What does this actually mean for my family?
Navigating the world of Medicaid waivers can feel overwhelming, but if you are caring for a loved one, you may have more options for financial support than you realize. Under the Health & Wellness Waiver, many family members—including spouses, parents of both minor and adult children, and legal guardians—can actually be paid to provide essential services like Attendant Care and Structured Family Care (SFC).
Beginning August 1, 2026, the Health & Wellness Waiver applies a 40-hour weekly payment limit to certain paid relatives and legal guardians. A parent of an adult waiver participant is considered a relative, whether or not the parent is also the adult child’s legal guardian.
- Parent of an adult, other relative, or legal guardian: The same paid caregiver may receive payment for no more than 40 combined hours per week across Attendant Care, Home and Community Assistance, and Skilled Respite.
- Parent of a minor child or spouse: These caregivers are Legally Responsible Individuals. They may be paid only for Attendant Care or Structured Family Caregiving when all applicable extraordinary-care and service requirements are met. Attendant Care furnished by all LRIs combined may not exceed 40 hours per week.
- Non-relative caregiver: The relative/legal-guardian 40-hour limit does not apply, although the person’s approved service plan, authorization, provider rules, and other service limits still apply.
FSSA's Definition of a "Relative"
“Relatives” means the following types of relatives (natural, adoptive and/or step relationships, whether by blood or by marriage, inclusive of half and/or in-law status):
- Parent of an Adult (natural, step, adopted, in-law)
- Grandparent (natural, step, adopted)
- Uncle (natural, step, adopted)
- Aunt (natural, step, adopted)
- Brother (natural, step, half, adopted, in-law)
- Sister (natural, step, half, adopted, in-law)
- Child (natural, step, adopted)
- Grandchild (natural, step, adopted)
- Nephew (natural, step, adopted)
- Niece (natural, step, adopted)
- First cousin (natural, step, adopted)
Guardianship Changes & Payment Limits
Before August 1, 2026, some families understood the 40-hour limit as applying to legal guardians. Under the approved amendment, a parent of an adult is independently classified as a relative. A parent therefore remains subject to the relative caregiver limit even if the parent is not, or is no longer, the adult child’s legal guardian.
Guardianship determines who has legal decision-making authority. It should not be created, ended, or modified solely because of a Medicaid payment rule. Families considering a change to guardianship should speak with an attorney or other qualified legal resource.
Example of how the hours are counted:
Maria is the parent of an adult waiver participant. She provides 30 hours of Attendant Care and 10 hours of Skilled Respite during the same week. Those services total 40 paid hours, so Maria could not be paid for additional Home and Community Assistance, Attendant Care, or Skilled Respite that week. This does not mean her adult child is limited to 40 total hours of support; another qualified caregiver may provide additional authorized hours.
Case Management Changes Families Should Expect
- Health & Wellness Waiver case management now operates through Indiana’s selected Case Management Organizations.
- The case manager must have face-to-face contact with the waiver participant at least every 90 days.
- At least one case management meeting each year must occur in the participant’s home.
- Case notes must generally be entered within seven calendar days of the activity or event.
- The Level of Care Assessment Representative contractor—not the CMO—continues to conduct nursing-facility level-of-care evaluations for the H&W Waiver.
Benefits Counseling - Hours Limited to 6 per Plan Year
Benefits Counseling may help a person understand how employment or earned income could affect public benefits. Beginning August 1, 2026, the waiver limits this service to six hours per plan year. If a participant reaches the limit, the case manager and support team should help identify other available waiver services, vocational-rehabilitation resources, community resources, or unpaid supports.
A participant whose approved Benefits Counseling hours are reduced has the right to receive written notice and information about Medicaid fair-hearing rights.
Updated Waiver Waiting-List Process
- Indiana uses one statewide H&W Waiver waiting list.
- Available reserved-capacity slots are offered to eligible people who meet the applicable reserved-capacity category.
- When general slots are available, priority is given to certain people transitioning from state-funded services, nursing facilities, or inpatient hospitals.
- A person generally has 45 days to accept an invitation and 180 days from the invitation letter to complete the enrollment steps. FSSA may rescind and reassign the slot when those steps are not completed within the required timeframe.
Service-Specific Updates
|
Service |
What changed |
What families should know |
|
Home Modifications and Assessments |
More detailed site-visit, bid, drawing, warranty, approval, and inspection requirements. |
Projects may require more documentation and planning before work can begin. The $20,000 lifetime cap and qualifying annual repair allowance remain important. |
|
Specialized Medical Equipment and Supplies |
New purchasing and documentation rules, including professional review for higher-cost items, multiple bids for certain items, and a 30% markup cap. |
Do not purchase equipment first and expect reimbursement later. State-plan coverage and prior approval may have to be addressed before waiver payment is available. |
|
Transportation |
Clarifies when transportation may be separately billed and confirms that relatives or legal guardians may provide the service when all requirements are met. |
Transportation needs should be discussed during person-centered planning and included correctly in the service plan. |
|
Community Transition |
Updates the definition of an eligible “own home.” |
|
What Did NOT Take Effect on August 1
No live-in caregiver reduction rate–yet
Indiana did not implement the proposed lower reimbursement rate for caregivers who live with the waiver participant in this amendment. The state indicated that it may pursue the change through a future waiver amendment. Families should watch for a separate public notice before assuming that a live-in rate reduction has taken effect.
Complaints and Appeal Rights
The waiver now references a statewide Bureau of Disabilities Services ombudsman as an additional resource for complaints and concerns. Contacting an ombudsman or using a CMO complaint process does not replace the right to request a Medicaid fair hearing when services are denied, reduced, suspended, or terminated.
Understanding Your Family Caregiver Options
Family caregiving is a labor of love, but it shouldn’t have to be a financial burden. Under the Health & Wellness Waiver, many family members can actually be compensated for the daily support they provide. To help you understand what’s possible for your unique situation, we’ve broken down the key options, requirements, and services available to different types of family caregivers below.
Which caregiver best describes you?
👨👩👧 Parent of a Child (Under Age 18)
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Parent must meet Extraordinary Care eligibility requirements.
Structured Family Care
✅ Yes
Parent must meet Extraordinary Care requirements and live in the same primary residence as the child.
Respite
❌ No
Parents of minor children cannot be paid to provide Respite.
👨👦 Parent of an Adult (Age 18+)
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Up to 40 hours per week.
Structured Family Care
✅ Yes
Parent and adult child must live in the same primary residence.
Respite
✅ Yes
A parent of an adult may provide Respite but cannot provide Respite to themselves as the individual’s usual caregiver.
⚖️ Legal Guardian of an Adult
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Up to 40 hours per week.
Structured Family Care
✅ Yes
Legal guardian and waiver participant must live in the same primary residence.
Respite
❌ No
Legal guardians cannot be paid to provide Respite.
❤️ Spouse
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Must meet Extraordinary Care eligibility requirements.
Structured Family Care
✅ Yes
Must live in the same primary residence.
Respite
❌ No
Spouses cannot be paid to provide Respite.
👪 Other Relative
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Up to 40 hours per week.
Structured Family Care
✅ Yes
Must live in the same primary residence.
Respite
Yes
YesMay provide Respite, but cannot provide Respite to themselves as the individual’s usual caregiver.
🤝 Non-Relative
Service
Can I Be Paid?
What Should I Know?
Attendant Care
✅ Yes
Standard provider requirements apply.
Structured Family Care
✅ Yes
Must live in the same primary residence.
Respite
Yes
YesMay provide Respite if they are replacing the individual’s usual caregiver.
Important Things to Know
Home Health Aide (HHA) is Different
Home Health Aide (HHA) is a Medicaid State Plan service. Attendant Care and Structured Family Care are Waiver services. Each service has different eligibility requirements and serves a different purpose.
40-Hour Weekly Limit
The 40-hour weekly limit applies to paid Waiver caregiver services.
This limit does not apply to State Plan Home Health Aide (HHA) or Home Health Nursing hours.
You Cannot Receive Both
A waiver participant cannot receive both Attendant Care and Structured Family Care (SFC) because the services are considered duplicative.
Questions?
Every family’s situation is different. The effect of these rules depends on the caregiver’s relationship to the waiver participant, the services being provided, the approved PCISP, and whether more than one caregiver is available. Tendercare can help families understand the waiver language and prepare questions for their case manager, but legal questions about guardianship should be discussed with an attorney.
Common Questions We Hear from Families
Can I receive both Attendant Care and Structured Family Care (SFC)?
No. Indiana’s Health & Wellness Waiver considers these services duplicative, so a waiver participant cannot receive both at the same time.
Does the 40-hour weekly limit include my Home Health Aide (HHA) hours?
No. The 40-hour weekly limit applies to paid Waiver services. Home Health Aide (HHA) is a separate Medicaid State Plan service and is not included in that limit.
Do I have to live with the waiver participant to provide Structured Family Care?
Yes. The caregiver and waiver participant must live together in the same primary residence to qualify for Structured Family Care.
What’s the difference between Home Health Aide (HHA) and Attendant Care?
Although both services are funded through Medicaid, they are different programs with different eligibility requirements and service definitions.
- Home Health Aide (HHA) is a Medicaid State Plan service.
- Attendant Care is a Home and Community-Based Waiver service.
A person may qualify for one service, both services, or neither depending on their individual circumstances.
Why are there different rules for parents of minor children and parents of adults?
Federal Medicaid rules allow states to treat legal responsibility differently for minor children than for adults. As a result, parents of children under age 18 must meet additional Extraordinary Care requirements before they can be paid to provide certain waiver services.
Can I switch between Attendant Care and Structured Family Care?
Sometimes. Families may choose to change services if their needs change, but the services cannot be authorized at the same time. Before making a change, it’s a good idea to talk with your waiver case manager and provider to understand how the transition may affect your family’s services and reimbursement.
What if I’m not sure which service is best for my family?
Every family’s situation is unique. Your eligibility depends on factors such as age, living arrangements, natural supports, and your overall package of Medicaid services.
Tendercare is always happy to talk through your options and help you understand how the different services work together.
Still Have Questions?
Reach out to our Director of Advocacy & Community Relations, Darcy Tower. She’ll be happy to walk you through your family’s current setup and explain any changes you can expect to take place on 8/1/2026.
(317) 251-0700 ext. 404 or darcy.tower@tchhs.net
