Op-ed:Mistakes and Misdeeds—The FSSA and GOP’s failure to put Hoosier families first

$1 billion was the most discussed number during the 2024 legislative session. It’s rare to talk about a figure that large during a non-budget year when most bills have a fiscal statement of zero. But the state legislature had a looming problem: the $1 billion Medicaid accounting error. This error has continued to threaten many of the programs Hoosier families desperately need – including the Attendant Care program. 

About 1,600 children have successfully obtained vital medical services from what is known as the Attendant Care program via a Medicaid Waiver. This program has been a true win-win for Indiana since it utilizes the flexibility of the Medicaid plan. Parents and guardians can remain with their children in their homes and provide support services in lieu of a state institutional facility (which would be a larger financial expense for the State). 

Sadly, due to the FSSA’s forecasting “error”, families that receive funding through the attendant care program will be now forced to transition to Structured Family Care if they want to remain their child’s caregiver. Even though Structured Family Care will technically permit parents to continue providing services, it’s an absurdly low and unrealistic reimbursement rate when compared to the Attendant Care Program. The rates are so low families will have to do some real soul-searching to see if they can somehow make it work. Some Hoosier families will be forced to make a hard choice due to economic necessity. They’ll be pressured to abandon their children to join the workforce or may even move out of their homes due to financial burden. 

Now the days quickly dwindle for families to receive adequate funds to provide services to their medically complex loved ones in their homes. The “transition” from Attendant Care to Structured Family Care on July 1st continues to march closer. Time doesn’t stop for anyone. As we near the start date I’m becoming more concerned that the move to this entirely new and untested way for families to access Medicaid services will not be smooth or successful. At the most recent State Budget Committee meeting, I expressed my continued uneasiness with the slow pace of this drastic transition to the Medicaid Director. 

Even though this transition to Structured Family Care is set to occur on July 1st, FSSA has not provided Hoosier families with tangible information. FSSA asserted that families were proactively contacted by their State Case Managers in March. However, some families say they have not been contacted by the administration. They haven't received any material information on the transition, the plan or if the switch is even viable for them. Concerning the families that have been contacted, they’ve received nothing substantial. They don’t know their reimbursement rate or who can provide their care. 

Contributing to this uncertainty is the fact that individuals who’ve been tapped to potentially provide care to these families have not received information about the new program. The FSSA has provided no guidance on how families should be evaluated and placed into one of the three service tiers determining their daily stipend. Tier placement is a necessary step before families can even enroll in Structured Family Care. Until FSSA provides clarity on these major design issues the move to Structured Family Care is an “empty” promise. 

As we get closer to July 1st, I hope the FSSA will prove me wrong and move to implement the necessary infrastructure to support the program. The FSSA has mandated Structured Family Care as the alternative to Attendant Care, so it’s in their best interest to get this program off the ground. I have no interest in being able to tell FSSA, “I told you so” if this program is unable to effectively launch on July 1st. My only true and continued interest is ensuring that these 1,600 children have a viable opportunity to give their children the quality of care they rightly deserve and are entitled to receive. We have a responsibility and obligation to care for them, and they should not be collateral damage for FSSA’s unexplained and culpable accounting error. Nobody’s a fan of empty promises, so I encourage FSSA and Republican leadership to keep their word to these Hoosiers families.