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2024 Medicaid & Medicaid Waiver Changes

Amendments to Indiana’s Medicaid Waiver program went into effect on July 1, 2024 for the new PathWays for Aging and Health and Wellness (H&W) waivers – formerly combined in the Aged and Disabled (A&D) waiver. Amendments to the Community Integration and Habilitation (CIH), Family Supports (FSW), and Traumatic Brain Injury (TBI) waivers also went into effect.

Effective July 1, individuals age 59 and younger who had been receiving services through the Aged and Disabled waiver will receive services through the Health and Wellness waiver.

Indiana PathWays for Aging, a Medicaid managed care program for individuals aged 60 and over also launched on July 1. Some individuals on the PathWays program will qualify for additional services based on their needs and will be eligible for the PathWays Medicaid Waiver. Those individuals were also previously served by the Aged and Disabled Waiver.

Resources, including a guide for who to contact if you are in need of assistance, are available to help individuals navigate any challenges faced with the transition.

Information and resources for individuals transitioning from the Aged and Disabled Waiver to the Health and Wellness Waiver can be found on FSSA’s website.

For information about Indiana PathWays for Aging visit in.gov/PathWays.

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

Following are fact sheets on changes made to Medicaid Waivers and a fact sheet on Prior Authorization Medicaid State Plan Services.

Waiting Lists Update – July 1

In April, FSSA established a waiting list for the former Aged and Disabled Waiver. Currently, 9,015 people are on the waiting list for the PathWays Waiver, and 3,762 are on the waiting list for the Health and Wellness Waiver.

Beginning July 1, FSSA will invite a group of individuals to continue the process to begin receiving services each month as follows:

  • 125 individuals per month to H&W Waiver – 1,500 people July 1, 2024 – June 30, 2025
  • 800 individuals per month to PathWays Waiver – 9,600 people July 1, 2024 – June 30, 2025

Individuals invited to proceed will receive a letter with further details.

Based on these numbers, people who apply for the H&W Waiver will face a 30 month waiting list and people who apply for the PathWays Waiver will face an 11 month waiting list.

The Arc of Indiana is concerned that planning is not taking place to fill all available PathWays and H&W waiver slots. It appears FSSA is not planning to fill 975 available PathWays slots and 1,437 H&W slots.

A&D Waiver Transition to H&W Waiver Webinars Hosted by DDRS
New webinars take place at 3:00 p.m. EST. Registration is not required.

Important Updates

FSSA clarifies that 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.

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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