Indiana Health & Wellness Waiver: Home Care Explained

What the Health & Wellness Waiver is

On July 1, 2024, Indiana’s Aged and Disabled (A&D) Waiver was split into two programs. The Health & Wellness (H&W) Waiver serves eligible individuals age 59 and younger. The PathWays for Aging Waiver serves eligible individuals age 60 and older. The H&W Waiver is administered through the Division of Disability and Rehabilitative Services (DDRS) / Bureau of Disabilities Services side of FSSA, while PathWays Waiver administration sits with the Office of Medicaid Policy and Planning (OMPP).

Like other 1915(c) HCBS waivers, Health & Wellness is designed so people who meet nursing facility level of care can receive supports in their home or community instead of living in a nursing facility—when they are eligible and a slot is available.

Who may qualify

Indiana Medicaid’s public HCBS pages describe core waiver eligibility themes that apply to these programs. In plain English, a person generally must:

• Be aged, blind, or otherwise disabled (as defined for Medicaid categories)
• Live in—or be transitioning into—an HCBS-compliant, non-institutional setting
• Meet financial eligibility rules for Medicaid (including special HCBS financial methodologies when applicable; income limits are tied to a percentage of SSI—confirm current figures with FSSA)
• Meet nursing facility level of care (NFLOC)
• Be age 59 or younger for the Health & Wellness Waiver specifically

What “nursing facility level of care” means

Level of care is the state’s way of saying the person’s care needs are similar to what would justify nursing facility admission. The initial level-of-care determination for these pathways typically involves the Area Agency on Aging (AAA). After someone is on waiver services, level of care is reassessed at least annually.

Do not self-diagnose level of care from a checklist online. The assessment is formal. If you disagree with a determination, ask about appeal rights—those processes are time-sensitive.

Services that may be authorized

Authorized H&W / related HCBS services published by Indiana Medicaid for these waiver pathways can include attendant care, home and community assistance, respite, adult day service, care management, home-delivered meals, home modifications, personal emergency response systems, transportation, structured family caregiving, specialized medical equipment, and other services listed on official pages.

Your loved one only receives services that are (1) needed, (2) on an approved service plan, and (3) delivered by a certified/enrolled provider. H&W is fee-for-service (not PathWays managed care); members may need to be in a compatible Medicaid delivery system—confirm with your Options Counselor.

Waiting lists and invitations

Demand for HCBS waiver services often exceeds the number of federally approved slots. FSSA publishes waiting-list information for Health & Wellness and PathWays Waiver services. The waiting list is not always a simple “first come, first served” static number—priority categories and nursing facility level-of-care assessment dates can affect invitation order.

When someone is invited, FSSA has used deadlines such as accepting the invitation within a stated number of days and completing Medicaid financial eligibility, NFLOC, and service-plan steps within a longer window (bulletins have referenced 45-day acceptance and 180-day completion timeframes). Those rules can be updated—read your invitation letter carefully and call your AAA immediately if you receive one.

How to apply

Start with your local Area Agency on Aging. The AAA can discuss community resources, help with Medicaid application assistance, and begin waiver screening. There are Area Agencies on Aging across Indiana; FSSA publishes a directory, and a statewide locator number is 800-713-9023.

You generally need both a pathway onto the waiver (including NFLOC) and active, compatible Indiana Medicaid. If Medicaid was denied before, ask the AAA whether you should reapply after waiver screening. Keep copies of every notice.

• Call or visit your AAA and ask about the Health & Wellness Waiver.
• Complete Medicaid financial eligibility steps as directed.
• Complete the NFLOC assessment process.
• If placed on a waiting list, keep your contact information current with the AAA.
• If invited, respond by the deadline and finish enrollment steps on time.

Turning 60 while on Health & Wellness

Because H&W is for age 59 and under and PathWays Waiver is for age 60+, aging into the next program is a real planning issue. Ask your case manager well before a 60th birthday how transition to PathWays / PathWays Waiver works for your situation. Do not assume services continue automatically without paperwork.

Frequently asked questions