Answering Frequently Asked Questions to the January 1, 2026 Waiver Amendment
Our Co-Owner and Chief Clinical Officer, Kelly Stahly, sat down with our Director of Advocacy & Community Relations, Darcy Tower, to chat through recent updates to Indiana’s Medicaid Waiver for Indiana in January 2026. In this video, we talk through frequently asked questions, and answer even more questions below.
After this video, Medicaid shared some clarifying information about Extraordinary Care. They shared:
Other comparable nursing services which include a combination of at least two of the below:
1. Seizures that are: frequent, severe, or medically complex and require monitoring of the individual following seizures, monitoring for needed post-seizure assistance
2. IV medication administration that requires close monitoring and observation
3. Complex wound care that is ongoing in nature and requires regular positioning, monitoring for signs of infection, protection of wound sites during activities of daily living (ADL) care, etc.
4. Noncontinuous ventilator management which may require close monitoring for signs of distress, breathing difficulty, etc.
Please see their IHCP Bulletin here.
FAQs for the Extraordinary Care Definition
As of January 1, 2026, are Legally Responsible Individuals (LRIs) able to be reimbursed for providing Attendant Care?
If the parent of a minor child or spouse on Health and Wellness Waiver or Traumatic Brain Injury Waiver qualify as meeting “Extraordinary Care”, then the LRI may provide up to 40 total hours of Attendant Care. The same scenario is in place for parents of minors and spouses of individuals on the Family Supports Waiver utilizing Personal Assistance and Care (PAC).
What is the definition of Extraordinary Care?
Extraordinary care in the provision of Attendant Care services means care that the individual is unable to perform independently to meet his or her intensive nursing care needs under the supervision of an interdisciplinary team. Intensive nursing care needs includes continuous ventilator care, tracheostomy care, Total Parenteral Nutrition (TPN), or other comparable nursing services approved by the Family and Social Services Administration (FSSA). The care must exceed the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person of the same age without a disability or chronic illness.
How do I know if my loved-one qualifies for Extraordinary Care?
First, contact your loved-one’s waiver case manager and ask them to assess your family member for Extraordinary Care. Your waiver case manager will submit the request to FSSA for review. FSSA makes the decision on whether your loved-one meets Extraordinary Care.
Does a G-Tube Qualify an individual for Extraordinary Care?
The definition of Extraordinary Care does not specifically list G-Tube as part of the criteria. If your loved-one has a g-tube, please make sure to document all other medical complexities that require care above and beyond an individual of the same age who does not live with a disability. FSSA will review needs related to the whole person.
If my loved one meets Extraordinary Care, will 40 hours per week automatically be approved?
No. The maximum number of Attendant Care hours that may be reimbursed when provided by LRIs must not exceed forty (40) hours per week per waiver participant. Hours are determined based on each individual’s unique needs and hands-on care that exceeds usual care that would be provided to a person of the same age who does not live with a disability. More than 1 caregiver can cover the Attendant Care hours approved, but hours are based on the individual’s needs and will not be awarded based on number of caregivers who would like to provide care.
What is Tendercare’s involvement in determining if a patient meets Extraordinary Care?
A patient’s waiver case manager will take the lead on submitting the request to FSSA for each individual who applies for Extraordinary Care. Please have the patient’s waiver case manager reach out to Tendercare’s clinical team if there are questions about the patient’s care needs. We can provide information to waiver case managers to help them better understand medical complexities of the families we serve.
FAQs for Attendant Care
For LRIs and non-LRIs working as an Attendant Caregiver, did FSSA make changes to documentation requirements?
No. FSSA proposed changes requiring paid caregivers to document personal care activities each hour. Based on community feedback, FSSA decided to remove this requirement for the January 2026 Waiver amendment. The documentation requirement may change in future waiver amendments.
Are relatives and legal guardians still allowed to provide Attendant Care services?
Yes. The Health and Wellness Waiver and Traumatic Brain Injury Waiver limit Attendant Care services to not more than 40 hrs. per week per paid relative or legal guardian. This weekly limitation was in effect for legal guardians prior to this amendment, while this limitation is new for relatives. To be clear, this “40-hour per week” limitation is not a limit on the hours of service an individual can receive, nor is it a combined limit for all relatives and legal guardians of a single participant. This limit is a “40-hour per week” limit per each paid relative or legal guardian.
How does the Health and Wellness Waiver and Traumatic Brain Injury Waiver define “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) (Health and Wellness Waiver page 167):
- 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)
Attendant Care services will not be reimbursed when provided by a LRI if the participant is self-directing this service per Indiana Code 12-10-17.1-10
FAQs for Self Direction
Included in FSSA’s January 1, 2026 Waiver amendments, self-direction was expanded to a variety of services across all waivers.
FSSA estimates 2% of the waiver population will elect to participate in the self-direction program during the waiver year including December 31, 2025. Thereafter, the estimated percentage of participation will increase by 2% each year to a total of 10% of the waiver population electing to participate in the self-direction program within five years. FSSA in collaboration with HSRI put together a Self-Direction Toolkit to determine if self-direction is the right choice for you and your family.
How is Self-Direction different than working for an agency to provide Attendant Care or Structured Family Care?
In self-direction, the patient or their representative selects and trains their own staff, develops their staff’s schedules, and sets their own standards for how their services will be delivered.
In self-direction, typically the patient is the legal employer of their staff.
Who can be a paid caregiver under Self-Direction?
Participants often choose to hire non-LRI family members and friends to provide needed services. LRIs and Legal Guardians CANNOT be the paid caregivers through self-directed care. POAs and Health Care Representatives can only be paid if they are not directing the care.
What if a parent of a minor would like for their child to receive self-directed services?
If an individual needs help self-directing their services, there are options for help. Individuals who want to use self-direction may appoint an unpaid representative to assist them with managing services. Representatives can help with activities like finding staff, managing staff, managing payment to staff.
An individual’s parent(s) if the person is a minor or the individual’s guardian may serve as an unpaid representative but will not be paid for providing self-directed services as staff.
In Indiana, what services are allowed to be self-directed?
In Medicaid programs, the specific services and supports that can be self-directed depend on the state in which the participant lives. FSSA has selected the below waivers and services for Self-Direction.
FSW
- Participant Assistance & Care
- Respite
- Workplace Assistance
CIH
- Residential Habilitation & Support (hourly)
- Respite
- Workplace Assistance
TBI
- Attendant Care
- Skilled Respite
- Home & Community Assistance
H&W
- Attendant Care
- Skilled Respite
- Home & Community Assistance
FSW
- Attendant Care
- Skilled Respite
- Home & Community Assistance
How does a self-directed worker get paid?
How does a self-directed worker get paid?
If you choose to self-direct, you will have support from a Financial Management Services (FMS) company. The FMS is involved with activities to pay your self directed workers such as helping with necessary forms and documentation, payroll, and taxes. The FMS company in Indiana is called Palco. The FMS will:
- Help you enroll as an employer
- Help your self directed workers enroll as employees
- Deliver paychecks to your self directed workers
- Help you keep track of your self directed budget
What is a self-directed budget?
An individual’s waiver case manager will work with them (or their representative) to develop a service plan that includes the type of service and amount of service hours based on the individual’s needs. The services that an individual chooses to self-direct have a budget amount associated per service. The budget is assigned to an individual for the entire year. The Financial Management Services vendor will pay the individual’s self-directed staff from that budget over the course of a year (or as long as the funds last) during the course of the year.
The number of hours will be multiplied by that rate to equal the self-directed budget amount. Ten percent (10%) of the self-directed budget is deducted to pay for administrative costs, like Financial Management Services.
What are the benefits of Self-Direction?
If you or your representative are empowered to take on the administrative work that a provider agency routinely completes on a patient’s behalf, this could be a good fit. It’s important for families to keep in mind that 10% of the individual’s yearly self-directed budget is used to pay administrative costs. This is similar to the reimbursement model provider agencies use to pay for administrative costs for hiring, scheduling, RN case management oversight, payroll and documentation review.
Have questions about January's Medicaid updates?
Our Director of Advocacy is always willing to chat and answer any questions you might have! Call Darcy at (317) 251-0700 ext. 404 today.
