The Indiana Family and Social Services Administration (FSSA) quietly paused determinations for disability Medicaid waivers in August, impacting Hoosiers across the Wabash Valley who rely on these waivers to remain in their homes rather than institutional settings. The pause, now lifted, was initiated to review how case managers were implementing the agency’s new interRAI assessment system, which determines waiver eligibility. This review came amid alarm from advocates and Democratic lawmakers regarding the tool's accuracy and a surge in denials following its January introduction.
An FSSA spokesperson confirmed that the agency paused level-of-care determinations on August 31 for assessments awaiting review by the Indiana Bureau of Disabilities Services. The spokesperson stated the review aimed to ensure consistency and adherence to state standards in how case managers conducted assessments. The Arc of Indiana, an organization advocating for disability rights, learned of the pause after filing a public records request on September 30 to understand how determinations were being made.
FSSA adopted the interRAI algorithm in January for level-of-care assessments after internal estimates suggested the previous system's nearly 100% approval rate for disability waivers should be closer to 90%. However, the new tool led to a rapid surge in denials, prompting concerns from lawmakers and advocates who feared errors in the process.
During the pause, Arc executives discovered that FSSA had ordered new assessments for Hoosiers with pending interRAI-based level-of-care denials. Additionally, the agency began rescinding denials that were currently in appeals or where individuals had raised concerns, allowing for reassessments of those cases. Karly Sciortino-Poulter, director of The Arc of Indiana Advocacy Network, described this as “essentially a fresh start,” advising individuals to carefully review new assessments and understand their appeal rights and deadlines.
Despite the review, an FSSA spokesperson affirmed full confidence in the interRAI tool, stating that the pause was primarily due to variability in how case managers administered assessments, rather than issues with the tool itself. InterRAI, also known as the international residential assessment instrument, was originally developed as an assessment tool for nursing homes.
Arc officials reported that FSSA informed them that new assessments would involve mentors and specially trained assessors working alongside a person's assigned case manager, a change praised by Arc CEO Kim Dodson. Despite this, advocates from The Arc continue to raise questions about how assessment information is specifically used to determine waiver eligibility.
The group is seeking detailed information on how FSSA maps interRAI assessment data onto Indiana’s level-of-care criteria and the methodology used to make eligibility determinations. They are also requesting records related to assessment training, quality assurance, implementation, and outcomes. Dodson emphasized the significant impact of this sophisticated assessment on individuals.
While not seeing the tool itself as the fundamental problem, Dodson expressed concern about the implementation's apparent deviation from the tool's design as a comprehensive, person-centered assessment. She stressed the need to understand which assessment information is considered crucial, how it is weighted, what criteria or thresholds are applied, and how the methodology was developed and tested. This transparency, Dodson stated, is essential to ensure the process accurately identifies everyone who meets Indiana's level-of-care requirements, not only those with the most significant or readily apparent disabilities.
