Effective August 1, 2026, some Medicaid Waiver regulations will change, including who can be a paid caregiver for certain services across Indiana’s waivers. The changes vary based on the service, the age of the individual receiving services, and the relationship between the individual and the paid caregiver.
We recognize these changes are very confusing. We have put together a chart for each waiver, as well as a document that includes information for all waivers, noting who can be paid for which service.
Notably, there is a big reduction in the services a legal guardian of an adult or a relative can now be paid for.
We strongly encourage you to carefully review these changes and share them with your casemanger and provider agencies.
If you have questions, please call The Arc of Indiana at 317-977-2375 and ask to speak with a family advocate or send us this “Contact Us” form.
To help us in our advocacy efforts, please consider sharing how these changes will impact you and/or your family by submitting this form: Share Your Story
Effective August 1, 2026
Who Can be Paid for
What Medicaid Service
Community Integration and Habilitation (CIH)
UPDATE: Definition of Extraordinary Care
The Indiana Family and Social Services Administration (FSSA) is implementing the “extraordinary care” allowance for individuals receiving the following services through one of the indicated Home- and Community-Based Services (HCBS) Medicaid waivers:
- Attendant Care – Health and Wellness (H&W) Waiver; Indiana PathWays for Aging (PathWays) Waiver
- Participant Assistance and Care (PAC) – Family Support Waiver (FSW)
This allowance is outlined in the approved HCBS Medicaid waiver, effective Dec. 31, 2025.
Requests for state review of extraordinary care must be submitted to the FSSA by the waiver case manager or managed care service coordinator.
Documentation from a physician involved in the individual’s care confirming skilled needs as outlined above must accompany the request using the Physician Certification for Long-Term Care form: https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:edc37828-9469-431c-8399-0d44b1f40245
Extraordinary care means care provided by the parent of a minor child or by a spouse (also known as a legally responsible individual [LRI]), where the individual receiving the care is unable to perform independently to meet his or her intensive nursing care needs under the supervision of an interdisciplinary team.
The care must be provided under the supervision of an interdisciplinary team and must exceed the range of activities that an LRI would ordinarily perform in the household on behalf of a person of the same age without a disability or chronic illness.
Extraordinary care refers to the characteristics of the individual in waiver services, not the care that will be provided through Attendant Care or PAC. All paid staff must adhere to the service definition and allowable activities when providing that service.
To qualify for the extraordinary care allowance, the care must:
- Meet the definition of extraordinary care
- Be documented in the Person-Centered Plan
- Be approved by the Individualized Support Team (IST) and FSSA
Extraordinary care is defined as those individuals who have the following needs:
- Tracheostomy care; or
- Continuous Ventilator management; or
- Total Parenteral Nutrition (TPN); or
- Other comparable nursing services which include a combination of at least two of the below:
- Seizures that are: frequent, severe, or medically complex and require monitoring of the individual following seizures,
- Monitoring for needed post-seizure assistance
- IV medication administration that requires close monitoring and observation
- Complex wound care that is ongoing in nature and requires regular positioning, monitoring for signs of infection, protection of wound sites during activities of daily living (ADL) care, etc.
- Noncontinuous ventilator management, which may require close monitoring for signs of distress, breathing difficulty, etc.