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Sunday, December 5, 2010

Medicaid Waiver Cut

The Bloomington Alternative has a story about Medicaid waiver cut in Indiana. The peg is the plight of Ron Habney a 25-year-old man with autism. He has been getting services through Options for Better Living, a Bloomington nonprofit. Options employee John Willman has been accompanying Habney on his hikes -- a necessity to avoid violent outbursts.

In the early 1990s, Options started providing services to those with developmental disabilities through the Medicaid Waiver, which permits federal funds to be used for "an array of home and community-based services that an individual needs to avoid institutionalization." Among the requirements for assistance: "The recipient would require institutionalization in the absence of the waiver and/or other home-based services."

Medicaid has five waiver types, which are administered through state governments. In Indiana, the responsibility falls to the Indiana Family & Social Services Administration (FSSA), which distributes the federal funds to agencies like Options to hire professionals like Willman to care for folks like Ron.

The bulk of individuals served by Options falls under the Autism Waiver and the Developmental Disabilities Waiver, which includes conditions like cerebral palsy, Down Syndrome, Angelman Syndrome and others, Willman says. Most of the rest are covered by the Traumatic Brain Injury Waiver.

FSSA says the Autism Waiver helps individuals living with their families or in other community settings to "gain and maintain optimum levels of self determination and community integration."

The Developmental Disabilities Waiver helps individuals stay in their own homes or in community settings and assists those who "transition from state operated facilities or other institutions to community settings."

On Nov. 10, the State announced $34 million in new budget cuts, which includes a 5 percent cut in reimbursements to hospitals serving patients on Medicaid. The Associated Press reported the reductions came "in response to state revenue shortfalls and growth in the state Medicaid rolls."


In January, their time alone together, and by extension Ron's hikes, will most likely come to an end.

Like nearly all Options houses, Ron's place houses two roommates and one support provider manning each of three shifts. Each roommate also has one-on-one time with individual providers every day. Ron and John's hikes are part of that routine.

Under the cutbacks, each house will now have three roommates, Willman says. And they are now classified on a scale of 1 through 6, with 1 needing the least support and 6 the most.

"When Ron's funding was reviewed recently, he was determined to be in a Category 3," Willman says, "which is kind of preposterous, given some of the behavioral issues he's had."

After an appeal process, Ron was reclassified to a 5, which Willman says leaves him wondering just what a 6 might be. But the chances that Ron will have any, let alone enough, time for riding in the car and hiking in the woods are slim.

"I can't stress enough what a catastrophe it's going to be for his life," Willman says. "I mean, basically his home will be his prison. He will not have freedom of choice. He will lose the routine."

Ron Habney's is but one story among dozens at Options, Willman notes. And the waiting list for others to even get services through the Medicaid Waiver is roughly seven years.