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 30, 2024
BILL NUMBER: HB 1386 BILL AMENDED: Jan 30, 2024
SUBJECT: Medicaid Matters.
FIRST AUTHOR: Rep. Barrett BILL STATUS: CR Adopted - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: (Amended) Medicaid Home- and Community-Based Services Waivers: The bill
sets forth the powers and duties of the Office of the Secretary of Family and Social Services (FSSA)
concerning Medicaid home- and community-based services (HCBS) waivers. It defines "home and
community based services waiver". It also requires a provider of services under a HCBS waiver to follow
any waiver requirements under federal law and developed by the FSSA. The bill establishes requirements
for HCBS waivers. The bill relocates a provision requiring the FSSA to annually determine any state savings
generated by HCBS.
Assisted Living: The 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 HCBS waiver; and (2) reimbursement is
required for certain services that are part of the individual's HCBS plan. The bill also relocates provisions
establishing limitations concerning assisted living services provided in a HCBS program.
Appeals: The bill removes a provision allowing the Division of Aging (DA) 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 FSSA to adopt rules concerning the appeals process.
Attendant Care Services: The bill requires an individual who provides attendant care services for
compensation from Medicaid to register with the FSSA.
In-Home Services: It removes the requirement that the DA administer programs established under Medicaid
waivers for in-home services for treatment of medical conditions.
HB 1386 1 Ombudsman: The bill provides that provisions of law concerning the Statewide Waiver Ombudsman apply
to an individual who has a developmental disability and receives services administered by the Bureau of
Disabilities Services. (Current law specifies that these provisions apply to an individual who has a
developmental disability and receives services under the federal HCBS program). It specifies that these
provisions do not apply to an individual served by the long-term care ombudsman program. It also changes
references from "Statewide Waiver Ombudsman" to "Statewide Bureau of Disabilities Services
Ombudsman".
Delinquent Child: It requires certain facilities to provide notice within a specified time to the Division of
Family Resources (DFR) that a delinquent child will be released from the facility. It also requires the DFR
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.
Third-Party Coverage: The 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 also 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.)
Repeals: The 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. The bill also repeals provisions
requiring the DA to submit a plan, before October 1, 2017, to the General Assembly to expand the scope and
availability of HCBS for individuals who are aged and disabled. It makes conforming amendments.
Effective Date: July 1, 2024.
Explanation of State Expenditures: (Revised) Delinquent Child: The provisions of the bill concerning soon
to be released delinquent children may allow the state to leverage federal financial participation for federally
required physical and behavioral screenings and case management services 30 days prior to release from an
institutional setting and for 30 days post-release. The federal law concerning the use of the Children’s Health
Insurance Program (CHIP) or Medicaid and the requirement to provide the services take effect on January
1, 2025.
Third-Party Coverage: 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.
(Revised) Ombudsman: The Statewide Bureau of Disabilities Services Ombudsman may have increased
workload with the addition of providers delivering services for the Bureau of Disabilities Services. The
magnitude of the increase will depend on the number of additional cases and the complexity of the cases.
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 (HCBS) from
programs for individuals in need of self-directed in-home care by moving certain waiver-related duties,
HB 1386 2 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 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.
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: (Revised) County sheriffs and local facilities responsible for
delinquent children may have some reduction in costs of prerelease testing and case management costs (see
Explanation of State Expenditures.)
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