There are many Waiver updates taking place NOW in Indiana. Darcy Tower, our Director of Advocacy & Community Relations, has created a video and written guide (below) to break down the details of these changes to make it easy to understand.
If you’re interested in learning more about the proposed changes for December 2025, please click here.
#1 Nursing Facility Level of Care Assessment
Transition from Area Agencies on Aging to Maximus
- In order for patients to qualify for services on the Health and Wellness Waiver or PathWays Waiver, they must complete an initial assessment to identify if the patient meets Nursing Facility Level of Care (NFLOC).
- Nursing Facility Level of Care is defined as a patient requiring assistance with 3 or more activities of daily living or having a skilled need.
- Every year a patient receives services on the Health and Wellness Waiver and PathWays Waiver, an assessment is completed to determine if they continue to meet eligibility for the Health and Wellness Waiver. Prior to July 1, 2025, waiver care managers were performing these assessments.
- Beginning July 1, 2025, FSSA contracted with Maximus to complete the assessment instead of area agencies on aging. Patients (or their representatives) will receive a phone call from Maximus within 90 days of the patient’s annual assessment to schedule a date/time to meet with the patient/representative.
Adult tool → Pediatric tool
- Prior to July 1, 2025, individuals on the Health and Wellness Waiver were assessed using an adult tool regardless of age.
- Beginning July 1, 2025, individuals ages 0-17 receiving initial and ongoing waiver services, will be assessed by Maximus using two new assessment tools tailored to the individual’s age. The adult assessment tool will no longer be used for individuals age 0-17.
- The InterRAI Early Years Assessment will be conducted by Maximus for individuals ages 0-3 yrs.
- The InterRAI Pediatric Home Care Assessment will be conducted by Maximus for individuals ages 4-17 yrs.
- Both assessments continue to identify whether an individual meets Nursing Facility Level of Care. The definition for Nursing Facility Level of Care remains the same regardless of the assessment tool: 3 activities of daily living or a skilled need.
#2 Differences: Adult → Pediatric Assessment
- InterRAI Adult Assessment specifically identifies an individual’s physical health related needs with a minimal focus on mental health care needs and social determinants of health.
- InterRAI Early Years Assessment and Pediatric Health Care Assessment both expand to a family care model. Areas of both assessments include:
- Child’s physical health
- Child’s mental health
- Household dynamic
- Paid & unpaid caregivers
- All services (PAC, waiver & school)
- Caregiver’s employment status
- Biological mother’s pre-and-postnatal care
- Social determinant of health needs for family
- Age
Unlike the adult assessment, both child-based assessment tools factor in age of the child to determine the need for ADL support. For example, every infant needs assistance with bathing regardless of disability.
#3 Health and Wellness Waiver Eligibility
- Beginning July 1st, 2025, Maximus will reach out to waiver individuals or their representative to schedule the annual assessment. Maximus is operating off of the calendar previously used by area agencies on aging for annual assessments.
- Once the assessment is conducted, Maximus sends assessment results to FSSA; FSSA makes the final decision on whether the individual meets Nursing Facility Waiver eligibility.
- If the individual is found ineligible → family has the opportunity to appeal the decision. A letter on steps to appeal will be provided to the family. Waiver individuals may continue to receive Health and Wellness Waiver services while the appeal is pending until there is a determination.
- If FSSA uphold’s its decision, FSSA will conduct a, 2nd assessment to determine if the individual qualifies for the Family Supports Waiver, which is based on intermediate care needs as opposed to Nursing Facility Level of Care.
- FSSA opened priority placement on the Family Supports Waiver for individuals who do not meet Nursing Facility Level of Care.
#4 Services on Family Supports Waiver vs. Health and Wellness Waiver
- Family Supports Waiver does not offer Structured Family Care.
- Family Supports Waiver does offer Personal Care and Assistance (PAC) which is similar to Attendant Care on the Health and Wellness Waiver. Guardians of individuals 18 and older are able to provide PAC hours. Legally Responsible Individuals for children and spouses are not allowed to provide PAC hours.
To read more about the transition from area agencies on aging to Maximus link here: https://www.in.gov/fssa/ddrs/ddrs-announcements/
