Introduction
Family caregivers provide incredibly valuable support to their loved ones, often incurring personal expenses related to their caregiving role. Understanding the available programs for compensation through Indiana’s Medicaid and other support systems is crucial for those providing this essential care. At FreedomCare, we can help guide you through the available options in Indiana and ensure you receive the support and compensation you deserve for your caregiving efforts. Let us assist you in navigating the process so that you can focus on what matters most: caring for your loved one.
Medicaid Programs
Medicaid is a joint federal and state program that provides health coverage to eligible low-income individuals, including families, seniors, and people with disabilities. Medicaid waivers allow states to offer additional services and benefits not typically covered under Medicaid by “waiving” certain federal requirements to provide more tailored support to specific populations, such as those needing long-term care.
In Indiana, the following Medicaid waiver is available with an option for caregiver pay:
Health & Wellness and Pathways Waivers
July 1, 2024, marks the end of the Aged and Disabled Waiver. Two new waivers, the PathWays Waiver for individuals aged 60 and older and the Health and Wellness Waiver for individuals 59 and younger, will provide home and community-based services to eligible Hoosiers who need nursing facility level of care.
Under this new waiver design, the Structured Family Care Program will be administered as follows:
Health & Wellness Waiver
This program provides support and services to individuals ages 59 and younger who were previously receiving services through the Aged and Disabled waiver.
The Health and Wellness (H&W) Waiver in Indiana is designed to enable aged, blind, or disabled individuals to live at home instead of in a nursing facility. This waiver provides Home and Community-Based Services (HCBS) to supplement informal support systems, aiming to prevent the need for institutionalized care.
Eligibility Requirements:
- Individuals must be aged, blind, or disabled.
- They must reside in or be transitioning to a non-institutional HCBS-compliant setting.
- Income should not exceed 300% of the maximum Supplemental Security Income (SSI) amount.
- They must meet the nursing facility level of care criteria.
Nursing Facility Level of Care: To qualify, individuals must have significant medical needs requiring direct assistance. This includes conditions like severe pain management, the need for medical equipment assistance (e.g., ventilators), special routines or treatments (e.g., tracheostomy care), and the need for medical observation due to unstable physical conditions. The initial and annual level of care assessments are conducted by the Area Agency on Aging (AAA) and waiver case managers, respectively.
Available Waiver Services: The H&W Waiver offers a range of services, including but not limited to:
- Adult day services and assisted living
- Attendant care (both traditional and self-directed)
- Case management and community transition assistance
- Environmental modifications and assessments
- Health care coordination and homemaker services
- Home-delivered meals and nutritional supplements
- Personal emergency response systems and pest control
- Respite care and specialized medical equipment and supplies
- Structured family caregiving
- Transportation
- Vehicle modifications
A case manager works with the eligible individual to identify the specific services required, which are then included in the individual’s Plan of Care (POC) and submitted for state approval. This comprehensive approach ensures that individuals receive tailored support to maintain their independence and quality of life in a community setting.
For more information on the Health & Wellness Waiver, please click here.
PathWays to Aging Waiver
This program provides support and services to individuals aged 60 years and older previously receiving services through the Aged and Disabled waiver. This waiver is administered by 3 Managed Care Entities (MCE): Anthem, United HealthCare, and Humana.
Launched on July 1, 2024, Indiana Pathways for Aging (Pathways) is a statewide Medicaid-managed long-term services and supports (MLTSS) program for residents aged 60+ who are Medicaid-eligible due to age, disability, or blindness. This program provides comprehensive medical care, including doctor appointments, hospitalizations, laboratory work, and x-rays, as well as nursing home care and home and community-based services (HCBS). The goal is to prevent and delay the need for nursing home admission by offering services such as personal care, homemaker services, adult day care, home modifications, personal emergency response systems, and home-delivered meals.
Eligibility and Enrollment: Pathways is mandatory for most eligible Hoosiers aged 60+ currently enrolled in Indiana Medicaid programs like Hoosier Care Connect, the Aged & Disabled Waiver, and Nursing Home Medicaid. Upon the program’s launch, these individuals were automatically transitioned to Pathways. Exceptions include members of recognized tribes and those on hospice, who can opt out. Eligible participants must choose one of three Managed Care Entities (MCEs): Anthem, Humana, or United Healthcare. While participants continue receiving Medicare benefits as before, their Medicaid health plan coordinates with their Medicare plan for seamless care.
Key Benefits: Pathways offers a wide range of benefits, including:
- Care coordination and physician appointments
- Laboratory work, x-rays, and hospital care
- Surgical and home health care
- Durable medical equipment, hospice care, and therapies (physical, occupational)
- Medications, vision, dental, and mental health services
- Substance abuse treatment
- Long-term care services like adult day care, adult family care, assisted living, and attendant care
- Respite care, community transition support, home modifications, meal delivery, pest control, and specialized medical equipment
Additionally, MCEs provide specific benefits such as over-the-counter pharmacy allowances, gift cards for groceries, and gym memberships. However, Pathways does not cover room and board costs in adult family care homes or assisted living residences.
Application Process: Applicants will need to meet eligibility criteria when applying. The process involves gathering documentation such as Social Security and Medicare cards, bank statements, proof of income, and insurance policies. The Medicaid application process can take up to three months or longer, with a federal review period of up to 45 days (90 days for disability applications). Applicants for HCBS may face a waiting list, as participant slots are limited.
Indiana Pathways for Aging is administered by the Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy & Planning (OMPP) and managed by contracted MCEs. For more information or assistance with the application process, individuals can contact the Indiana Pathways for Aging Helpline at 87-PATHWAY-4.
Structured Family Caregiving Program: This program allows family members (including spouses) to be able to be paid a tax-free daily stipend for the care they provide, seven days a week.
For more information on the PathWays to Aging Waiver, please click here.
How Medicaid Waivers Work
Medicaid waivers allow caregivers to get paid through self-direction programs (also known as consumer direction, participant direction, or other similar names), allowing Medicare Recipients more control over their care by enabling them to choose who provides it, including family members.
To get paid, the care recipient must be evaluated and approved for in-home care, after which the caregiver must complete onboarding including providing personal documents and a background check.
Payment Details for Family Caregivers in Indiana
Caregivers are required to submit a Patient Log daily to receive a daily stipend. The daily stipend is based on the participant’s level of care.
Program guidelines: Each waiver program may have specific rules and regulations regarding caregiver compensation. These guidelines often outline the maximum hourly rate allowed.
Steps to Becoming a Paid Family Caregiver
Assess the Needs of Your Loved One
The first step to becoming a paid family or friend caregiver is calling FreedomCare who will serve as your advocate during this process. The next step is working with a Case Manager to assess the needs of your loved one and help create a comprehensive care plan.
This will help you determine the level of care they require. It’s important to understand that the level of care needed by a primary caregiver may change over time as their condition progresses.
The assessment should evaluate the individual’s physical, emotional, and cognitive needs. This may include their ability to perform daily living activities, their medical conditions and medications, their mental health status, and their cognitive abilities.
Step 1: Apply for the Structured Family Caregiving (SFC) Program
One of the primary programs that pay family caregivers in Indiana is the Structured Family Caregiving (SFC) program. This program is administered by Indiana’s Division of Aging and is funded through Medicaid.
To apply for the SFC program, you’ll need to contact FreedomCare who will assist you in coordinating with your local AAA (Area Agency on Aging or a similar agency) that administers the program. FreedomCare will guide you through the application process and help you understand the eligibility requirements.
The SFC program provides financial compensation to family caregivers who live with and care for an eligible family member. To qualify for the SFC program, your loved one must:
- Be eligible for Medicaid.
- Require assistance with at least 3 activities of daily living (ADL):
Personal Hygiene- including using the restroom, bathing, nail care and more
Mobility- walking, stairs and getting in and out of bed
Dressing- including buttons and zippers
Eating- using utensils
- Live in the same residence as the caregiver.
Step 2: Undergo a Home and Family Assessment
After applying for the SFC program, a care manager from your local Area Agency on Aging will conduct a Level of Care assessment. They will evaluate the care recipient’s needs and your ability to meet those needs.
During the assessment, the care manager will likely review the physical layout of your home, the availability of necessary medical equipment, and the overall safety of the environment. They may also ask about your relationship with the care recipient and your ability to handle the emotional and physical demands of caregiving.
Step 3: Develop a Care Plan
Once your application is approved, you’ll work with the care manager to develop a care plan. This plan outlines the specific services and supports your loved one needs and how you will provide these services.
The care plan is a crucial document in caregiving as it guides your activities and ensures that the care recipient’s needs are being met. It should be reviewed and updated regularly to reflect any changes in the individual’s condition or needs.
Step 4: Begin Providing Care and Receiving Payment
Once the care plan is in place, you can start providing care and receiving payment. The amount you receive depends on the level of care your loved one requires.
Remember that providing care involves more than just physical tasks. Emotional support, companionship, and maintaining a high quality of life are equally important aspects of caregiving.
Other Programs and Resources Available in Indiana
Apart from the SFC program, there are other programs and resources that can help you become a paid family caregiver in Indiana. These include the Aged and Disabled Waiver, the Family Supports Waiver, and the Community Integration and Habilitation Waiver. Each of these programs has its eligibility criteria and application process.
Additionally, Indiana offers the CHOICE (Community and Home Options to Institutional Care for the Elderly and Disabled) program, which provides home and community-based supportive services to prevent unnecessary institutionalization.
Conclusion
As a family caregiver, you provide invaluable support to your loved one, often navigating emotional, physical, and financial challenges. Understanding the requirements and opportunities available to you is crucial for making informed decisions that benefit both you and your loved one. At FreedomCare, we are dedicated to supporting caregivers like you. Our program can help you get compensated for the essential care you provide, offering guidance and resources throughout the process. Let FreedomCare help you manage your caregiving responsibilities while ensuring you receive the support you deserve. Reach out today to explore how we can assist you.
Reference
Attendant Care & SFC Indiana Programs — Structured Family Caregiving Indiana. (n.d.). Structured Family Caregiving Indiana. https://www.structuredfamilycaregivingindiana.com/structured-family-caregiving-indiana
Cobb, D. (2024, May 30). Indiana’s Structured Family Caregiving Program. https://www.payingforseniorcare.com/indiana/medicaid-waivers/structured-family-caregiving
Leifer, M. (2023, December 24). Applying to Structured Family Caregiving in Indiana – Freedom Care. Freedom Care. https://freedomcare.com/applying-to-structured-family-caregiving-in-indiana/