IN Community Integration and Habilitation Waiver

The Community Integration and Habilitation (CIH) Waiver in Indiana is a Medicaid program that provides home and community-based services for eligible individuals. In this article, we explore the CIH waiver, who can qualify for it, what services it offers, and how it can compensate family caregivers.

Overview of the Community Integration and Habilitation (CIH) Waiver

The CIH waiver is one of two Medicaid Home and Community-Based Services (HCBS) waivers provided by the Bureau of Developmental Disabilities Services (BDDS) in Indiana to children and adults with an intellectual disability, developmental disability, or related condition. The CIH waiver aims to provide services that let individuals remain in their homes or community-based settings or transition from institutional settings into the community1. The CIH waiver also allows flexibility in providing the support necessary to help care recipients maintain self-determination and community integration.

Eligibility requirements

The eligibility requirements for the CIH waiver are based on the diagnosis, income, level of care, priority criteria, and availability of slots.

• Diagnosis: To qualify for the CIH waiver, individuals must have a diagnosis of an intellectual disability, developmental disability, or related condition that originated before the age of 22 years and is expected to continue indefinitely. A related condition is defined as a severe chronic disability resulting in impairment of functioning similar to that of a person with an intellectual disability, which includes autism spectrum disorder, epilepsy, cerebral palsy, or similar condition other than mental illness.
• Income: To qualify for the CIH waiver, individuals must have an income of at most 300% of the maximum SSI amount. For 2023, this amount is $2,382 per month. Parental income for children under 18 years of age is disregarded. However, if individuals or families request coverage for the 90 days before the application date, then household income eligibility requirements are taken into consideration2.
• Level of care: Individuals must meet the ICF/IID level of care to qualify for the CIH waiver. This means they must exhibit substantial functional limitations in at least three prominent life areas: self-care, receptive and expressive language, mobility, learning, self-direction, and capacity to live independently. They must also require access to 24-hour assistance as needed.
• Priority criteria: To qualify for the CIH waiver, individuals must meet at least one of the priority criteria established by BDDS. These include:
  > Transitioning from a nursing facility, extensive support needs facility, or state-operated facility to the community 
  > Determined to no longer require active treatment in Supervised Group Living
  > Transitioning from 100% state-funded services
  > Aging out of the Department of Education, Department of Child Services, or Supervised Group Living
  > Requesting to leave a large private ICF/IID
  > Death of a primary caregiver where no other caregiver is available
  > Caregiver over the age of 80 years when no other caregiver is available
  > Evidence of abuse or neglect in current Supervised Group Living Placement
  > Extreme health and safety risks as reviewed and approved by the Division Director
• Availability of slots: Individuals must have a funded space available to qualify for the CIH waiver. This means there must be enough funding and capacity to provide services to the individual. The state budget and the federal approval of the waiver determine the number of slots. Individuals who meet the eligibility criteria but do not have a funded space are on a waiting list until a space becomes available.

Services and supports

The CIH waiver offers services and supports chosen based on person-centered principles and delivered by an approved Medicaid provider in the home and community settings. The services and supports are intended to help individuals achieve their goals and outcomes, enhance their quality of life, and increase their independence and inclusion. The services and supports available under the CIH waiver include:

• Adult Day Services: These structured activities provide opportunities for socialization, skill development, recreation, and community integration in a group setting.
• Behavioral Support Services/Crisis Assistance: These interventions address challenging behaviors that interfere with the individual’s functioning and well-being. They include assessment, planning, training, monitoring, and crisis response.
• Case Management: This service coordinates and monitors the delivery of waiver services for the individual. It includes assessment, planning, linking, advocacy, and follow-up.
• Community-Based Habilitation-Group: This service provides training and assistance in self-care, communication, socialization, relationship building, and other skills in a group setting in the community.
• Community-Based Habilitation-Individual: This service provides training and assistance in self-care, communication, socialization, relationship building, and other skills in an individualized setting in the community.
• Community Transition Services: These services help individuals move from an institutional to a community-based setting. They include expenses for security deposits, household items, moving costs, and other one-time expenses.
• Electronic Monitoring: This service uses technology to monitor the individual’s safety and well-being in their home. It includes equipment installation, maintenance, monitoring, and response.
• Extended Services: These are services that provide ongoing support and supervision for individuals who are employed in competitive or integrated settings. They include job coaching, job development, job retention, and transportation.
• Environmental Modifications: These are physical adaptations to the individual’s home that improve accessibility, safety, and independence. They include ramps, grab bars, widened doorways, and other modifications.
• Facility-Based Habilitation-Group: This service provides training and assistance in self-care, communication, socialization, relationship building, and other skills in a group setting in a facility.
• Facility-Based Habilitation-Individual: This service provides training and assistance in self-care, communication, socialization, relationship building, and other skills in an individualized setting in a facility.
• Facility-Based Support Services: These provide supervision and assistance with personal care and daily living activities. They include personal hygiene, grooming, eating, toileting, mobility, medication administration, and other activities.
• Family & Caregiver Training: This service educates family members or caregivers on supporting the individual’s needs and goals. It includes behavior management, communication strategies, crisis prevention, health care needs, and community resources.
• Intensive Behavior Intervention: This service provides intensive one-on-one interventions for individuals with severe challenging behaviors that pose a risk to themselves or others. It includes functional assessment, behavioral plan development, implementation, and evaluation.

Compensation for caregivers

One of the benefits of the CIH waiver is that it allows individuals to choose who provides their services through a self-direction option. This means that individuals can hire their workers instead of using an agency. The workers can be family members, friends, neighbors, or other people who know the individual well. The workers must meet specific qualifications, such as passing a background check, completing training, and following the individual’s service plan. The workers are paid by a fiscal intermediary, which handles payroll, taxes, and other administrative tasks.

The self-direction option can be an excellent way for family caregivers to get paid for the care they provide to their loved ones. Family caregivers are often the primary source of support for people with intellectual and developmental disabilities, but they may face financial hardships, stress, and burnout due to their caregiving responsibilities. By getting paid through the CIH waiver, family caregivers can receive compensation for their work, recognition for their skills, and flexible schedules. They can also ensure their loved ones receive quality care from someone they trust.

A Note from Givers

If you are interested in applying for this waiver or finding out if you are eligible for compensation as a family caregiver, please fill out this form, and we will get back to you as soon as possible. We want to help you get the support you need and deserve.