This research was supported by Health Care Financing Administration Contract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the Lewin Group. The opinions expressed in the report are those of the authors and do not necessarily reflect the position of the Health Care Financing Administration or the Urban Institute.
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Table of Contents
Introduction
The Long-Term Care System in Indiana
Administrative Structure
Accessing The System
Eligibility Criteria and Assessment
Case Management and Service Planning
Services
Consumer Direction
Cost Containment
Quality Assurance
Federalism Issues
Issues for the Future
Introduction
Indiana, a midwestern state with about 6 million people in 1999,1 provides home and community services to about 2,300 beneficiaries through its Aged/Disabled Medicaid waiver and an additional 10,000 persons with disabilities through its state-funded Community and Home Options to Institutional Care for the Elderly (CHOICE) program. The Medicaid waiver and the CHOICE program rely on an agency-based model for provision of home care services; with CHOICE providing a particularly flexible set of services. The state also funds two small programs that provide supplemental payments to people in board and care homes.
Medicaid's role in Indiana's home and community services system has grown since the mid-1990s because the state views these services as a mechanism for reducing long-run cost growth in the institutional sector. The state received HCFA approval for a total of 12,500 waiver slots in 2003. The state made this request so it could begin to move people off the waiver waiting list but state funds are currently not available to use the newly approved slots. The increased slots will be used should the state shift money from its institutions to its home and community services sector. To date, the state has limited the number of slots it will fund to 2,500.
This paper analyzes the home and community-based service system for older people and younger adults with physical disabilities in Indiana, focusing on the state administrative structure for home and community-based services, eligibility and assessment, services covered by Medicaid and other programs, cost containment and quality assurance. This report also summarizes government officials' and key stakeholders' opinions about how well the Medicaid and state-funded programs work.
Information was obtained from public documents, state of Indiana web sites, and interviews with state officials, consumer representatives and provider associations. Interviews were conducted in person in Indianapolis, Indiana, during December 1999. Questions were asked using a structured, open-ended interview protocol. To encourage candor in their answers, respondents were told that they would not be quoted by name or identified by type of respondent within a state (e.g. home health industry representative in Indiana).
Notes
1. http://www.census.gov.
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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
