2024 Medicaid Waiver Changes

We will provide updates and information on proposed changes to Indiana’s Medicaid Waivers on
this page.

Public Comments 

  Family Supports Waiver Public Comments
  CIH Waiver Public Comments
  TBI Waiver Public Comments
  Health and Wellness Waiver Public Comments
  Pathways to Aging Public Comments 

On January 17, 2024, the Family and Social Services Administration (FSSA) submitted new waiver amendments to the Centers for Medicare and Medicaid Services (CMS) for the proposed Pathways for Aging, Community Integration and Habilitation (CIH), Family Supports (FSW), Traumatic Brain Injury (TBI), and Health and Wellness (H&W) waivers – currently the Aged & Disabled (A&D) waiver.

While not authorized in the current A&D waiver*, the practice has been to allow Legally Responsible Individuals (LRIs) – parents of a minor and spouses – and legal guardians to serve as paid personal care attendants (PCAs).

CMS allows states to pay LRIs through a Medicaid Waiver; however, as proposed, the H&W Waiver and TBI Waivers would not allow LRI’s to be paid to provide attendant care. Instead, LRI’s would be required to transition to Indiana’s Structured Family Caregiving program. New guidance issued January 26th clarifies that legal guardians of adults can be paid to provide PCA up to 40 hours a week.

This will negatively impact families caring for medically fragile children with significant disabilities.
We are working with FSSA and talking with state leaders and legislators to identify areas to help bring Medicaid costs into alignment while minimizing the impact on people with disabilities and their families.

Lt. Governor Crouch letter to FSSA – 2/20/24

Medicaid Waivers – Who can be paid for what services charts – 2/22/24

Fact Sheet: Why is This Happening 
Updated 1/30/24

Fact Sheet: Families as Personal Care Attendants
Updated 1/30/24

Fact Sheet: Nursing Services
Updated 1/30/24

Fact sheet: Structured Family Caregiving 

FSSA side-by-side comparison of Structured Family Caregiving and Attendant Care – 2/14/24

FSSA Attendant Care and Structured Family Caregiving Relationship Guidance – 1/26/44

*Click here to view A&D Waiver Attendant Care Services Activities Not Allowed

2024 Medicaid Waiver Changes Webinar – 2/8/24
2024 Medicaid Waiver Changes Webinar – 2/12/24
DDRS Slides 
The February 8 and February 12 webinars provide information on proposed changes to Indiana’s TBI, CIH and Family Supports Waivers and information on the new Health & Wellness and Pathways to Aging Waivers. The DDRS slides provide information on changes made from when the waiver amendments were first open for public comment in Nov./Dec. 2023.

Slides – Intellectual and Developmental Disabilities Task Force – 1/29/24

FSSA – New Guidance Issued January 26, 2024

FSSA FAQ on Medicaid Waiver Changes

State Definitions of Extraordinary Care 

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