2024 Medicaid & Medicaid Waiver Changes

Waiver amendment submitted by the Family and Social Services Administration (FSSA) to the Centers for Medicare and Medicaid Services (CMS) have been approved for the new 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.

A significant change in the H&W and TBI Waivers is ending the practice of paying parents of minor children and spouses (Legally Responsible Indiviuals) to provide attendant care. Effective July 1, 2024 LRI’s will be required to transition to Indiana’s Structured Family Caregiving (SFC) program.

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

Visit in.gov/fssa/medicaid-strategies for information and updates from FSSA


Important Updates

FSSA announces SFC & HHS cannot be provided by same paid caregiver
FSSA updated Structured Family Caregiving FAQ – June 18, 2024


Status of Families United for Care requests to Governor Holcomb – June 20, 2024


Care managers will not use an evaluation tool to determine the SFC tier level for children, at this time. The SFC tier level will be based on authorized attendant care hours as of May 1:

  • SFC Level One: 1-20 hours/week
  • SFC Level Two: 21-40 hours/week
  • SFC Level Three: 41+ hours/week

FSSA has received approval from the Centers for Medicare and Medicaid Services (CMS) for eligible individuals to be able to receive skilled respite while receiving SFC. This is in addition to the 15 days per calendar year of unskilled respite available within SFC. Foster parents are also approved to provide SFC.


A&D Waiver Transition to H&W Waiver Webinars Hosted by DDRS


The Arc of Indiana Webinars

Ask The Arc – Finalized 2024 Medicaid Waiver Changes – 6.14.24 

Ask The Arc – Structured Family Caregiving Session I
Kelli Tungate and Lisa Bennett from Careforth, Indiana’s largest Structured Family Caregiving provider agency, discuss how Structured Family Caregiving works and what families should think about when considering Structured Family Caregiving.
     Webinar Video
     Webinar Slides

Ask The Arc – Structured Family Cargiving Session II
Evan Reinhardt, executive director, Indiana Association of Home and Hospice Care, talks about Structured Family Caregiving and the role that home health services can play in serving individuals on the Health & Wellness, Pathways for Aging, and TBI Waivers. He also gives an overview of the training requirements for home health aides so families know what the aides’ qualifications are and if they want to explore becoming a home health aide for their loved one.
     Webinar Video
     Webinar Slides 


4.3.24 – Waiting list started for Aged & Disabled Waiver (Health & Wellness effective July 1, 2024)
What happens when you are added to the waiting list. 


4.3.24 – Cost-share Restart: July 1, 2024. During the COVID-19 public health emergency, Indiana paused Medicaid cost sharing. This will end July 1, 2024, and Indiana will restart cost sharing for Medicaid, including the Healthy Indiana Plan (HIP), Children’s Health Insurance Program (CHIP); and MEDWorks program for employed individuals with a disability. Click here for information.


Why is This Happening 
Families as Personal Care Attendants
Nursing Services
Structured Family Caregiving
Who Can be Paid for What Services Guide
FSSA Attendant Care and Structured Family Caregiving Relationship Guidance
A&D Waiver Attendant Care Service Activities Not Allowed
FSSA Guidance on Attendant Care, SFC, and LRIs
FSSA Attendant Care and Structured Family Caregiving Side by Side
FSSA March 15 Update for A&D Waiver Recipients and Families


Webinars hosted by The Arc of Indiana on February 8 and February 12 provide information on changes to Indiana’s TBI, CIH and Family Supports Waivers and information on the new H&W and Pathways to Aging Waivers.

Medicaid Waiver Changes Webinar I
Medicaid Waiver Changes Webinar II
DDRS Slides 

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