Medical Assistance-Eligible Indianans v Indiana Family and Social Services Administration
Medical Assistance-Eligible Indianans Settle Community-Based Care Action with Indiana Family and Social Services Administration
The parties have reached a tentative settlement in an action filed against the state of Indiana on behalf of all Indiana residents with disabilities who are Medical Assistance recipients and who are either in a Medicaid funded facility or who are at imminent risk of such placement and who have either applied for Medicaid funded services in the community through the Aged and Disabled funded home- and community-based waivers administered by the state or who would be eligible for such services if they were available. The action alleges that the state refused to properly implement the law that allows community-based services to be financed through the waiver program. Interested persons should contact the class attorneys for more information.
The lawsuit claimed that the state of Indiana has failed to allow disabled Medicaid recipients in nursing homes, or who are at imminent risk of going into nursing homes, an opportunity to receive services in the community through the Aged and Disabled funded home- and community-based waiver program, instead of being forced into nursing homes. This waiver program was supposed to allow such services, as long as their cost did not exceed that of nursing home placement.
The settlement will provide for expansion of services under the Aged and Disabled funded home- and community-based waiver program. In total 2,000 additional persons are to be allowed to seek community-based services, and 1,000 persons who wish to be diverted from present nursing home placements. These new positions are to be implemented by June 30, 2003, contingent upon federal funding for 1,400 new positions to be sought by the state. The settlement specifies that the positions are to spread throughout the state in an equitable fashion. The state will also undertake an advertising campaign to assure that those persons in nursing homes or at imminent risk of nursing home placement will be made aware of the possibility of in-community services, and will maintain a toll-free hotline to answer questions regarding services.
When a person decides that they would rather receive community-based services than reside in a nursing home, and there is an opening, a comprehensive plan of care will be developed by a Medicaid-enrolled case manager selected by the Medicaid recipient. The state has agreed to have in place a quality assurance plan to guarantee that all community-based services meet acceptable standards. If an assessment is carried out, and a finding is made that the person is not at imminent risk of being placed in a nursing home, they will be given written notice, and will have a chance to appeal the decision.
The settlement class does not include persons who have applied for ICF/MR funded home- and community-based programs or the Developmentally Disabled funded home- and community-based waivers or who would be eligible for such services if they were available unless they elect to participate in the Aged and Disabled funded home- and community-based waivers.
The settlement will not be effective until the court grants it final approval. The court has not yet scheduled a hearing on the matter.
