INDIANA

Indiana has undertaken Olmstead-related initiatives for people with disabilities in two stages. The first, led by the state's Family and Social Services Administration (FSSA), resulted in the first edition of Indiana's Comprehensive Plan for Community Integration and Support of People with Disabilities, released on June 1, 2001. The second stage involved an executive order in July 2002 that created the Governor's Commission on Home and Community-Based Services. The purpose of the commission has been to develop short- and long-term strategies to create or expand community services for people with disabilities.

The commission released an interim report on December 23, 2002, which contained 16 recommendations that the commission said could be "implemented quickly and with little or no fiscal impact or regulatory requirements." A final report was published on June 30, 2003, which reported progress on those 16 recommendations and proposed 28 other strategies. The latter are organized into four categories: rebalancing the long-term care system, removal of barriers, community capacity, and children at-risk. The final report can be found at http://www.in.gov/fssa/community/pdf/finalrpt063003.pdf.

One recommendation in the interim report called for using federal Systems Change grant funds to award mini-grants to local communities to "help people with limited options live as independently as possible in their homes and communities." The first round of mini-grants, totaling $430,000, was awarded in February 2003 to 12 communities; the second round, totaling $320,000, was awarded to 11 communities in May 2003. Each community received up to $40,000 for proposals to foster collaboration among community partnerships. The focus was on maximizing and leveraging the funds by working to match other funding sources in the communities.

The other initial 16 recommendations included a proposal to implement spousal impoverishment protections in the Medicaid Aged and Disabled Waiver program, as is provided for Medicaid-funded nursing home residents. The federal government approved the waiver amendment on February 24, 2003. Another recommendation called for a comprehensive fiscal impact analysis of raising the monthly eligibility standard for the Aged and Disabled waiver to 300 percent of the Supplemental Security Income (SSI) amount. The analysis, completed in March 2003, estimated state costs for the change at $2.7 million for the first year.

The recommendations in the commission's final report include creation by the governor a cross-disability consumer advisory council to advise him, the Indiana Family and Social Services Administration, and other state agencies on issues that facilitate continuing progress on Olmstead plan implementation. Other recommendations propose a Medicaid home and community-based services waiver for adult foster care; additional FSSA staff to develop the assisted living program that has been in place since July 1, 2001; an FSSA study on how to streamline and significantly reduce the time involved in determining Medicaid waiver program eligibility; and development of the infrastructure for a consumer-directed care program.

The Indiana legislature enacted Senate Bill 493 in April 2003, mandating the implementation of the 300-percent-of-SSI eligibility standard, effective July 1, 2003. In a July 2003 report on implementation strategies in regard to the mandates in SB 493, FSSA noted that during the last biennium (July 1, 2001 - June 30, 2003), an additional 1,600 slots had been added to the Medicaid Aged and Disabled waiver program, and an additional 1,000 slots have been added to that waiver for diversions and conversions from nursing homes. Another change was the addition of an incentive to the contracts with Area Agencies on Aging to pay a fee for successful diversions, which the department said resulted in several hundred diversions in the last six months of the biennium. The department said that implementation of Senate Bill 493 needed to become an FSSA priority, despite the legislature's "failure to allocate funding to fully implement" the changes envisioned in the bill.

The Governor's Commission on Home and Community-Based Services planned a last meeting in December 2003 to evaluate progress made on both its short- and long-term recommendations, to evaluate the effects of the mini-grants on advancing systems change, and to assess the effects of Senate Bill 493 on the state community-based service system.