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Medicaid Strategies

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

Posted Jan. 19, 2024. This information will be updated.

Please click here for a side-by-side look at Structured Family Caregiving and Attendant Care.

Interested stakeholders can find additional guidance related to Attendant Care, Structured Family Care, and Legally Responsible Individuals at this link. This information was updated on January 26, 2024.

On January 31, 2024, FSSA shared additional information about Medicaid forecast data and the associated Medicaid strategies. This information is available by clicking here.

Frequently Asked Questions

Updated Jan. 19