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During the past decade, an important shift in the delivery of disability services has occurred. When the Fort Wayne State Developmental Center closed in April 2007, Indiana became the largest state with no large public institutional settings to serve individuals with developmental disabilities. This shift toward providing services in the family home and small community-based settings created a significant impact on state spending, Medicaid, and other funding sources over the past several years.
In 2012, the Centers for Medicare and Medicaid Services (CMS) awarded Indiana approximately $78 million of enhanced Federal Medical Assistance Percentages (FMAP) to improve how Long-Term Services and Supports (LTSS) in home and community-based settings are accessed and delivered throughout the state. While these funds are only available through September 30, 2015, the Balancing Incentives Program (BIP) is dedicated to helping states provide quality care to individuals in the most appropriate, least restrictive settings.
Among many other strategies planned through this initiative, the State is investing in small Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) or Supervised Group Living (SGL) providers via grants to assist in the voluntary conversion of their group home beds into Medicaid Waiver slots.
If a provider elects to convert its SGL home beds to HCBS waiver slots, the SGL residents will be given the option to transfer to another SGL setting or access the HCBS waiver. If the consumer elects to access the HCBS waiver, he/she will:
Overall, the consumer’s day and service mix under the waiver may look very similar to what it had been in the SGL or it may look very different based upon the services identified in the ISP.
Risk Mitigation grants are to be utilized by providers to offset allowable expenses of transitioning individuals from receiving services in a group home setting, to receiving Medicaid Waiver supported living services. It is not intended that these Risk Mitigation grants will cover profit loss attributed to consumers’ transition onto Waiver services.
SGL providers who are seeking to close a licensed SGL and convert its existing occupied group home beds to HCBS Waiver slots are asked to submit a Letter of Intent. The State will contact providers upon receipt to schedule a time to discuss and further prepare providers for submission of a full grant proposal.
Guidance regarding requirements for both Letters of Intent and Proposals are listed below.