Proposed Indiana Waiver Changes: What Providers and Families Need to Know

‍Health and Wellness Waiver Draft Amendment Effective August 1, 2026

The Indiana Family and Social Services Administration (FSSA), through its Division of Disability, Aging and Rehabilitative Services (DDARS), has released a draft amendment to the Health and Wellness (H&W) Waiver that proposes significant changes impacting waiver participants, providers, and caregivers across Indiana. The proposed amendment is scheduled to take effect August 1, 2026.

High-Level Overview of Proposed Changes

The draft Health and Wellness Waiver Amendment includes a wide range of administrative, service definition, and payment updates. The most impactful proposed changes are:

Live-In Caregiver Rate Reduction (Attendant Care – ATTC)

• A reduced reimbursement rate would apply when a paid caregiver lives in the same residence as the individual receiving services.
• While DDARS has not released specific rate details, the stated rationale appears to be related to the lack of caregiver travel time.
• Live-in caregivers will continue to perform all other reimbursable duties under the attendant care definition, including transportation to community activities and support with ADLs and IADLs. Providers may wish to highlight these responsibilities in public comments.

Expanded Documentation Requirements

The draft amendment proposes new and enhanced documentation standards across multiple services, including:

• Hourly documentation requirements for Home and Community Assistance (HCA) and Skilled Respite Care
• Service records must clearly support:
• Medical necessity
• Frequency and duration of services
• Alignment with the individual’s Person-Centered Individualized Support Plan (PCISP)

Providers should carefully review each service’s definition to ensure documentation practices align with the proposed standards.  

Quarterly Provider Progress Reports

For certain waiver services, providers will be required to submit quarterly progress reports detailing:

• Service delivery
• Progress toward individual goals
• Ongoing needs or barriers

This represents a notable operational change and may require updates to internal reporting workflows.

Additional Notable Updates

The draft amendment also proposes:

• Alignment with the state’s 1915(b)(4) waiver, transitioning case management services to contracted Case Management Organizations (CMOs)
• Updates to waiver waiting list procedures, including a new 180-day enrollment timeline
• A new six-hour annual cap on Benefits Counseling services
• Revised definitions for “own home,” transportation services, and certain provider types
• Updated quality assurance and incident reporting requirements
• Revised payment policies for services provided by relatives and legal guardians

Paradigm will continue monitoring updates and will share additional guidance once DDARS releases the anticipated fact sheet or final amendment details.