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 medicaid@fssa.in.gov.
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
- Who is a Legally Responsible Individual?
A parent of a minor child or a spouse providing an HCBS waiver service.
- Do Legally Responsible Individuals need to stop providing attendant care services now?
No. There will be a transition period.
- Can Legally Responsible Individuals continue to provide paid care to their loved one?
Yes. Members will have the choice to have an LRI provide paid care through Structured Family Caregiving beginning in July.
- I’m enrolled in the CIH/FSW waiver—does this change affect me?
No. The LRI changes primarily impact Aged & Disabled waiver members.
- Can I receive both Attendant Care and Structured Family Caregiving?
No.
- When will I need to stop providing LRI services on Attendant Care and transition to an alternative?
By July 1, 2024.
- Will I have choices?
Yes. Members and their LRIs may choose to continue attendant care and have a non-LRI provide the care or may transition to structured family caregiving in order for the LRI to provide paid care. There may be other waiver services that would benefit a member that would be determined via person-centered planning.
- How do I transition?
Your case manager will work with you to develop a transition plan. More guidance will be shared soon.
- How will FSSA support my transition?
FSSA will be working with providers and case managers to consider each individual’s circumstances and help develop a person-centered approach to the transition. More information will be available soon.
- As a member or an LRI providing attendant care, is there anything I need to do now?
Care managers are asked to start talking with families now to begin developing a transition plan.
- I am an attendant care provider for the Aged & Disabled Waiver. Can I become a structured family care provider?
Yes. FSSA is working on guidance for providers and will give an update soon.
Additional resources
April 2024
- Aged and Disabled Waiver Waiting List
- Waiting list implemented for Aged and Disabled Waiver, Apr. 3, 2024
- Waiting list Frequently Asked Questions, Apr. 3, 2024
- Waiting list process, Apr. 3, 2024
- Additional helpful resources, Apr. 3, 2024
March 2024
- Updated Guidance Regarding Service Plan Elements Which Require Manual Review for Management Companies Mar. 22, 2024
- Updated Guidance Regarding Service Plan Elements Which Require Manual Review for Providers Mar. 22, 2024
- Retroactive Payments for Waiver Services Not Permitted Prior to Approved Medicaid Eligibility Mar. 22, 2024
- Update for Aged and Disabled Waiver Recipients and Their Families, Mar. 15, 2024
February 2024
- Paid Family Caregiver Disclosure webinar, Feb. 19, 2024
- Paid Family Caregiver Disclosure Form Companion Guide, Feb.19, 2024
- Paid Family Caregiver Disclosure Form PowerPoint presentation, Feb. 19, 2024
January 2024
- Important billing information for structured family care and attendant care providers, Jan. 30, 2024
- Announcement regarding Medicaid forecast and initiatives, Jan. 17, 2024
- Task Force for Individuals with Intellectual and Developmental Disabilities | FSSA Medicaid Forecast & HCBS Waiver Update, Jan. 29, 2024 - Presentation PDF
This page was last updated on Apr. 3, 2024