For Hoosiers who receive Medicaid waiver services, 2026 has brought significant changes—and more changes may still be ahead.
Changes involving Medicaid waivers, Participant Assistance and Care, behavioral services, and Home- and Community-Based Services can be confusing and, for many families, upsetting. The system can be difficult to navigate even under normal circumstances.
One message remains important: individuals with disabilities and their families have the right to ask questions, seek assistance, appeal decisions, and advocate for the services they need.
Indiana’s Medicaid waiver system has undergone several changes in recent years. For people with intellectual and developmental disabilities, the primary programs are the Family Supports Waiver and the Community Integration and Habilitation Waiver.
Beginning January 1, 2026, Indiana added new self-directed service options to the Family Supports Waiver. Through self-direction, eligible individuals can have greater control over certain services, including who provides support and how those supports are managed. Indiana’s INCharge program also provides self-directed options for several waiver programs.
Indiana has also placed greater emphasis on deadlines associated with waiver invitations and enrollment. Individuals receiving an invitation to participate in certain waiver programs must complete the required steps within the established timeframe. While the goal is to prevent waiver slots from going unused, families must pay close attention to notices, deadlines, and required paperwork.
Another significant issue involves proposed changes to payments for certain services provided by live-in caregivers. FSSA has proposed reduced rates for certain services when a caregiver lives with the waiver participant. The proposal affects services including Attendant Care, Participant Assistance and Care, and Residential Habilitation and Support–Hourly. The proposed effective date is August 1, 2026, pending approval.
For families who rely on a parent, spouse, relative, or other live-in caregiver to provide paid support, changes to reimbursement could have a direct financial impact.
The state is also continuing to update waiver requirements and the way services are administered. In addition, Indiana is moving forward with a broader BDS Waiver Reset that includes changes to case management organizations. Individuals already receiving a BDS waiver will not have to reapply, but some participants may need to select a new case management organization as the new system takes effect.
Indiana is also using the interRAI assessment process as part of its evaluation of eligibility for the Family Supports and Community Integration and Habilitation waivers.
The change has raised concerns among individuals, families, and disability advocates. The Indiana Family and Social Services Administration says applicants continue to receive eligibility determinations and appeal rights whether they are approved or denied. However, advocates say some families are struggling to understand why they were denied and how to navigate the appeals process.
The Arc of Bartholomew County and other disability advocates have raised concerns about the number of people who may be denied access to waiver services under the new assessment process. Those concerns deserve attention as Indiana continues to evaluate how the new system is working for Hoosiers with intellectual and developmental disabilities.
Another development has drawn attention from disability advocates across the country.
The Arc of Bartholomew County posted about this: On July 20, 2026, the U.S. Department of Justice published a notice stating that its 2011 guidance on enforcement of the integration mandate under Title II of the Americans with Disabilities Act and Olmstead v. L.C. is not enforceable as guidance. Disability advocates have expressed concern about what this could mean for the future of community-based services and protections for people with disabilities.
The Olmstead decision has long been associated with the principle that people with disabilities should receive services in the most integrated setting appropriate to their needs, rather than being unnecessarily segregated in institutions.
https://www.federalregister.gov/documents/2026/07/20/2026-14566/clarification-on-department-of-justice-guidance-titled-statement-of-the-department-of-justice-on
The recent federal action has prompted advocates to emphasize the importance of state-level protections and continued public involvement.
What does this mean for you? The answer will vary from person to person.
For some individuals, expanded self-direction may provide greater control over their services. For others, new assessments, deadlines, documentation requirements, caregiver reimbursement changes, and changes to case management may create additional challenges.
Indiana’s Medicaid waiver programs are designed to help eligible individuals live in their homes and communities instead of receiving services in institutional settings. The Family Supports Waiver and CIH Waiver provide a variety of services, including behavioral supports, case management, respite, therapies, transportation, Participant Assistance and Care, residential supports, and other services based on an individual’s approved plan of care.
While the system can be overwhelming, individuals and families do not have to navigate it alone.
For families in Decatur County, The Arc of Decatur County is their most important resource.
Executive Director Teresa Hooten has extensive knowledge of disability services and is available to help individuals and families find answers and locate information. Even when she does not immediately have an answer, she works to help find the information families need.
The Arc of Decatur County
P.O. Box 126
355 South Michigan Avenue
Greensburg, Indiana 47240
Email: arcofdecaturcountyin@gmail.com
Phone: 812-900-3789
Indiana Disability Rights is the state’s federally designated Protection and Advocacy organization. It provides advocacy and legal assistance involving disability discrimination, abuse and neglect, education, employment, housing, voting, guardianship, Medicaid, and other disability rights issues.
The Indiana Protection and Advocacy Services Commission oversees Indiana Disability Rights and helps guide statewide protection and advocacy efforts.
Indiana Legal Services provides civil legal assistance to eligible low-income Hoosiers. Depending on the circumstances, that may include assistance involving public benefits, housing, discrimination, and other legal issues affecting people with disabilities.
Centers for Independent Living throughout Indiana provide peer support, advocacy, independent living skills training, information and referral services, and assistance with community participation.
The Arc of Indiana advocates for people with intellectual and developmental disabilities and their families. The organization works on issues including public policy, employment, housing, community inclusion, and long-term supports.
The Arc of Indiana is also asking individuals and families to share their experiences with Medicaid and Medicaid waiver services. Personal stories can help policymakers, the media, and the public understand how these programs affect real people.
Families who are receiving services—or who are waiting for services—can share their experiences through The Arc of Indiana’s Medicaid and HCBS story initiative.
Self-Advocates of Indiana helps people with intellectual and developmental disabilities speak up for themselves, participate in policy discussions, and advocate for their rights.
The Indiana Institute on Disability and Community at Indiana University provides research, training, technical assistance, and resources involving disability inclusion, community living, employment, education, and public policy.
Individuals and families affected by Medicaid and waiver services can also contact their state legislators and share their story. Personal stories can help policymakers understand the real impact of decisions made in Indianapolis and Washington.
Advocacy has always been important. With significant changes occurring in Indiana’s Medicaid waiver system, it is more important than ever for individuals, families, and friends to speak up about the services people need to live safely and successfully in their communities.
This article is intended to promote self-advocacy and remind individuals and families that they are not alone. I have worked in the disability services field for 19 years and have worked with countless individuals and families, seeing firsthand how important advocacy can be. Navigating disability services can be confusing and overwhelming, but people have the right to ask questions, seek help, and speak up about the services they need. Knowing where to turn for support is just as important as advocacy itself, and no one should feel they have to navigate the system alone.
Written by Chris Ramey. All Rights Reserved to WTRE Radio.
