The landscape of long term care in Indiana has undergone a monumental shift as we move through 2026. For families seeking to keep their loved ones at home, the Indiana Medicaid waiver system serves as the primary financial engine for making that goal a reality. These programs, technically known as Home and Community Based Services (HCBS), are designed to provide the same level of care found in a nursing facility but within the familiar and comfortable setting of a private residence. Since the major regulatory changes of 2024, the state has refined its focus to ensure that every Hoosier, regardless of age or specific disability, has a pathway to independence. Navigating the intersection of the Health and Wellness (H&W) waiver and the Traumatic Brain Injury (TBI) waiver requires a deep understanding of both clinical necessity and financial eligibility. This sub pillar serves as a technical guide for families and advocates who need to understand how these systems function in the current Indiana care systems guide environment. At Nana Cares, we believe that informed families are empowered families, and this guide provides the clarity needed to navigate the complex world of state funded home care.
In 2026, the primary Medicaid waivers for home care are segmented by age and diagnosis to provide more targeted support. Following the 2024 “split” of the former Aged and Disabled (A&D) waiver, Indiana now operates three distinct programs for seniors and individuals with physical disabilities. The first is the Health and Wellness (H&W) waiver, which is specifically dedicated to individuals aged 59 and under who have a recognized physical disability. The second is the PathWays for Aging program, which is a managed care model for Hoosiers aged 60 and older. While PathWays functions similarly to a waiver, it is managed by private health plans. The third critical program is the Traumatic Brain Injury (TBI) waiver, which serves individuals of any age who have suffered an external brain injury. These Medicaid HCBS Indiana programs are all governed by the Family and Social Services Administration (FSSA) and require participants to meet specific Nursing Facility Level of Care (NFLOC) standards. In addition to these, Indiana also maintains the Family Supports waiver and the Community Integration and Habilitation (CIH) waiver, though these are typically reserved for individuals with intellectual or developmental disabilities. For families looking for attendant care waiver options, the H&W and TBI waivers remain the most common vehicles for funding non medical home support. Each waiver has a specific “slot” capacity, meaning that while they are designed to help everyone who qualifies, there can sometimes be waiting lists depending on current state funding levels. You can find more details on these categories in our Indiana care systems guide.
The distinction between the Health and Wellness waiver Indiana and the PathWays for Aging program is primarily based on age and the method of service delivery. The H&W waiver is administered by the Division of Disability and Rehabilitative Services (DDRS) and is intended for younger individuals with physical disabilities. Because this is a traditional waiver, services are typically coordinated through a dedicated Case Management Organization (CMO). In contrast, PathWays for Aging is for those 60 and older and utilizes a managed care model. In the PathWays system, members must choose a Managed Care Entity (MCE) like Anthem, Humana, or UnitedHealthcare, which then oversees the member’s entire health journey. Another key difference is the care coordination. In the H&W waiver, the emphasis is often on long term stability and habilitation for younger adults who may be working or attending school. PathWays is more focused on the aging process and integrating Medicare benefits with Medicaid services. Both programs utilize the same financial eligibility rules, but the “human” experience of navigating them differs. For instance, the H&W waiver offers more direct control over choosing individual providers, whereas PathWays members must stay within the network of their chosen MCE. Understanding which door to enter is vital for a successful Indiana waiver application.
Qualifying for the TBI waiver Indiana requires a combination of a specific medical diagnosis and a functional assessment. Unlike the H&W waiver, which is focused on physical disability, the TBI waiver is specifically for individuals who have an acquired brain injury caused by an external force. This includes injuries from falls, motor vehicle accidents, or sports, but generally excludes internal events like strokes or tumors, which are often covered under the H&W waiver or PathWays. To be eligible, the individual must be an Indiana resident and meet the Nursing Facility Level of Care (NFLOC). This means a state assessor must confirm that the person’s cognitive or physical limitations are severe enough that they would otherwise require placement in a nursing home or intermediate care facility. Financially, the applicant’s income must not exceed 300 percent of the maximum Supplemental Security Income (SSI) amount. In 2026, this threshold is approximately $2,982 per month for an individual. Assets are also limited to $2,000. For children under 18 applying for the TBI waiver, parental income is often disregarded, which allows many families to access specialized Medicaid HCBS Indiana services regardless of their household wealth. The goal of the TBI waiver is to provide the high level supervision and rehabilitative support needed to help survivors regain as much independence as possible.
The Waiver Case Manager, often employed by a Case Management Organization (CMO), is the primary advocate and coordinator for anyone on the H&W or TBI waivers. Their role begins with the creation of the Person Centered Service Plan (PCSP). This document outlines every service the member will receive, from the number of attendant care waiver hours to the specific medical equipment needed in the home. The Case Manager is responsible for ensuring that the services authorized are actually being delivered by the chosen agencies. They conduct regular home visits, usually once every 90 days, to monitor the member’s health and well being. If a senior’s condition declines or a younger adult’s needs change due to a new job or educational goal, the Case Manager is the one who initiates the request for more hours or different services. In 2026, the Case Manager’s role has become even more data driven, as they must ensure all services meet the state’s quality and safety standards. They also act as a buffer between the family and the state’s complex billing systems. For families using Nana Cares, we work in close partnership with these Case Managers to ensure our companion care services are seamlessly integrated into the overall plan of care. Without a strong Case Manager, navigating the Indiana waiver application process and maintaining long term eligibility can be nearly impossible.
One of the most frequently asked questions is whether a family member can be reimbursed for the care they provide. In Indiana, the rules for “paid family caregivers” were significantly updated in 2024 and 2025. Today, there are two primary pathways. The first is through Structured Family Caregiving (SFC). This program is designed for family members who live in the same home as the waiver recipient, including spouses and parents of minor children. Instead of an hourly wage, the caregiver receives a daily stipend. This model is ideal for those providing 24/7 “extraordinary care.” The second pathway is through Attendant Care. This is an hourly paid service. However, since the 2024 “LRI” (Legally Responsible Individual) transition, spouses and parents of minor children are generally not allowed to provide hourly Attendant Care: they must use the SFC model instead. Other relatives, such as adult children, siblings, or grandparents, can still be hired through an agency to provide hourly attendant care waiver services. In 2026, there is an aggregate limit of 40 hours per week for paid care provided by certain relatives and legal guardians to ensure the member also has access to external professional support. This hybrid system ensures that families are supported financially while still maintaining a high standard of professional oversight. (Source: arcind.org)
The Health and Wellness waiver Indiana includes a robust benefit for Environmental Modifications, commonly known as “E mods.” These are physical adaptations to the home that are necessary to ensure the member’s health, welfare, and safety. Common modifications covered by the waiver include the installation of wheelchair ramps, widening of doorways to allow for medical equipment, and the installation of grab bars or specialized shower seats. More extensive modifications, such as the remodeling of a bathroom to create a roll in shower, are also possible if they are deemed a medical necessity. In 2026, the FSSA introduced new bid requirements to ensure that these modifications are completed by qualified contractors at a fair market price. There is usually a lifetime cap on the amount of money the waiver will provide for modifications, often around $15,000 to $20,000, though exceptions can sometimes be made for catastrophic changes in a member’s condition. These modifications are a vital part of the Medicaid HCBS Indiana strategy because they remove the physical barriers that often force people into nursing homes. A safer home environment reduces the risk of falls, which is the leading cause of hospital readmission for waiver participants. For families in the Indiana care systems guide, integrating these physical changes with professional caregiver support creates a comprehensive safety net.
Financial eligibility for any Medicaid HCBS Indiana program involves a deep dive into the applicant’s financial history. Indiana enforces a 60 month “look back” period. This means that when you submit an Indiana waiver application, the state will review all bank statements and property records from the previous five years. They are looking for “uncompensated transfers,” which are essentially gifts of money or property given to family members or charities. If the state determines that an applicant gave away assets to meet the $2,000 asset limit, they will impose a “penalty period” of ineligibility. The length of this penalty is calculated by dividing the value of the gifted assets by the average monthly cost of nursing home care in Indiana. For example, if a senior gifted $50,000 to a grandchild, they might be disqualified from receiving waiver services for several months. There are certain exceptions, such as transfers between spouses or to a disabled child, but these must be documented carefully. In 2026, asset limits have remained strict, making it essential for families to engage in proactive planning. Using a Miller Trust or an irrevocable funeral trust are common ways to manage assets while staying within the legal Medicaid waiver Indiana requirements.
Receiving a denial for a Medicaid waiver can be devastating, but it is not the end of the road. Most denials happen for one of two reasons: the applicant’s income/assets were too high, or the functional assessment determined they did not meet the Nursing Facility Level of Care (NFLOC). If the denial is financial, families can often “spend down” assets on medical bills or home repairs and then reapply. If the denial is functional, you have the right to a Fair Hearing. You must file an appeal within a specific timeframe, usually 30 days from the date of the denial letter. During the appeal process, you can provide additional medical evidence from doctors or therapists to prove that the individual cannot safely live alone. In 2026, many families use the services of an ombudsman or a specialized advocate to help navigate these hearings. It is also important to check if the denial was simply due to missing paperwork: a frequent issue in the Indiana waiver application process. At Nana Cares, we often see families succeed on their second or third attempt once they have a clearer understanding of how to document their loved one’s daily struggles. Persistence is key to accessing the attendant care waiver hours that make a difference. (Source: arcind.org)
Navigating the Indiana Medicaid waiver system is a complex journey, but it is one of the most important steps you can take to protect your loved one’s future. Whether you are exploring the Health and Wellness waiver Indiana for a younger family member or the TBI waiver Indiana for a survivor of a brain injury, the goal remains the same: dignity, safety, and independence. At Nana Cares, we are more than just a home care provider; we are your partners in navigating the Indiana care systems guide. We understand how the attendant care waiver and companion care fit into your loved one’s daily life, and we are here to support you through every stage of the application and care process. If you are feeling overwhelmed by the technicalities of the Indiana waiver application or are unsure how to maximize your authorized hours, let us help. We invite you to book a free 1-hour information session with our expert team. We will listen to your story, review your options, and help you map out a clear path toward the “peace of mind” your family deserves. Our mission is to provide quality care, from our family to yours, and that begins with making sure you have access to every resource available in our state. Connect with Nana Cares today and let us help you find the way home.
Compassionate, non-medical in-home care for seniors and adults with disabilities across Central Indiana.
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