HCBS Waivers

Overview

Section 1915(c) of the Social Security Act permits states to offer, under a waiver of statutory requirements, an array of home and community-based services (HCBS) that an individual needs to avoid institutionalization. Eligibility for all waiver programs requires the following:

  • The recipient would require institutionalization in the absence of the waiver or other home-based services.
  • The total Medicaid cost of serving the recipients on the waiver (waiver cost plus other Medicaid services) cannot exceed the total cost to Medicaid that would have been incurred for serving the recipients in an appropriate institutional setting had the waiver not been granted. (Note: Services to individual waiver recipients may cost more than the services in institutional settings. The total cost of the waiver programs or the average per capita cost of services to an individual cannot exceed the equivalent institutional level-of-care costs if the waiver did not exist.)

HCBS Waivers in Indiana

Indiana administers five HCBS waivers and one demonstration grant through the Indiana Family and Social Service Administration (FSSA) Division of Aging (DA), Division of Disability and Rehabilitative Services (DDRS), and Division of Mental Health and Addiction (DMHA). HCBS waivers and the demonstration grant are funded with state and federal dollars and are approved by the Centers for Medicare & Medicaid Services (CMS) for a specified time.

Within each HCBS waiver program, specific services can be accessed to meet the recipient's individual needs. These services are submitted by the recipient's case manager to the state agency for approval and are listed on the individual's Plan of Care (POC)/Notice of Action (NOA).

Division of Aging Waivers

The Division of Aging (DA) administers the following waivers and grant. The following links will take you to more information about each program.

To become a Medicaid provider under one of the previous programs, a provider must first be certified by the DA. To find out more about the enrollment process, visit the DA Provider Enrollment page. For more information, see the Division of Aging Home and Community-Based Services Waivers provider reference module.

Division of Disability and Rehabilitative Services (DDRS) Waivers

The DDRS administers the following waivers. The following links will take you to more information about each program.

To become a Medicaid provider under one of the previous programs, a provider must first be certified by the DDRS. To find out more about the enrollment process, visit the DDRS Provider Relations page. For more information, see the Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers provider reference module.

Division of Mental Health and Addiction (DMHA) Waivers

The following waiver is administered by the DMHA:

In compliance with §6063 of the Deficit Reduction Act (DRA) of 2005, the Community Alternatives to Psychiatric Residential Treatment Facilities (CA-PRTF) Demonstration Grant expired September 30, 2012. Effective October 1, 2012, the DRA authorizes the demonstration grantee states to continue to serve eligible participants under a new CMS-approved PRTF level of care waiver.

Eligible participants on the PRTF Transition Waiver are solely those participants served on the CA-PRTF Demonstration Grant who are still active as of September 30, 2012. These participants transitioned to the new waiver beginning October 1, 2012. No new participants can be added to the PRTF Transition Waiver.

There are no changes in the participant eligibility, provider qualifications, or home and community-based services on the new waiver program. Enrolled providers were transitioned from the grant to the waiver effective October 1, 2012. Eligible providers may apply to become a PRTF Transition Waiver provider by contacting the DMHA. For contact information, visit the DMHA website.

Enrolling as a Waiver Provider

Before enrolling as a Medicaid provider, a waiver provider must be certified by the FSSA division that administers the waiver. Waiver providers can be certified to provide multiple waiver services. Please contact the appropriate division to learn how to become a certified waiver provider. After certification, the provider must then enroll as an Indiana Health Coverage Programs (IHCP) provider. Visit the Provider Enrollment pages of this website for more information about that process.

Note that some providers also offer nonwaiver services within the IHCP. These providers are issued two unique provider identification numbers for billing purposes - one for waiver billing and one for nonwaiver billing. Providers must submit claims using the provider ID number that corresponds to the services rendered and included on the claim.