LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 7677 NOTE PREPARED: Feb 19, 2025
BILL NUMBER: HB 1391 BILL AMENDED: Feb 11, 2025
SUBJECT: Services for the Aged and Disabled.
FIRST AUTHOR: Rep. Clere BILL STATUS: 2
nd
Reading - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State
DEDICATED
XFEDERAL
Summary of Legislation: CHOICE Program: This bill amends the definition of "community and home care
services" for purposes of Community and Home Options to Institutional Care for the Elderly and Disabled
Program (CHOICE).
This bill prohibits the Division of Aging (Division) from requiring a CHOICE provider to be certified under
a Medicaid waiver program. It requires a local Area Agency on Aging (AAA) to prioritize CHOICE funding
to identify specified individuals and provide community and home care services to these individuals. It
requires the Office of the Secretary of Family and Social Services (FSSA), in negotiating reimbursement
rates for CHOICE services, to consider the location and availability of service providers.
Medicaid Diversion Pilot Program: This bill establishes the Medicaid Diversion Pilot Program to evaluate
the effectiveness of home modification and telehealth enhanced chronic care services provided by specified
AAAs in reducing Medicaid expenditures.
Level of Care Assessments: This bill allows FSSA, a managed care organization that has contracted with the
Office of Medicaid Policy and Planning, and a person who has contracted with a certain managed care
organization or the FSSA to contract with an AAA to provide and receive reimbursement for a level of care
assessment for the: (1) Health and Wellness Medicaid waiver; (2) Traumatic Brain Injury Medicaid waiver;
and (3) risk based managed care program for the covered population.
AAA Report: This bill allows FSSA to study and prepare a report containing recommendations for realigning
and consolidating the AAA planning and service areas.
Effective Date: Upon passage; July 1, 2025.
Explanation of State Expenditures: CHOICE Program: The bill’s provisions affect expenditures, services,
reimbursement, and providers within the CHOICE Program. The bill will increase CHOICE claims, yet any
increase in expenditures resulting from the newly established Medicaid Diversion Pilot Program, newly
HB 1391 1 negotiated rates, expanded service offerings for individuals with dementia, and access to additional providers,
must be within the amount appropriated to the CHOICE Program. The CHOICE Program was appropriated
$48.8 M per year for FY 2024 and FY 2025.
The bill impacts workload for the FSSA, including FSSA’s Division of Aging, to negotiate reimbursement
rates and update requirements regarding the selection of providers for the CHOICE Program. It also requires
the AAAs to prioritize program funding for specific purposes such as identifying at risk individuals and
provide them with community and home care services. These requirements should be able to be implemented
using existing staffing and resources.
Medicaid Diversion Pilot Program: Subject to FSSA approval, the bill establishes the Medicaid Diversion
Pilot Program to evaluate the effectiveness of home modification and telehealth enhanced chronic care
services. The pilot program will be administered by the Indiana Association of Area Agencies on Aging in
collaboration with the Notre Dame Wilson Sheehan Lab for Economic Opportunities, will be implemented
in two AAA service areas, and may provide services to up to 1,000 eligible individuals. Any increase in
CHOICE expenditures resulting from the pilot program may be mitigated by reduced expenditures for the
state Medicaid program; however, any increases in CHOICE expenditures must be within the amount
appropriated to the CHOICE Program. Any net change in overall state expenditures resulting from the pilot
program is indeterminable.
Level of Care Assessments: Currently, level of care assessments are conducted by an AAA until July 2025.
At that time, responsibility for completing level of care assessments will be transferred to Maximus (the
state’s enrollment broker). This bill allows an AAA to enter into a contract to continue conducting level of
care assessments.
AAA Report: The bill allows, but does not require, FSSA and the AAAs, in consultation with the Division
of Disability and Rehabilitative Services Advisory Council, the CHOICE Board, and the State Commission
on Aging, to issue a report to the Legislative Council regarding recommendations for realigning and
consolidating the AAA planning and service areas. This should be able to be implemented using existing
staffing, resources, and meeting schedules.
Additional Information: The CHOICE Program is administered through Indiana’s AAAs and provides home
and community-based services to assist individuals in maintaining their independence in their own homes
or communities. CHOICE Program applicants must be at least 60 years of age or have a disability, must meet
specific asset/resource requirements, and must be found to be at risk of losing their independence (usually
indicated by difficulties with activities of daily living such as bathing, dressing, walking, transferring, or
using medications). CHOICE Program funds may not be used if other funding such as Medicare or Medicaid
is available to meet the individual’s needs.
There are a total of 15 AAAs in Indiana covering 16 geographic regions. The AAAs serve as the primary
access point for: home and community based waiver programs, the Older Americans Act, the Social Services
Block Grant, and the CHOICE Program. The AAAs also serve as the primary provider of case management
services for Medicaid members receiving state plan long-term care services and those participating in the
state’s Aged and Disabled waiver program.
Explanation of State Revenues:
Explanation of Local Expenditures:
HB 1391 2 Explanation of Local Revenues:
State Agencies Affected: Family and Social Services Administration; Division of Disability and
Rehabilitative Services Advisory Council; CHOICE Board; State Commission on Aging.
Local Agencies Affected:
Information Sources: PeopleSoft Financials data;
https://www.in.gov/fssa/da/community-and-home-options-to-institutional-care-for-the-elderly-and-disabled;
https://www.in.gov/fssa/da/files/AAA_Map.pdf;
https://www.in.gov/pathways/provider-frequently-asked-questions/#How_will_enrollment_work_for_clie
nts_not_currently_in_a_waiver__but_may_be_eligible_for_waiver_services_.
Fiscal Analyst: Jason Barrett, 317-232-9809.
HB 1391 3