Medicaid Waiver: New Indiana Assessment Draws Criticism
A mother in southern Indiana says the new state procedure for disability eligibility is too complex for her son, who functions at the level of a five-year-old.
By Jillian Foster ·
Angie Brookshire, a teacher in Loogootee, Indiana, says the new state assessment for disability benefits was overwhelming for her son, Cameron. The family has relied on a Medicaid waiver for a decade to access a day program at the First Chance Center in Paoli. Brookshire describes the program as a daily source of joy for her son, who has autism and numerous health problems.
The Indiana Family and Social Services Administration (FSSA) implemented the new assessment procedure earlier this year. The process evaluates individuals across six areas: self-care, language use, learning, mobility, self-direction, and independent living capacity. Brookshire states that the interview lasted two hours and 20 minutes. She argues that many questions exceeded the cognitive level of her son, who functions like a five-year-old.
Brookshire recalls a specific moment during the visit where an FSSA assessor asked Cameron if he was a positive influence in his community. Cameron nodded, but Brookshire intervened, explaining that he did not understand the terms. She asked him to define community and positive, and he could not. She instructed the assessor not to record a yes answer. Other questions cited by Brookshire include inquiries about primary life goals, closest confidants, and feelings of anxiety or depression over the previous three days.
Brookshire, who tests special education students for a living, felt the format was flawed. She noted that the assessor often turned to her to answer on Cameron's behalf. She also mentioned that the assessor handed her a computer to input Cameron's medical data. After posting her experience on Facebook, the comment received hundreds of responses and more than 800 shares. One commenter called it a waste of state resources given existing doctor statements confirming a lifelong disability.
Despite the criticism, Brookshire reports that Cameron was approved for the waiver. She remains worried about applicants who were not as fortunate. Her central concern is that the process may set people up to fail while the state attempts to trim costs.
FSSA officials dispute the idea that the changes are designed to save money. Kelly Mitchell, director of the Division of Disability Aging and Rehabilitative Services, stated that the goal is to identify needs consistently and accurately. Holly Wimsatt, director of the Bureau of Disability Services, explained that the assessment uses a holistic perspective to inform care eligibility and service planning. The agency noted that the process includes guided interviews, record reviews, and assessor observations.
FSSA acknowledged issues found during an internal review. Mitchell said there were reports that individuals or guardians were not always included in interviews, or that questions were read aloud rather than part of a guided process. The agency has re-trained staff to verify information with other knowledgeable individuals when inconsistencies arise. FSSA says the current denial rate is 3.5%, down from 6% earlier this summer. Under the previous system, the denial rate was 0.02%.
The agency added 800 slots for the family support waiver and is scheduling reassessments for 500 people currently in active appeal. Mitchell emphasized that services do not terminate immediately upon a negative determination, and individuals have at least 90 days plus an appeal process. FSSA also said it would review the specific concerns raised by Brookshire regarding her son's interview.
The Arc of Indiana, an advocacy group, has filed a public records request to examine the new process. CEO Kim Dodson cited concerns about inconsistent assessments, inadequate training, and poor communication. The organization seeks details on how the assessment tool, referred to as InterRAI, determines eligibility. Dodson said the group needs to understand how information is weighted and what criteria are used to ensure the process accurately identifies everyone who meets state requirements.
Brookshire waits for the state to respond to her specific case while the agency continues to adjust its procedures. The Arc of Indiana expects to receive records regarding assessment training, quality assurance, and implementation problems as part of its ongoing inquiry.
