Indiana Medicaid waivers fund critical services for individuals who need care at home rather than in institutional settings. As a home care provider, understanding how Indiana waivers work, who qualifies, and how to navigate the process is essential for supporting your clients.
In 2024, Indiana launched two new waiver programs to replace the Aged & Disabled (A&D) Waiver: the Health & Wellness (H&W) Waiver and PathWays for Aging. Additionally, the state offers a few waivers for individuals with developmental disabilities that we will cover: the Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver.
Waiver Overview for Providers
PathWays for Aging (60+)
The PathWays waiver serves adults aged 60 and older who meet nursing facility level of care requirements and are financially eligible for Medicaid. This waiver was launched on July 1, 2024, as a replacement for the Aged & Disabled Waiver for seniors.
Services covered include:
- In-home personal care
- Respite care
- Transportation
- Home modifications
- Medical equipment and supplies
Providers must enroll with the appropriate MCOs to deliver services.
Health & Wellness Waiver (Under 60)
This Indiana Medicaid waiver supports adults under 60 with physical disabilities or chronic conditions. Like PathWays, the H&W Waiver was created in 2024 (splitting off from the old A&D Waiver) to provide in-home services as an alternative to institutional care. This program supports younger adults with serious disabilities or chronic conditions.
Clients apply through their local Area Agency on Aging (AAA), and due to high demand, many are put on a Medicaid waiver waiting list.
Family Supports Waiver (FSW)
The Family Supports Waiver is tailored for children and adults who have significant developmental disabilities (such as autism, Down syndrome, or other intellectual disabilities) that manifest before age 22 and are expected to be lifelong. It covers services like:
- Respite care
- Habilitation services
- Therapy
- Assistive technology
There’s a capped budget (around $26,000/year), and it often has a multi-year waiting list.
Community Integration and Habilitation (CIH)
The Community Integration and Habilitation (CIH) Waiver is for individuals with intellectual and developmental disabilities. It is the “comprehensive” waiver for those with the highest needs. The CIH waiver supports individuals with high needs who exceed the FSW cap. It is uncapped and can fund more intensive, 24/7 services, including supported living.
CIH slots are for those who meet specific crisis or emergency criteria.
Eligibility and Requirements
To receive services, clients must:
- Be financially eligible for Medicaid
- Require a specific level of care (nursing home level or ICF/IDD level)
- Submit a Medicaid waiver application through their AAA (PathWays/H&W) or BDDS (FSW/CIH)
Most waivers currently have waiting lists, so it’s critical for families to apply early and keep their contact information updated. However, you can help by pointing them to the official HCBS waitlist portal and assisting with documentation.
Navigating Indiana Medicaid Waiver Reimbursement Rates
Understanding Indiana Medicaid waiver reimbursement rates is key to managing your agency’s operations. Rates for services under Indiana Medicaid waivers can vary depending on the waiver type, the service provided (e.g., personal care vs. respite), and the provider category.
The state publishes standard rate schedules for each waiver periodically. These rates are the maximum amounts Medicaid will reimburse for services. Providers need to ensure that their billing aligns with the authorized services in each client’s individualized support plan.
How Home Care Providers Fit In
As a provider, your agency must be certified and enrolled with Indiana Medicaid. For PathWays and Health & Wellness waivers, you’ll also need to contract with the appropriate managed care entities (MCEs) to deliver services.
In addition, Indiana requires providers of personal care and attendant care services under Medicaid waivers to use Electronic Visit Verification (EVV). EVV systems (like GEOH’s!) document service delivery by capturing the date, time, and location of visits electronically. This is mandatory for compliance with federal regulations and state billing policies.
Conclusion
Waiver programs are the backbone of Indiana’s home and community-based Medicaid system. Whether you’re supporting older adults or individuals with developmental disabilities, knowing how PathWays, H&W, FSW, and CIH work will help you advocate for clients and ensure they receive the services they need.
Encourage early application, assist with the process where appropriate, and stay informed about waitlist updates and eligibility rules.
And remember, GEOH is always here for you! Reach out to us with any questions, and we’d be happy to help!
