a joint work group with INARF that is meeting in two subgroups to address both issues. 

Our goal is to develop a clarified approach to employment that ensures a range of employment supports, and that provides supports and services that cover a variety of options that reflect the choice of the individual.  The members of these groups are working aggressively to develop solutions to address these issues within the 90 day timeframe.

The first people that could be affected by time limits would be those whose Medicaid waiver is scheduled to be renewed at the end of October.  That is one reason why we want to have a plan in place within 90 days that includes FSSA submitting an amendment to the DD Waiver.  

We hope to have a joint proposal that will address these critical issues to FSSA by mid November.  If accepted, it would then be submitted to the federal government for approval as an amendment to the DD Waiver before anyone was affected by the new time limits.