LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 7038 NOTE PREPARED: Jan 9, 2024
BILL NUMBER: HB 1386 BILL AMENDED:
SUBJECT: Medicaid Matters.
FIRST AUTHOR: Rep. Barrett BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: This bill sets forth the powers and duties of the Office of the Secretary of Family
and Social Services (Office of the Secretary) concerning Medicaid Home and Community Based Services
waivers. It defines "Home and Community Based Services waiver". It requires a provider of services under
a Home and Community Based Services waiver to follow any waiver requirements under federal law and
developed by the Office of the Secretary. It establishes requirements for Home and Community Based
Services waivers.
This bill relocates provisions requiring reimbursement for assisted living services for individuals who are
aged and disabled and receiving services under a Medicaid waiver. It specifies that: (1) these provisions
apply to an individual receiving services under a Home and Community Based Services waiver; and (2)
reimbursement is required for certain services determined to be medically necessary for the individual.
This bill relocates provisions establishing limitations concerning assisted living services provided in a Home
and Community Based Services program. It relocates a provision requiring the Office of the Secretary to
annually determine any state savings generated by Home and Community Based Services.
This bill removes a provision allowing the Division of Aging to adopt rules concerning an appeals process
for a housing with services establishment provider's determination that the provider is unable to meet the
health needs of a resident and allows the Office of the Secretary to adopt rules concerning the appeals
process. It requires an individual who provides attendant care services for compensation from Medicaid to
register with the Office of the Secretary. It removes the requirement that the Division of Aging administer
programs established under Medicaid waivers for in-home services for treatment of medical conditions.
HB 1386 1 This bill requires certain facilities to provide notice within a specified time to the Division of Family
Resources that a delinquent child will be released from the facility. It requires the Division of Family
Resources to take action necessary to ensure that the delinquent child, if eligible, participates in the Medicaid
program upon the child's release and receives services required by federal law.
This bill specifies that an insurer may not deny a Medicaid claim solely due to a lack of prior authorization
in accordance with federal law. It requires an insurer to respond to a state inquiry regarding a Medicaid claim
not later than 60 days after receiving the inquiry. It specifies, for purposes of a provision concerning
Medicaid third party liability, that the state is considered to have acquired the rights of the person to payment
by any other party for accumulated and future health care items or services. (Current law provides that the
state is considered to have acquired these rights for the health care items or services.)
This bill repeals a provision providing that licensed home health agencies and licensed personal services
agencies are approved to provide certain services under a Medicaid waiver granted to the state under federal
law that provides services for treatment of medical conditions. It repeals provisions requiring the Division
of Aging to submit a plan, before October 1, 2017, to the General Assembly to expand the scope and
availability of Home and Community Based Services for individuals who are aged and disabled. It also makes
conforming amendments.
Effective Date: July 1, 2024.
Explanation of State Expenditures: A child within 30 days of release from a state or local facilities must
have screening and services under federal law. The Division of Family Resources will have an increase in
workload and potentially costs to enroll Medicaid-eligible delinquent children in Medicaid within 30 days
of release. This will potentially increase state Medicaid costs with higher enrollment and by undertaking
some of the screening and case management costs. Overall, state cost savings could occur, if services that
would be paid exclusively with state funds may be partially reimbursed through Medicaid.
The state could recover more health services spending when Medicaid pays for health care services when
there is a third-party liability payment. The state is the recipient of the payment and future related payments,
under the provision of the bill.
The bill allows the Office of the Secretary of Family and Social Services (FSSA) to designate the division
or office in charge of Medicaid home-and-community based services waivers, potentially resulting in
administrative efficiency. The bill separates the Medicaid home-and-community based services from
programs for individuals in need of self-directed in-home care by moving certain waiver-related duties,
requirements, and authority among the divisions of the FSSA and within regions.
The FSSA will have workload increase to adopt rules regarding individuals in need of self-directed in-home
care (and may adopt rules regarding other requirements prescribed in the bill). Workload for the FSSA will
increase to restructure the agency's duties and responsibilities and to adopt rules. It is expected that the
requirements of this bill should be able to be implemented with no additional appropriations, assuming near
customary agency staffing and resource levels.
Additional Information - Medicaid and the Children’s Health Insurance Program (CHIP) are jointly funded
between the state and federal governments. The state share of costs for most Medicaid medical services for
FFY 2023 is 34% and 24% for CHIP. The state share of administrative costs is 50%. The state share of most
Medicaid and CHIP expenditures is paid from General Fund appropriations.
HB 1386 2 Explanation of State Revenues: The bill separates the personal services attendant registration for waivers
from the registration to provide services to individuals in need of self-directed in-home care. There is
potential for a personal services attendant to register with both programs. Each program charges a registration
fee as determined by the agency. Registrations must be renewed, and the fee paid, every two years. Any
increase in fee revenue will depend on the number of individuals registered by the FSSA and the fee amount
set by the agency.
Explanation of Local Expenditures: Local facilities for delinquent children may have some reduction in
costs of prerelease testing and case management costs.
Explanation of Local Revenues:
State Agencies Affected: Family and Social Services Administration.
Local Agencies Affected: Local facilities for delinquent children.
Information Sources:
Fiscal Analyst: Karen Rossen, 317-234-2106; Jason Barrett, 317-232-9809.
HB 1386 3