FSSA: Medicaid Strategies

Note: After Aug. 1, all new information about the Health and Wellness and Traumatic Brain Injury Waivers may be found here and PathWays waiver information is available here.

Indiana Medicaid programs support more than 2 million Hoosiers, including some of the most vulnerable, such as children and people with disabilities, by providing access to quality healthcare and supports and services to live self-sufficient and productive lives. The program is funded with a mix of federal and state dollars.

The Family and Social Services Administration, which administers the Indiana Medicaid program, learned in late 2023 that it was facing an unanticipated increase in Medicaid expenditures, which threatened the sustainability of the entire Medicaid program. FSSA identified a variance of more than $900 million in state funding, compared to previously anticipated expenses, to fund the program through July 2025.

Since then, FSSA has been diligently reviewing data, policies, and federally approved program authorities to identify the key causes of the unexpected anticipated increase in expenses. The agency sought to understand the issues so solutions can be as tailored as possible and maintain focus on the people served and supported by FSSA.

Some identified solutions impact the entire Medicaid program; other solutions are related to the Aged & Disabled waiver. The A&D waiver strategies are important because data showed this is where the Medicaid program is most acutely seeing an unanticipated growth in spending. Overall, the strategies the agency has outlined are expected to have a fiscal impact of $300 million over the biennium.

We understand that families are concerned, specifically about a disruption to the model that allowed parents of minors or spouses (legally responsible individuals) of A&D waiver members to be paid as attendant care providers for their loved ones. For specific questions regarding the transition, please see the Questions and Answers below.

FSSA had previously offered a means for legally responsible individuals to support the direct personal care needs of recipients. However, we must now move to a service model that aligns with allowable waiver practices, is more financially sustainable, and also better recognizes support needs of caregivers.

FSSA is committed to partnering with stakeholders, including members and their families, to provide a path forward so that the member receives the care they need while ensuring the financial stability of the Medicaid program for the 2 million Hoosiers it serves.

As always, FSSA remains committed to clear communication with members, their families, care managers, providers, and all interested stakeholders.

Please explore the information on this website, such as FAQs and waiver documents, for more information. Questions, comments and suggestions regarding additional solutions can be directed to medicaid@fssa.in.gov.

This information was originally posted Jan. 19, 2024. This page is regularly updated.

Frequently Asked Questions

Updated June 12, 2024.

Who is a Legally Responsible Individual?

A parent of a minor child or spouse providing an HCBS waiver service. You can read more about LRIs here.
Can a Legally Responsible Individual provide Attendant Care Services?

No, beginning July 1, 2024, current LRIs (parents of minor children (biological or adoptive), spouses, and legal guardians of a minor child) may NOT provide attendant care.
For additional information on who can provide Attendant Care Services, please see this guidance.
If I am an LRI providing paid care for a waiver member, what do we do if we don’t have a transition plan to move to SFC or non-LRI provided attendant care?

You must work with your care manager immediately so that a plan can be submitted by June 15, 2024. Please see this guidance for more information about how to do this.
Is Attendant Care going away?

No. Adults and children will continue to be able to access Attendant Care, but it can not be provided by a legally responsible individual.
When can a child start receiving the Structured Family Caregiving service on the Health and Wellness and Traumatic Brain Injury Waivers?

For a minor – July 1, 2024. Families interested in receiving this service in July should be planning now with their care managers.
For additional information please see this guidance.
Where can I find a list of approved Structured Family Caregiving providers?

Individuals interested in Structured Family Caregiving can contact their care manager for a list of approved Structured Family Caregiving providers in their area.
I’m enrolled in the CIH/FSW Waiver—does this change affect me?

No. The LRI changes primarily impact Aged and Disabled Waiver members.
Can I receive both Attendant Care and Structured Family Caregiving?

No.
Is there a waiting list for the Aged and Disabled Waiver?

Yes. A waiting list was started in April 2024. You can find more information about how to join the waiting list here.
Why is there a waiting list for the Aged and Disabled Waiver?

FSSA has reached the maximum number of individuals approved to be served under the current Aged and Disabled Waiver and must implement a waiting list for individuals seeking to access services through the Aged and Disabled Waiver.
How can I stay up to date on all the changes?

FSSA is hosting a series of informational webinars and sending bi-weekly newsletters for individuals who are recipients of the Aged and Disabled Waiver and their families, in an effort to help them in their waiver transition planning. For links to attend each webinar, please visit the FSSA: Medicaid Strategies webpage under Additional Resources.

Additional information

Member webinars and newsletters

Webinars

July 24 - New Resources Available, Navigating Website, and How to Stay Connected.
July 10 - Welcome to BDS, FSW Priority Criteria, Age-In Transition Process for Pathways, How to Stay Connected
Schedule of webinars: FSSA hosting informational sessions for Aged and Disabled Waiver members, families Apr. 24,2024
June 26 - Waiver eligibility, Offering Choice, Transportation, Home Health and Structured Family Caregiving, and Myth Busters
Family webinars to continue, June 24,2024
June 12 - Waiver Amendments, Waivers - Using Integrated Supports, Medicaid State Plan – Therapy Services, Waiver Services – Person-Centered Support Plan requirements, Service Plan Reviews, Myth Busters
May 29 - Waivers – Important to, Important for, and Person-Centered Service Plan, Waiver Services Highlight – Attendant Care and Transportation, Medicaid State Plan – Durable Medical Equipment, Service Plan Reviews, Myth Busters
May 15 - Overview of Waivers, Waiver Services Highlight – Skilled Respite, Medicaid State Plan – EPSDT and available services, Service Plan Reviews, Myth Busters
May 1 - Overview of Transition, Waiver Services Highlight - ATTC & SFC, Medicaid State Plan - Home Health overview, Service Plan Review, Waiting List, Role of Care Manager
- Please note: The above presentation erroneously indicated that Structured Family Caregiving tiers will be determined through July 1, 2024 based on attendant care hours approved per month. This presentation should have indicated that the tiers are determined based on approved attendant care hours per week.