Indiana Home and Community-Based Services (HCBS) waivers are special Medicaid programs that “waive” certain federal rules so the state can fund services outside of hospital institutions.

At The Sibling Foundation, we believe access to clear and understandable information is essential for empowering families and strengthening communities. This guide provides a simple overview of Indiana Medicaid waiver programs, the populations they serve, and the support services available through them.

Disability & Aging Waivers

Community Integration and Habilitation (CIH) Waiver

Serves children and adults with intellectual and developmental disabilities (IDD) and substantial functional limitations by providing individualized support to assist them in living successfully in their homes and communities. This waiver is intended for individuals with higher support needs.

Eligibility Requirements

To qualify for Indiana’s Medicaid waiver programs (such as the Family Supports Waiver or CIH Waiver), individuals must meet several criteria:

• Be diagnosed with an intellectual disability prior to the age of 22
• Reside in or be transitioning into an HCBS-compliant setting (non-institutionalized)
• Have income no greater than 300% of the maximum Supplemental Security Income (SSI) amount (parental income for children under 18 years of age is disregarded)
• Meet Intermediate Care Facility for Individuals with Intellectual Disabilities/Developmental Disabilities (ICF/IID) level of care
  • ICF/IID level of care is the minimum need an individual must have to be considered eligible for HCBS waiver services. Level of care is evaluated when a person applies and then at least once a year after that. For the purposes of ICF/IID level of care, a person must have a disability that:
    • Results in impairment of functioning similar to that of a person who is intellectually disabled, including autism spectrum disorder, epilepsy, cerebral palsy, or a similar condition (other than mental illness)
    • Originates before the age of 22
    • Has continued or is expected to continue indefinitely
    • Substantially limits a person’s ability to function normally in society in three of the six major life areas: self-care, receptive and expressive language, learning, mobility, self-direction, and capacity for independent living
    • Requires access to 24-hour assistance, as needed

What services are provided with the CIH Waiver?

• Adult Day Services
• Psychological Therapy
• Behavioral Support Services
• Prevocational Services
• Case Management
• Recreational Therapy
• Community Transitions
• Remote Supports
• Day Habilitation
• Rent and Food for Unrelated Live-in Caregiver
• Electronic Monitoring
• Residential Habilitation and Support
• Extended Services
• Respite
• Facility-Based Support Services
• Specialized Medical Equipment and Supplies
• Family and Caregiver Training
• Speech/Language Therapy
• Intensive Behavioral Intervention
• Structured Family Caregiving
• Music Therapy
• Transportation
• Occupational Therapy
• Wellness Coordination
• Personal Emergency Response System
• Workplace Assistance
• Physical Therapy

How to Apply

Applications for the CIH Waiver can be found on the Bureau of Disabilities Services (BDS) website or by visiting your local BDS office.

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Family Supports Waiver (FSW)

Serves individuals with IDD who have less intensive support needs to live at home or in their communities with support services instead of institutional care.

Eligibility Requirements

• Be diagnosed with an intellectual disability prior to the age of 22
• Reside in or be transitioning into an HCBS-compliant setting (non-institutionalized)
• Have income no greater than 300% of the maximum Supplemental Security Income amount (parental income for children under 18 years of age is disregarded)
• Meet Intermediate Care Facility for Individuals with Intellectual Disabilities/Developmental Disabilities (ICF/IID) level of care

ICF/IID level of care is the minimum need an individual must have to be considered eligible for HCBS waiver services. Level of care is evaluated when you apply and then at least once a year after that. For the purposes of ICF/IID level of care, a person must have a disability that:

• Results in impairment of functioning similar to that of a person who is intellectually disabled, including autism spectrum disorder, epilepsy, cerebral palsy, or a similar condition (other than mental illness)
• Originates before the age of 22
• Has continued or is expected to continue indefinitely
• Substantially limits the person’s ability to function normally in society in three of the six major life areas: self-care, receptive and expressive language, learning, mobility, self-direction, and capacity for independent living
• Requires access to 24-hour assistance, as needed

What services are provided with the FSW Waiver?

• Adult Day Services
• Day Habilitation
• Prevocational Services
• Workplace Assistance
• Extended Services
• Participant Assistance and Care
• Transportation
• Respite Services
• Family and Caregiver Training
• Case Management
• Speech/Language Therapy
• Occupational Therapy
• Physical Therapy
• Psychological Therapy
• Behavioral Support Services
• Intensive Behavioral Intervention
• Recreational Therapy
• Music Therapy
• Personal Emergency Response System (PERS)
• Specialized Medical Equipment and Supplies
• Environmental Modifications (home accessibility changes)
• Remote Supports (technology-based assistance and monitoring)

How to Apply

Applications can be submitted by contacting your local BDS office or by visiting the BDS website.

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Health & Wellness (H&W) Waiver

Provides services to individuals with disabilities who are 59 years of age and younger through individualized support that helps them live successfully in their homes and communities.

Eligibility Requirements

To qualify for Indiana’s Health & Wellness (H&W) Waiver, an individual must:

• Be age 59 or younger
• Be aged, blind, or disabled under Medicaid guidelines
• Meet Nursing Facility Level of Care requirements, meaning they need significant medical or daily living support
• Qualify for Medicaid and meet financial eligibility requirements
• Live in, or plan to live in, a home- or community-based setting rather than a nursing facility

To apply, individuals must complete a Medicaid application and level of care assessment through their local Area Agency on Aging (AAA).

What services are provided with the H&W Waiver?

• Adult Day Service
• Adult Family Care
• Attendant Care
• Assisted Living
• Care Management
• Community Transition
• Home and Community Assistance
• Home-Delivered Meals
• Home Modifications
• Home Modification Assessment
• Integrated Health Care Coordination
• Nutritional Supplements
• Participant-Directed Home Care Services
• Personal Emergency Response Services
• Pest Control
• Skilled Respite
• Specialized Medical Equipment and Supplies
• Structured Family Care
• Transportation
• Vehicle Modification

How to Apply

For information on acquiring H&W Waiver services, contact your local Area Agency on Aging for a level of care assessment by calling 800-713-9023 or visiting the INconnect Alliance website.

You may also contact BDS for inquiries about the H&W Waiver by calling 800-545-7763 or emailing [email protected].

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Indiana PathWays for Aging Waiver

Provides services to Indiana residents age 60 and older who need ongoing assistance with daily living or medical needs in their homes or communities instead of a nursing facility.

Eligibility Requirements

• Be 60 years of age or older
• Be eligible for a full-coverage aged, blind, or disabled category (with or without Medicare)
• Be receiving long-term support services, including:
  • Residing in a nursing or long-term care facility
  • Being approved for an Aged and Disabled Waiver
  • Being on the Behavioral and Primary Health Coordination program

What services are provided with the PathWays for Aging Waiver?

• Adult Day Services
• Adult Family Care
• Assisted Living
• Attendant Care
• Care Management
• Caregiver Coaching
• Community Transition
• Home and Community Assistance
• Home-Delivered Meals
• Home Modifications
• Home Modification Assessment
• Integrated Health Care Coordination
• Nutritional Supplements
• Participant-Directed Home Care Services
• Personal Emergency Response Systems
• Pest Control
• Respite Care Services
• Specialized Medical Equipment and Supplies
• Structured Family Caregiving
• Transportation
• Vehicle Modification

How to Apply

Contact your local Area Agency on Aging for more information on how to apply for the Indiana PathWays for Aging Waiver or call 87-PATHWAY-4 (877-284-9294).

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Traumatic Brain Injury (TBI) Waiver

Provides access to services and support that promote choice, autonomy, and quality of life for eligible individuals who have experienced traumatic brain injury.

Eligibility Requirements

To qualify for Indiana’s Traumatic Brain Injury (TBI) Waiver, an individual must:

• Have a diagnosed traumatic brain injury
• Be age 59 or younger
• Meet Nursing Facility Level of Care requirements, meaning they need significant medical or daily living support
• Qualify for Medicaid and meet financial eligibility requirements
• Live in, or plan to live in, a home- or community-based setting rather than a nursing facility

What services are provided with the TBI Waiver?

• Adult Day Service
• Adult Family Care
• Assisted Living
• Attendant Care
• Behavioral Management / Behavior Program and Counseling
• Care Management
• Community Transition
• Home and Community Assistance
• Home-Delivered Meals
• Home Modifications
• Home Modification Assessment
• Integrated Health Care Coordination
• Nutritional Supplements
• Personal Emergency Response
• Pest Control
• Residential-Based Habilitation
• Skilled Respite
• Specialized Medical Equipment
• Structured Day Program
• Structured Family Care
• Supported Employment
• Transportation
• Vehicle Modification

How to Apply

Contact your local Area Agency on Aging for a level of care assessment by calling 800-713-9023 or visit the INconnect Alliance website.

You may also contact BDS for inquiries by calling 800-545-7763 or emailing [email protected].

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Mental Health HCBS Programs

Adult Mental Health Habilitation (AMHH) Program

Provides services to adults with serious mental illness and addiction disorders who reside in HCBS settings to help them live safer lifestyles.

Eligibility Requirements

• Be age 19 or older
• Be enrolled in Medicaid
• Reside in or be transitioning to a setting that meets federal HCBS setting requirements (noninstitutionalized)
• Be AMHH-eligible with a Division of Mental Health and Addiction (DMHA)-approved diagnosis
• Demonstrate a level of need by meeting the following criteria:
  • Receive a score of 3 or higher on the DMHA-approved assessment tool
  • Not be a danger to self or others
  • Without ongoing habilitation services, be likely to deteriorate and be at risk of institutionalization
  • Need significant assistance in major life domains related to mental illness (for example: physical problems, social functioning, basic living skills, self-care, and potential for harm to self or others)
  • Have significant needs related to behavioral health
  • Have significant impairment in self-management of mental illness or need assistance with mental illness management
  • Lack sufficient natural supports to assist with mental illness management

What services are provided with the AMHH Program?

• Adult Day Services
• Home- and Community-Based Habilitation and Support
• Respite Care
• Therapy and Behavioral Support Services
• Addiction Counseling
• Supported Community Engagement Services
• Care Coordination
• Medication Training and Support

Referrals

Referrals to the AMHH program may come from:

• Community Mental Health Centers (CMHCs) or other treatment providers
• Individuals who meet the eligibility criteria
• Family members or caregivers

How to Apply

To apply for AMHH services, go to your local CMHC and apply for Medicaid.

For more information on AMHH services, contact [email protected].

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Behavioral and Primary Healthcare Coordination (BPHC) Program

Provides services to help members manage their physical and behavioral health care needs through education, support, and advocacy.

Eligibility Requirements

• Be 19 years of age or older
• Be diagnosed with a BPHC-eligible primary behavioral health diagnosis
• Be eligible for Traditional Medicaid, Healthy Indiana Plan (HIP) State Plan Plus, HIP State Plan Basic, Hoosier Care Connect, Hoosier Healthwise, or Indiana PathWays for Aging (PathWays)
• Demonstrate a level of need by meeting the following criteria:
  • Demonstrated needs related to management of behavioral and physical health
  • Demonstrated impairment in self-management of physical and behavioral health services
  • A health need that requires assistance and support in coordinating behavioral and physical health treatment
  • A recommendation for intensive community-based care, based on the uniform DMHA-approved behavioral health assessment tool, as indicated by a rating of 3 or higher

What services are provided with the BPHC Program?

BPHC offers one service that consists of the coordination of healthcare services to manage the mental health/addiction and physical healthcare needs of eligible individuals.

The program may include:

• Healthcare Coordination
• Assistance Scheduling and Managing Medical Appointments
• Coordination Between Physical Health and Behavioral Health Providers
• Medication Education and Monitoring Support
• Health Education and Wellness Support
• Assistance Accessing Community Resources and Services
• Support with Managing Chronic Health Conditions
• Care Planning and Goal Development
• Crisis Prevention and Support Coordination

Referrals

Referrals may come from:

• Community Mental Health Centers (CMHCs) or other treatment providers
• Individuals who appear to meet the eligibility criteria
• Family members or caregivers

How to Apply

To apply for BPHC services, go to your local CMHC and apply for Medicaid.

For more information on BPHC, email [email protected].

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Child Mental Health Wraparound (CMHW) Program

Provides services to youth ages 6–17 who have a diagnosis of a serious emotional disturbance. It builds a person-centered treatment plan based on the member’s and family’s strengths to identify:

• The unique needs of CMHW members
• Services and strategies that assist the member and family in achieving more positive outcomes in their lives

Eligibility Requirements

• Be 6 through 17 years of age
• Be eligible for Indiana Medicaid
• Have two or more Diagnostic and Statistical Manual of Mental Disorders Text Revision diagnoses that are not considered excluded
• Demonstrate a level of need by meeting the following criteria:
  • Receive a score of 4 or higher on the Division of Mental Health and Addiction (DMHA)-approved assessment tool
  • Have one or more of the following behavioral or emotional needs:
    • Adjustment to trauma
    • Psychosis
    • Debilitating anxiety
    • Conduct problems
    • Sexual aggression
    • Fire-setting
  • Demonstrate a significant need in at least one family or caregiver area that results in a negative impact on the applicant’s mental illness:
    • Mental health
    • Supervision issues
    • Family stress
    • Substance abuse

What services are provided with the CMHW Program?

In addition to Indiana Medicaid covered-services, individuals receiving CMHW services are eligible for the following:

• Wraparound facilitation
• Habilitation
• Respite care
• Family support and training for the unpaid caregiver

How to Apply

To apply for the CMHW program, a referral must be submitted to the access site and the individual must apply for Medicaid coverage.

For more information on the CMHW program, visit the CMHW webpage or email [email protected].