Applying for Medicaid Waivers

PATHWAYS FOR AGING WAIVER
For Indiana residents ages 60+ who meet nursing‑facility level of care

How to Apply for Indiana’s PathWays for Aging Waiver (updated July 2025)

1. Apply for Medicaid  *Start here, even if you assume your income is too high.

1. • If you’re not already on Medicaid, complete the “Aged, Blind, or Disabled” (ABD) application through the FSSA Benefits Portal, by phone, mail, or at your local Division of Family Resources (DFR) office.

   • Applying to Medicaid is an important start.  If you’re denied under standard limits, you’ll re‑apply later under the higher waiver limits.
     
     

2. Open a PathWays record

   • Call the PathWays Enrollment Line: 877‑284‑9294 (87‑PATHWAY‑4).

   • The enrollment broker creates your file, confirms basic information, and gives you next steps.
     
     

3. Schedule your Level‑of‑Care assessment

   • A nursing‑facility–level‐of‐care review is required for home‑ and community‑based services.

   • As of July 2025, Indiana contracts with Maximus (LCAR) to do these assessments. You can book directly at 833‑597‑2777, or ask the enrollment broker to refer you.
     
     

4. Watch for your approval packet

   • Once financial eligibility (DFR) and functional eligibility (LCAR) are both cleared, the state mails you a packet—often called a “targeting letter.” This confirms you can enroll and explains your plan options.
     
     

5. Choose your health plan (MCE)

   • PathWays is delivered through three managed‑care entities: Anthem, Humana, or UnitedHealthcare.

   • Call the helpline (or go online, if you’ve set up an account) to pick a plan. You’ll have 90 days after enrollment to switch plans if you change your mind.
     
     

6. Meet your Care Coordinator and build your service plan

   • Your chosen plan assigns a Care Coordinator. Together you’ll create a person‑centered service plan that lists the supports you need (e.g., attendant care, structured family caregiving, meals, home modifications).

   • Services start as soon as that plan is approved.

HEALTH AND WELLNESS (H&W) WAIVER
For Indiana residents age 59 and younger who meet nursing‑facility level of care

How to Apply for Indiana’s Health and Wellness for Aging Waiver (updated July 2025)

Step 1. Apply for Medicaid  *Start here, even if you assume your income is too high.

1. • If you’re not already on Medicaid, complete the “Aged, Blind, or Disabled” (ABD) application through the FSSA Benefits Portal, by phone, mail, or at your local Division of Family Resources (DFR) office.

   • Applying to Medicaid is an important start.  PathWays can’t move forward until a Medicaid record exists. If you’re denied under standard limits, you’ll re‑apply later under the higher waiver limits.

Step 2. Contact your Area Agency on Aging (AAA) 

1. • Call Indiana’s statewide AAA intake line at 800‑713‑9023 or visit INconnectAlliance.org to locate your local agency.

   • The AAA will screen you over the phone to check if you meet the nursing facility level of care and place you on the waiver waitlist if you qualify. You'll get a confirmation letter by mail.

Step 3. Wait for your invitation letter

1. • When a spot becomes available, you’ll receive a waiver invitation letter.

   • This gives you 30 days to respond and starts a 180-day timeline to complete enrollment.

Step 4. Schedule your Level‑of‑Care assessment

1. • A nursing‑facility–level‐of‐care review is required for home‑ and community‑based services.

   • As of July 2025, Indiana contracts with Maximus (LCAR) to do these assessments. You can book directly at 833‑597‑2777, or ask the enrollment broker to refer you.

Step 5. Watch for your approval packet

1. • Once financial eligibility (DFR) and functional eligibility (LCAR) are both cleared, the state mails you a packet—often called a “targeting letter.” This confirms you can enroll and explains your plan options.

Step 6. Switch to Traditional Medicaid 

1. • If you're already on income-based Medicaid (like HIP or Hoosier Healthwise), you’ll need to switch to Traditional Medicaid before your waiver services can begin.

Once your waiver invitation is accepted:

1. • • 1. Call 800‑457‑4584 (the Indiana Medicaid enrollment helpline)

       2. Request to be moved to Traditional Medicaid due to waiver enrollment

This ensures you're enrolled in the correct type of Medicaid, which helps you remain eligible under the higher income limits—and in some cases, excludes parental income—allowed for waiver programs.

Step 7. Meet your Care Coordinator and build your service plan

1. • Your chosen plan assigns a Care Coordinator. Together you’ll create a person‑centered service plan that lists the supports you need (e.g., attendant care, structured family caregiving, meals, home modifications).

   • Services start as soon as that plan is approved.

FAMILY SUPPORTS (FSW) & 

COMMUNITY INTEGRATION & HABILITATION (CIH) WAIVERS

For Indiana residents with intellectual or developmental disabilities who need basic or intensive community-based supports

Step 1. Submit Your Waiver Application

Two ways to apply:

1. Paper application

   • Download State Form 55068, complete it digitally or by hand, then sign the form.

   • Return it to your local BDDS office by fax, mail, or in person.

2. Online

   • The BDDS Gateway may be accessed at: Bddsgateway.fssa.in.gov

   • Need help? Check out:

     • • Application Instructions

       • Video Tutorial

       • Applicant/Legal Representative Application Submission Procedure

       • Gateway FAQ for Individuals and Families

Step 2. The Intake Process

Once you have completed and returned the waiver application packet and all requested documents, an Intake Specialist from your local BDDS office will contact you to complete the assessment for a preliminary Level of Care (LOC) using the information and documents you provide. This part of the process determines Intellectual and/or Developmental Disability (I/DD) eligibility and preliminary Level of Care (LOC).

Step 3. Application Process Complete...Now What?

1. After the application process is complete and LOC is determined, you will be placed on the Waiting List for waiver services.

2. While you are waiting for an open slot, you may:

   • • Utilize Medicaid State Plan Services, if eligible

     • Apply for Supplemental Security Insurance (SSI).

     • Apply for Caregiver Supports (respite) as they are available

     • Use natural supports for help (e.g. family members, church, neighbors, co-workers and friends)

     • Utilize the other resources, such as the Department of Education (if under age 22), the Indiana Centers for Independent Living Services  and the Aging and Disability Resource Centers.

3. Contact your Local BDDS Office immediately and annually to update your address or telephone number.

4. To better serve Individuals on the FSW waiting lists, DDRS has developed the BDDS Waitlist Web Portal. The Portal will allow you to review and update your contact information and to review the waiver application dates the BDDS has on record. Check the BDDS Waiting List Online Portal.

Step 4. Beginning Waiver Services

1. When a slot opens, DDRS mails a targeting letter. Confirm you still want services, and an Intake Specialist completes a current LOC.

2. Once you have confirmed that you still want to receive services, an Intake Specialist will contact you and complete a current LOC. If you do not currently meet LOC, you will not be able to utilize the available waiver slot.

Step 5. Medicaid Reminders 

• If you were previously denied Medicaid, bring your targeting letter to your local Division of Family Resources (DFR) to reapply.

• If you're currently on income-based Medicaid (like HIP or Hoosier Healthwise), call 800‑457‑4584 and request to be moved to Traditional Medicaid due to waiver enrollment.

✅ This ensures you’re in the correct Medicaid program, which supports eligibility under higher income limits—and in some cases, excludes parental income for children and young adults.

Step 6. Choosing your Case Management Company (CMCO)

1. After you accept a waiver slot, BDDS will give you a “Pick List”—a roster of all certified case‑management companies (CMCOs) that serve your county. This decision matters: the CMCO you choose will be your day‑to‑day partner, guiding you through waiver rules, coordinating services, and helping you stay in control of your own supports. Feel free to interview any—or all—of the companies on the list and select the one that best fits your needs, communication style, and long‑term goals.

2. To inform your  Local BDDS Office of your case‑management choice, just fax them your completed pick list. If you prefer, send it to your selected case‑management company, and they’ll forward it to BDDS for you.

Tips to keep things moving

• Renew Medicaid every year. If your coverage lapses, waiver services stop.

• Keep your contact info current with both DFR and AAA or PathWays—missed mail can delay everything.

• Check for FSSA updates about the waitlist, or verify your spot using the dashboard (see instructions)

• Respond to your invitation quickly so you don’t lose your place

• You can call Maximus directly at: 1-833-597-2777 if you haven’t heard from your Options Counselor

• Call the helpline first for any questions about PathWays enrollment, plan switching, or covered services: 877‑284‑9294.

Keep in mind:

If your child has a serious, chronic medical condition, consider applying for Indiana Children’s Special Health Care Services (CSHCS). This program provides supplemental medical coverage for children ages birth to 21 who meet financial and medical criteria (families with income up to 250% of the federal poverty level may be eligible).

CSHCS supports children with conditions that are long-term, may limit daily functioning, or require special treatments or devices. Services can include specialty care, prescription drugs, immunizations, routine dental care, travel reimbursement, and community referrals.

CSHCS can run alongside Medicaid and waiver services, giving families additional support while waiting for waiver enrollment.

My Child Will be Graduating from High School. How Long is the Wait for Waiver Services?

Indiana reserves certain waiver slots for individuals aged 18–24 who permanently separate from school (graduate, age out, or leave). If those priority slots are filled, eligible graduates go on the regular waiting list and are offered the next available slot in order of application date.

Priority access by reserve capacity category is made available as long as priority waiver slots in the reserve capacity category remain open. Once the priority waiver slots in the reserve capacity category are filled, Individuals meeting the priority access criteria will be placed on the waiting list. They will subsequently be tracked based on their need for a priority waiver slot and offered a waiver slot when:

• A newly available priority waiver slot for which they qualify becomes available.

• A non-priority waiver slot using the first come, first served criteria for waiver enrollment (date placed on the waiting list) becomes available and the applicant is the first person on the waiting list.

My Loved One Has Urgent Needs. How Do Priority Slots Work for the Health & Wellness Waiver?

Indiana reserves a limited number of priority (reserve capacity) slots on the Health & Wellness Waiver for individuals in specific situations, such as:

• Transitioning out of a nursing facility, hospital, or rehabilitation center

• Facing homelessness or unstable housing

• At risk of placement in an institutional setting without waiver support

These individuals may be offered waiver enrollment ahead of the regular waitlist if they meet the criteria and a priority slot is open.

If all priority slots in a reserve capacity category are already filled, the person is placed on the regular waiting list. They are still tracked for potential future priority access, and will be offered a waiver slot in one of two ways:

1. A new priority slot becomes available in a category they qualify for

2. A standard (non-priority) slot opens, and they are next in line based on their original application date

👉 Important: Priority slots are limited and subject to state-defined categories. Being in a high-need situation does not guarantee immediate enrollment unless a matching priority slot is available.

Need help at any stage? Reach out—we’re happy to guide you through the process and connect you with resources while you wait.

Eligibility for Indiana's Home and Community-Based Services (HCBS) waivers begins with a required Level of Care (LOC) assessment. This is the first step to see if you qualify. The assessment, conducted by Maximus, evaluates your health needs to determine if you meet the medical criteria for waiver services.

👉Level of Care Assessment Information

👉FSSA Pre-admission Screening and Resident Review (PASRR)