Indiana Medicaid waiver invitations hit capacity, more than 10,000 still on waitlists

More than 10,000 people are still on waitlists for home- and community-based services through two Medicaid waivers. But the number of people invited off the waitlist so far would fill all the available slots on the waivers.

Advocates said Indiana won’t invite new people off the waitlist until previous invitations have been declined or rescinded.

Last week, a Family and Social Services Administration official confirmed invitations off the waitlist have depended on other people declining or the state rescinding an invitation since February.

Once someone is invited off the waitlist for the Health and Wellness or Pathways waiver, they have 30 days to accept the invitation. Then, they have 180 days to complete a service plan and several assessments to start receiving services. If they don’t, FSSA rescinds the invitation and offers it to another person on the waitlist.

Tom Crishon, Arc of Indiana’s chief legal officer, said it’s still important for people to stay updated.

“The advice that we’re providing individuals is to regularly — probably monthly — contact the entities that they’ve gone to to get on the waitlist. And see, and just check on their status on the waitlist,” Crishon said.

Crishon said consistent communication with the state is especially important with the recent change to a 180-day timeline for service plans and assessments. Prior to February, people had 30 days to accept an invitation, but a full year to complete the additional requirements.

FSSA said prior to the change, slots were held and unused indefinitely in cases where people didn’t complete necessary steps. Some Medicaid members have said, despite efforts to contact people after being invited off the waitlist, they could not make any progress.

READ MORE: Indiana ended Medicaid waiver waitlists before. As thousands wait, could it do it again?

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Crishon said the waitlist for home- and community-based services will continue to have a negative effect on vulnerable Hoosiers and the state.

“Long waitlists not only increase institutional placements, which carry significantly higher costs to the state, but more importantly: These delays result in decreased quality of life, shorter life spans for people with disabilities, greater hardships for families,” Crishon said.

People still waiting once Indiana runs out of slots will have to wait until at leastJuly for services. That’s because once a slot is used, it’s considered used for the entire fiscal year — even if the person in the slot moved out of state, no longer needs services or died.

Crishon said Indiana currently has no plans to increase the number of slots to the Health and Wellness or Pathways waiver.

He also said even if someone fits one of the three priority categories — being discharged from a hospital, transitioning from the CHOICE program or transitioning from a nursing facility — they will have to wait for an invitation to become available.

The waitlist was introduced last year in response to the $1 billion forecasting error announced in December 2023.

As of March, there are more than 4,600 people waiting for services through the Health and Wellness waiver, and the state has sent more than 3,100 invitations since July 2024. There are 5,700 people waiting for the Pathways waiver, and Indiana has sent more than 12,600 invitations since July 2024.

To get on the Health and Wellness and Pathways Waiver waitlist requires an evaluation called a “level of care” determination, or screening. The date someone completes this evaluation determines where they are on the waitlist.

FSSA said it couldn’t estimate how long people would be on the waitlist, but it started including the “original” level of care assessment date in November to give people an idea of where the agency was in processing the waitlist. The last level of care assessment date processed for the Pathways waiver was in September. For the Health and Wellness waiver, that date was back in May.

Abigail is our health reporter. Contact them at [email protected].