DDRS Waiver Manual

Internet access, call toll free 1-800-403-0864 and an operator will provide you with this information.
Information required to complete a Medicaid application
Go to the http://www.DFRBenefits.IN.gov web site to learn what information is required to
complete a Medicaid application.
To get started, the following information for all of your household members may help you
complete the application
o Names, date of birth and social security numbers
o Employer and income information
o Tax filing status and tax dependent information
o Current health insurance information including policy numbers
DFR may contact you by phone or by mail if additional information or documentation is required
to complete your application.
Applicants under the age of 18 should submit the Plan of Care/Cost Comparison Budget
(POC/CCB) approval letter (described under Section 5.8) to the Division of Family Resources
(DFR) when submitting an application for Medicaid benefits or when requesting for a change
of Medicaid Aid Category in order to qualify for waiver eligibility.
NOTE: Medicaid eligibility is required prior to the start of waiver services.
Section 5.3: Initial Level of Care Evaluation
An individual targeted for the Family Supports Waiver (FSW) or meeting reserved waiver capacity
(priority) criteria and approved for entrance to the FSW or Community Integration and Habilitation
(CIH) Waiver must meet the level of care required for placement in an Intermediate Care Facility for
Individuals with Intellectual Disabilities (ICF/IID).
Initial Level of Care determinations are made by a Family and Social Services Administration
(FSSA)/Division of Disability and Rehabilitative Services (DDRS)/Bureau of Developmental
Disabilities Services (BDDS) Service Coordinator
Reevaluations are performed by the selected provider of Case Management services.
For those applicants whose initial Level of Care (LOC) evaluation was unfavorable, an
independent third party contractor conducts a subsequent LOC evaluation and makes a
recommendation to the State Medicaid Agency, the Family and Social Services
Administration (FSSA), and FSSA makes the final determination of eligibility.
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