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Family and Social Services proposes ending attendant care payments to parents, spouses to cover nearly $1B shortfall
The Indiana Statehouse dome in 2023. (Credit: Mark Curry)
The Indiana Family and Social Services Administration has proposed “sustainability strategies” to mitigate a nearly $1 billion forecasting error it made last year. But critics argue the administration’s proposals would burden Hoosier families who rely on some Medicaid services by reducing caregivers’ pay.
Last month, Family and Social Services Administration leaders told the State Budget Committee that the administration had underestimated the cost of covering Hoosiers’ Medicaid services over the biennium by $984.3 million. Lawmakers plan to cover the loss by using monies from the state surplus and a state Medicaid reserve account.
After additional data analysis, the administration determined the state’s Aged & Disabled waiver program “is where the Medicaid program is most acutely seeing an unanticipated growth in spending,” it said in a Jan. 17 announcement.
“Overall, attendant care expenditures on the A&D waiver have grown from approximately $30 million per month in April 2022 to approximately $120 million in December 2023, which is a 300% increase in a little more than a year and a half and have nearly quintupled since July 2020,” Michele Holtkamp, an administration spokesperson, said in an email to State Affairs.
Through the waiver program, spouses or parents of minor children — termed legally responsible individuals — are paid an hourly rate to care for their aging or disabled spouse or child at home. The program serves as an alternative to nursing facilities. In December, 41,157 Hoosiers received services through the waiver, Holtkamp said.
Under the administration’s proposal, Aged & Disabled waiver recipients currently providing attendant care for their disabled children or spouses will be transitioned to Indiana’s Structured Family Caregiving program by July 1. The caregiving program, however, would pay spouses and parents a daily rate, based on the dependents’ need, that is substantially less than what attendant care providers receive, said Karly Sciortino-Poulter, The Arc of Indiana’s advocacy network director.
Yesterday, dozens gathered to protest the administration’s proposals, and more than 12,000 people have signed a petition to continue allowing parents and spouses to provide attendant care through the Aged & Disabled waiver program.
“The payment to family caregivers is what is taking the most attention immediately because that is the one that will be felt most immediately by individuals and families,” Sciortino-Poulter said. “We recognize that the proposals being made will have a huge impact on families and individuals, and will have a negative impact on families. And this is coming off the heels of the state reassuring families in May that these programs were going to continue.”
The caregivers are paid by Medicaid approved waiver agencies, so the administration does not collect individual caregivers’ pay, Holtkamp said, making the exact pay discrepancy between the two programs uncertain.
Come July 1, dependent Hoosiers could still receive attendant care from a professional, just not from a spouse or parent.
On Jan. 17, the administration also made immediate changes to the waiver program, prohibiting any new waiver recipients from providing attendant care — often assistance with basic life functions — for dependent family members.
In addition, spouses or parents of minor children can now no longer be paid to provide home and community assistance services, which are often “less intimate” than attendant care, such as helping a dependent family member drive to the bank or go grocery shopping, Sciortino-Poulter said. Families can currently only provide either attendant care or home and community assistance services, she said.
Over the next several months, the administration has outlined plans to make myriad changes to Indiana’s Medicaid programs to save an estimated $300 million annually, including temporarily pausing a 2% rate indexing across Medicaid services and restricting retroactive waiver coverage.
Implementing many of the Family and Social Services Administration’s proposals requires the agency to issue new draft waivers, which are out for public comment. A second round of public comment began Jan. 17 for the state’s Aged & Disabled, PathWays, Traumatic Brain Injury, Community Integration and Habilitation and Health & Wellness waivers. The draft waivers open for public comment will be submitted to the Centers for Medicare & Medicaid Services for approval. The public comment period is open through Feb. 16. The effective date for the waivers is July 1.
The Aged & Disabled waiver will be split into two new waivers — a PathWays waiver (for ages 60 and older) and a Health & Wellness waiver (for ages 59 and younger) — by July 1 as Indiana rolls out its upcoming Indiana PathWays for Aging program.
On Jan. 18, Indiana Medicaid Director Cora Steinmetz told the Community and Home Options to Institutional Care for the Elderly and Disabled Board that the waiver program accounted for about half of the “unanticipated variance” reported in December.
Reduced pharmacy rebates, the delayed implementation of the state’s applied behavioral analysis therapy rate fee schedule (to Jan. 1, 2024, from July 1, 2023) and a lesser federal medical assistance percentage also contributed to the shortfall, Steinmetz said.
“We understand that families are concerned, specifically about a disruption to the model that allowed parents of minors or spouses (legally responsible individuals) of A&D waiver members to be paid as attendant care providers for their loved ones,” the administration wrote on its website. “FSSA had previously offered a means for legally responsible individuals to support the direct personal care needs of recipients. However, we must now move to a service model that aligns with allowable waiver practices, is more financially sustainable, and also better recognizes support needs of caregivers.”
Contact Jarred Meeks on X @jarredsmeeks or email him at [email protected].
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How McCormick, Braun view abortion, taxes and other key issues
A Democrat-turned-Republican and Republican-turned-Democrat will soon face off in the race to become Indiana’s next governor.
Sen. Mike Braun, who voted as a Democrat prior to 2012, captured the Republican nomination in Tuesday’s primary. Jennifer McCormick, formerly a Republican Superintendent of Public Instruction, will represent the Democrats.
Voters will decide the state’s next chief executive in November.
A State Affairs analysis of the candidates’ campaign platforms and public statements found key differences — and a few similarities — in their planned approaches to a variety of issues impacting Hoosier voters.
Here is how they match up.
Abortion
Braun: As a senator, Braun has long supported abortion restrictions.
In 2020, he called for the Supreme Court to re-examine Roe v. Wade.
In 2023, he proposed federal legislation that would have required parental notification before any unemancipated minor could seek an abortion. He said at the time: “Hoosiers put their trust in me to stand up for the unborn, and that’s what I’ve been proud to do every day in the Senate.”
He has since signaled support for the state’s abortion ban. His platform reads: “State lawmakers must work to ensure the gains we have made to protect life are secured and strengthened.”
McCormick: In a Tuesday interview with State Affairs, McCormick said her candidacy represented a referendum on reproductive rights.
“I’m going to fight to restore those rights under any authority I can, working in a bipartisan fashion, using our committees, board and our agencies. I also know, too, what everybody’s fear is: that they’re [Republicans] not going to restore those rights and will take [restrictions] further.”
From her platform: “Indiana’s Republican-led extreme abortion ban has taken away the right of women to make deeply personal decisions regarding their own health care.”
Marijuana
Braun: At a March 26 Republican primary debate, Braun suggested an openness to legalizing medicinal marijuana.
“It’s gonna hit all of us. I’m gonna listen to law enforcement — they have to put up with the brunt of it,” he said. “Medical marijuana is where I think the case is best made that maybe something needs to change. But I’ll take my cue from law enforcement there as well. … I hear a lot of input where [medical marijuana is] helpful, and I think that you need to listen and see what makes sense.”
McCormick: The Democrat’s platform also addresses medical marijuana legalization, while speculating on possible recreational use.
“We will fight for the legalization of medical marijuana as a source of state revenue established on a well-regulated marketplace and monitored by a Cannabis Task Force in order to study the issues, opportunities and potential obstructions associated with recreational marijuana legalization.”
McCormick said she would also support expunging low-level marijuana-related convictions.
Taxes
Braun: At a March 19 National Federation of Independent Business forum, Braun said the state’s property tax system “went out of whack because it couldn’t respond to inflation like we’ve never seen before.”
“The way you finance any lower taxes would be to bank on the government being run more efficiently,” he said.
His platform also calls for government spending cuts to finance lower taxes: “Reducing the size of government is the key to cutting taxes, and Mike Braun will work through every state agency to find ways to save money while delivering high-quality services to taxpayers.”
McCormick: McCormick also spoke about taxes at the March 19 forum.
“I agree with a revamp of our taxing system,” she said. “But also it’s about not just how we’re getting our revenue, it’s about our expenditures. Yes, we need to fix our gas tax. Yes, we need to look at the income tax. But here’s the thing: There are hidden taxes we’re not having a conversation about.”
Her platform also references the possibility of combining state agencies as a way to save money.
Education
Braun: In his platform, Braun supports broadening school choice and parental rights.
“As a former school board member, Mike Braun knows parents are the primary stakeholders in their children’s education and every family, regardless of income or zip code, should be able to enroll in a school of their choice and pursue a curriculum that prepares them for a career, college or the military,” the platform reads.
Braun also pledged to ensure critical race theory and discussions about gender are banned in public schools.
McCormick: Education is one of McCormick’s primary issues, according to her platform.
She calls for the elimination of statewide testing, increased early childhood reading and child care options and a minimum base salary of $60,000 for all K-12 teachers.
McCormick also addresses the state’s school choice movement.
“We will call for a pause in the expansion of school privatization efforts while requiring fiscal and academic accountability and transparency for all of Indiana schools that receive public tax dollars,” her platform reads.
U.S.-Mexico border
Braun: Braun’s television ads have touched on border security, and his platform calls for increased focus on the area.
“Joe Biden and the left have created a humanitarian and national security crisis on our southern border,” the platform reads. “As governor, Mike will continue to support and enact the America First policies that were working. Otherwise, every town will become a border town.”
McCormick: McCormick’s border-related plans are more focused on facilitating legal immigration.
“We will work with local, state and federal officials in supporting an immigrant system that creates a safe, timely, orderly and humane pathway for those seeking legal immigration while keeping our communities and those responsible for border security safe,” her platform reads.
Contact Rory Appleton on X at @roryehappleton or email him at [email protected].
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