Indiana Medicaid programs support more than 2 million Hoosiers, including some of the most vulnerable, such as children and people with disabilities, by providing access to quality healthcare and supports and services to live self-sufficient and productive lives. The program is funded with a mix of federal and state dollars.
The Family and Social Services Administration, which administers the Indiana Medicaid program, learned in late 2023 that it was facing an unanticipated increase in Medicaid expenditures, which threatened the sustainability of the entire Medicaid program. FSSA identified a variance of more than $900 million in state funding, compared to previously anticipated expenses, to fund the program through July 2025.
Since then, FSSA has been diligently reviewing data, policies, and federally approved program authorities to identify the key causes of the unexpected anticipated increase in expenses. The agency sought to understand the issues so solutions can be as tailored as possible and maintain focus on the people served and supported by FSSA.
Some identified solutions impact the entire Medicaid program; other solutions are related to the Aged & Disabled waiver. The A&D waiver strategies are important because data showed this is where the Medicaid program is most acutely seeing an unanticipated growth in spending. Overall, the strategies the agency has outlined are expected to have a fiscal impact of $300 million over the biennium.
We understand that families are concerned, specifically about a disruption to the model that allowed parents of minors or spouses (legally responsible individuals) of A&D waiver members to be paid as attendant care providers for their loved ones. For specific questions regarding the transition, please see the Questions and Answers below.
FSSA had previously offered a means for legally responsible individuals to support the direct personal care needs of recipients. However, we must now move to a service model that aligns with allowable waiver practices, is more financially sustainable, and also better recognizes support needs of caregivers.
FSSA is committed to partnering with stakeholders, including members and their families, to provide a path forward so that the member receives the care they need while ensuring the financial stability of the Medicaid program for the 2 million Hoosiers it serves.
As always, FSSA remains committed to clear communication with members, their families, care managers, providers, and all interested stakeholders.
Please explore the information on this website, such as FAQs and waiver documents, for more information. Questions, comments and suggestions regarding additional solutions can be directed to medicaid@fssa.in.gov.
This information was originally posted Jan. 19, 2024. This page is regularly updated.
Frequently Asked Questions
Updated June 12, 2024.
- Who is a Legally Responsible Individual?
A parent of a minor child or spouse providing an HCBS waiver service. You can read more about LRIs here.
- Can a Legally Responsible Individual provide Attendant Care Services?
No, beginning July 1, 2024, current LRIs (parents of minor children (biological or adoptive), spouses, and legal guardians of a minor child) may NOT provide attendant care.
For additional information on who can provide Attendant Care Services, please see this guidance.
- If I am an LRI providing paid care for a waiver member, what do we do if we don’t have a transition plan to move to SFC or non-LRI provided attendant care?
You must work with your care manager immediately so that a plan can be submitted by June 15, 2024. Please see this guidance for more information about how to do this.
- Is Attendant Care going away?
No. Adults and children will continue to be able to access Attendant Care, but it can not be provided by a legally responsible individual.
- When can a child start receiving the Structured Family Caregiving service on the Health and Wellness and Traumatic Brain Injury Waivers?
For a minor – July 1, 2024. Families interested in receiving this service in July should be planning now with their care managers.
For additional information please see this guidance.
- Where can I find a list of approved Structured Family Caregiving providers?
Individuals interested in Structured Family Caregiving can contact their care manager for a list of approved Structured Family Caregiving providers in their area.
- I’m enrolled in the CIH/FSW Waiver—does this change affect me?
No. The LRI changes primarily impact Aged and Disabled Waiver members.
- Can I receive both Attendant Care and Structured Family Caregiving?
No.
- Is there a waiting list for the Aged and Disabled Waiver?
Yes. A waiting list was started in April 2024. You can find more information about how to join the waiting list here.
- Why is there a waiting list for the Aged and Disabled Waiver?
FSSA has reached the maximum number of individuals approved to be served under the current Aged and Disabled Waiver and must implement a waiting list for individuals seeking to access services through the Aged and Disabled Waiver.
- How can I stay up to date on all the changes?
FSSA is hosting a series of informational webinars and sending bi-weekly newsletters for individuals who are recipients of the Aged and Disabled Waiver and their families, in an effort to help them in their waiver transition planning. For links to attend each webinar, please visit the FSSA: Medicaid Strategies webpage under Additional Resources.
Additional information
Member webinars and newsletters
Webinars
NEW
July 24 - New Resources Available, Navigating Website, and How to Stay Connected.- July 10 - Welcome to BDS, FSW Priority Criteria, Age-In Transition Process for Pathways, How to Stay Connected
- Schedule of webinars: FSSA hosting informational sessions for Aged and Disabled Waiver members, families Apr. 24,2024
- June 26 - Waiver eligibility, Offering Choice, Transportation, Home Health and Structured Family Caregiving, and Myth Busters
- Family webinars to continue, June 24,2024
- June 12 - Waiver Amendments, Waivers - Using Integrated Supports, Medicaid State Plan – Therapy Services, Waiver Services – Person-Centered Support Plan requirements, Service Plan Reviews, Myth Busters
- May 29 - Waivers – Important to, Important for, and Person-Centered Service Plan, Waiver Services Highlight – Attendant Care and Transportation, Medicaid State Plan – Durable Medical Equipment, Service Plan Reviews, Myth Busters
- May 15 - Overview of Waivers, Waiver Services Highlight – Skilled Respite, Medicaid State Plan – EPSDT and available services, Service Plan Reviews, Myth Busters
- May 1 - Overview of Transition, Waiver Services Highlight - ATTC & SFC, Medicaid State Plan - Home Health overview, Service Plan Review, Waiting List, Role of Care Manager
- Please note: The above presentation erroneously indicated that Structured Family Caregiving tiers will be determined through July 1, 2024 based on attendant care hours approved per month. This presentation should have indicated that the tiers are determined based on approved attendant care hours per week.
A&D and TBI Waiver Update newsletters
- Sept. 9 newsletter
- August 26 newsletter
- August 13 newsletter
- July 31 newsletter
- July 17 newsletter
- July 3 newsletter
- June 19 newsletter
- June 3 newslette
- May 20 newsletter
- May 8 newsletter
Resources
NEW
Money Follows the Person Temporary Enrollment Pause (9/27/24)- Guidance for Self-Direction (PDAC) exemption from PA Home Health (8/30/24)
- H&W Waiver Waiting Checklist (7/12/2024)
- PathWays Waiver Checklist For those enrolled in PathWays (7/12/2024)
- PathWays Waiver Checklist for those not in PathWays (7/12/2024)
- H&W-Waiver-Waiting-List-Process (7/12/2024)
- PathWays Waiver Waiting List Process (7/12/2024)
UPDATED
Waiver Waiting List Initiation FAQ (8/13/2024)- Home Health FAQs (7/12/2024)
- Home Health Guidance for Care Managers (7/12/2024)
- Home Health Fact Sheet (7/12/2024)
- Medicaid State Health Plan vs Medicaid Waiver Services
- PathWays Waiver Transition Directory
Announcements
July 2024
- FSSA announces launch of Indiana PathWays for Aging Medicaid managed care program, new waivers (07/1/2024)
June 2024
- Resources available to help individuals transitioning to Indiana PathWays for Aging or Health and Wellness Waiver (06/28/2024)
- Aged and Disabled Waiver & Traumatic Brain Injury Waiver Recipients and Their Families Prompted to Take Immediate Action (06/11/2024)
- CMS approves FSSA’s Indiana’s PathWays for Aging Program and Home and Community-Based Services Waivers (6/4/2024)
- Updated Guidance Regarding Service Plan Elements Which Require Manual Review (06/06/2024)
- Urgent Reminder for Aged and Disabled Waiver & Traumatic Brain Injury Recipients and Their Families
May 2024
- Guidance for providers: Video with instructions regarding billing that includes legally responsible individuals is available here, May 15, 2024
- Response to Requests from Indiana Families United for Care, May 3, 2024
- Aged & Disabled Waiver & Traumatic Brain Injury Legally Responsible Individuals Transition Update, May 1, 2024
- Structured Family Caregiving Frequently Asked Questions for Waiver Individuals and Families - Updated June 18, 2024
- Structured Family Caregiving Frequently Asked Questions for Care Managers and HCBS Providers - Updated June 18, 2024
April 2024
- Updated important billing information for structured family care and attendant care providers, Apr. 23, 2024
- Aged and Disabled Waiver Waiting List
- Waiting list implemented for Aged and Disabled Waiver, Apr. 3, 2024
UPDATED
Waiting list Frequently Asked Questions, Aug. 13, 2024- Waiting list process, Apr. 3, 2024
- Additional helpful resources, Apr. 3, 2024
March 2024
- Updated Guidance Regarding Service Plan Elements Which Require Manual Review for Management Companies Mar. 22, 2024
- Updated Guidance Regarding Service Plan Elements Which Require Manual Review for Providers Mar. 22, 2024
- Retroactive Payments for Waiver Services Not Permitted Prior to Approved Medicaid Eligibility Mar. 22, 2024
- Update for Aged and Disabled Waiver Recipients and Their Families, Mar. 15, 2024
February 2024
- Side-by-side look at Structured Family Caregiving and Attendant Care, February
- Paid Family Caregiver Disclosure webinar, Feb. 19, 2024
- Paid Family Caregiver Disclosure Form Companion Guide, Feb.19, 2024
- Paid Family Caregiver Disclosure Form PowerPoint presentation, Feb. 19, 2024
January 2024
- Forecast Data and Medicaid Strategies, Jan. 31, 2024
- Important billing information for structured family care and attendant care providers, Jan. 30, 2024
- Additional guidance related to Attendant Care, Structured Family Care, and Legally Responsible Individuals, Jan. 26
- Announcement regarding Medicaid forecast and initiatives, Jan. 17, 2024
- Task Force for Individuals with Intellectual and Developmental Disabilities | FSSA Medicaid Forecast & HCBS Waiver Update, Jan. 29, 2024 - Presentation PDF
Waivers
The following have been approved by CMS and will take effect July 1, 2024.
This page was last updated on September 27, 2024