INDIANA

Indiana State Department of Health

2 North Meridian Street, Indianapolis, IN 46204
http://www.in.gov/isdh/

Home and Community-Based 1915(c) Waivers for Respite Support

Medicaid is a program in every state that pays for medical assistance for certain individuals and families with low incomes and
resources. It is the largest source of funding for medical and health-related services for Americas poorest people. Because
Medicaid is funded jointly by the federal and state governments, the services paid for vary from state to state. In addition to
medical services, Medicaid will pay for home and community-based services (HCBS) through the state plan as well as through
Medicaid waivers that offer services as a lower-cost alternative to treatment in a medical or long term care facility, such as a
nursing home. Respite is usually paid for through one or more of the following types of waivers: research and demonstration
(1115), managed care (1915b) and HCBS (1915c) waiver programs. This states Medicaid waivers that include respite are:

Aged & Disabled (A&D) Waiver

Provides adult day, attendant care, case management, homemaker, respite, adult family care, assisted living, community
transition, environmental modifications assessment, environmental modifications, health care coordination, home delivered
meals, nutritional supplements, Personal Emergency Response System, pest control, specialized medical equipment and
supplies, structured family caregiving, transportation, and vehicle modifications for individuals 65 years and older and
individuals from birth to age 64 with a disability.
Traumatic Brain Injury
Provides adult day, attendant care, case management, homemaker, residential based habilitation, respite, structured day
program, supported employment, adult family care, behavior management/behavior program and counseling, community
transition, environmental modifications, health care coordination, home delivered meals, nutritional supplements, Personal
Emergency Response System, pest control, specialized medical equipment and supplies, transportation, and vehicle
modifications for individuals diagnosed with brain injury with no age restrictions.
Community Integration and Habilitation
Provides adult day, case management, prevocational, rent and food for unrelated live-in caregiver, residential habilitation
and support, respite, supported employment follow along, occupational therapy, physical therapy, psychological therapy,
speech/language therapy, behavioral support, community based habilitation -group or individual, community transition,
electronic monitoring, environmental modifications, facility based habilitation-group or individual, facility based support
services, family and caregiver training, intensive behavior intervention, music therapy, Personal Emergency Response
System, recreational therapy, specialized medical equipment and supplies, structured family caregiving, transportation,
wellness coordination, and workplace assistance for individuals diagnosed with autism, an intellectual disability and/or a
developmental disability with no age restrictions.
Family Supports
Provides adult day, case management, prevocational, respite, occupational therapy, physical therapy, psychological therapy,
speech/language therapy, behavioral support services, community based habilitation-group or individual, extended services,
facility based habilitation-group or individual, facility based support services, family and caregiver training, intensive
behavioral intervention, music therapy, participant assistance and care, Personal Emergency Response System, recreational
therapy, specialized medical equipment and supplies, transportation, and workplace assistance for individuals diagnosed
with autism, an intellectual disability and/or a developmental disability with no age restrictions.
PRTF Waiver

Provides habilitation, respite, consultative clinical and therapeutic services, flex funds, non-medical transportation, training
and support for unpaid caregivers, as well as wraparound facilitation/care coordination, and wraparound technician for
individuals, ages 18-20, diagnosed with a mental illness and children, between ages 6-17, diagnosed with SED (serious
emotional disturbance).

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org
INDIANA

Aged and Disabled (A&D) Waiver (0210.R05.00)

State Operating Agency: Office of Medicaid Policy and Planning, Indiana Division of Aging

Description This waiver services supplement informal supports for people who require care in a nursing facility
without waiver supports. Services can be used to help people remain in their homes, as well as assist
people living in nursing facilities return to community settings such as their own homes, apartments,
assisted living or adult family care. Services include adult day, attendant care, case management,
homemaker, respite, adult family care, assisted living, community transition, vehicle and environmental
modifications, assessment of modifications, health care coordination, home delivered meals,
nutritional supplements, PERS (personal emergency response systems), pest control, specialized
medical equipment and supplies, structured family caregiving, and transportation.
Waiver Type 1915(c)
Target Population- Individuals who have disabilities ages birth to 64 as well as individuals who are 65 or older. At age 65,
Eligibility participants in these disabled target subgroups seamlessly transition to the Aged target subgroup.

Level of Care Individuals require level of care available in a nursing facility (NF).
Respite Services Respite is provided temporarily or periodically in the absence of the usual caregiver and may be
provided in an individuals home or in the private home of the caregiver. The level of professional care
provided depends on the needs of the individual. Allowable respite activities include home health aide
and skilled nursing. Individuals requiring assistance with bathing, meal preparation, specialized feeding
due to difficulty swallowing, refusing to eat, or not eating enough; dressing or undressing; hair and oral
care; and weight bearing transfer assistance should be considered for respite home health aide under
the supervision of a registered nurse. For needed infusion therapy; venipuncture; injection; wound
care, decubitus, incision; ostomy care; and tube feedings, consider respite nursing services.
Respite may not be used as day/child care for primary caregivers to work or attend school; to provide
service to a participant while participant is attending school; or to replace services that should be
provided under the Medicaid State Plan. Respite must not duplicate any other service being provided
under the participants service plan or to participants receiving Adult Family Care waiver, Structured
Family Caregiving waiver, or Assisted Living waiver services.
Respite Provider To apply to be a Provider, contact: Director of Provider Relations, DDRS - Division of Disability and
Eligibility Rehabilitative Services at 402 W. Washington St., RM 453, MS 18, Indianapolis, IN 46207 - 7083
BDDSprovider@fssa.IN.gov Phone: 1-800-545-7763 Fax: (317)232-1240
Go to: http://www.in.gov/fssa/da/3476.htm#jump_provider
Caregiver Eligibility Service may be provided by a relative, but not a legally responsible person or legal guardian.
Enrollment Limit 16,384: Year ending 06/30/2016
How to Apply You may apply online at or in person at a local office, or call 1-800-403-0864 to request an application
be mailed to you.
Contact Information Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at
317-232-4650 or by email at daproviderapp@fssa.in.gov
More information is available online at: www.in.gov/fssa/ddrs
Link to Waiver http://www.in.gov/fssa/files/AD_Waiver_Renewal_2013-07-01.pdf
Application
Expiration Date 06/30/2018

Date of Last Update 09/11/2015

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org
INDIANA

Traumatic Brain Injury (4197.R03.00)

State Operating Agency: Office of Medicaid Policy and Planning, Indiana Division of Aging

Description This waiver offers services and supports to ensure that individuals with a traumatic brain injury receive
appropriate services based on their needs and the needs of their families. Wavier services include adult
day and/or family care, attendant care, case management, homemaker, residential based habilitation,
respite, structured day program, supported employment, behavior management/behavior program
and counseling, community transition, environmental and vehicle modifications, health care
coordination, home delivered meals, nutritional supplements, personal emergency response systems,
pest control, specialized medical equipment and supplies, and transportation.
Waiver Type 1915(c)
Target Population- Individuals of all ages diagnosed with a traumatic brain injury defined as a trauma that has occurred as
Eligibility a closed or open head injury by an external event that results in damage to brain tissue, with or
without injury to other body organs. Examples of external agents are mechanical events that result in
interference with vital functions. Traumatic brain injury means a sudden insult or damage to brain
function, not of a degenerative or congenital nature. The insult or damage may produce an altered
state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical
functioning resulting in partial or total disability not including birth trauma related injury.
Level of Care Individuals require level of care available in a nursing facility (NF) or Intermediate Care Facility for
Individuals with Intellectual Disabilities (ICF/IID).
Respite Services Respite services are those services that are provided temporarily or periodically in the absence of the
usual caregiver. Service may be provided in an individuals home or in the private home of the
caregiver. The level of professional care provided under respite services depends on the needs of the
individual. An individual requiring assistance with bathing, meal preparation and planning, specialized
feeding, such as an individual who has difficulty swallowing, refuses to eat, or does not eat enough;
dressing or undressing; hair and oral care; and weight bearing transfer assistance should be considered
for respite home health aide under the supervision of a registered nurse. An individual requiring
infusion therapy; venipuncture; injection; wound care for surgical, decubitus, incision; ostomy care;
and tube feedings should be considered for respite nursing services. Allowable activities include home
health and skilled nursing services. Respite may not be used as day/child care for primary caregivers to
work/attend school; to assist participant while attending school; or to replace services that should be
provided under the Medicaid State Plan. Respite must not duplicate any other service being provided
under the participants service plan or to participants receiving Adult Family Care waiver service.
Respite Provider To apply to be a Provider: Director of Provider Relations, DDRS - Division of Disability and
Eligibility Rehabilitative Services, 402 W. Washington St., RM 453, MS 18, Indianapolis, IN 46207 7083,
Email: BDDSprovider@fssa.IN.gov Phone: 1-800-545-7763 Fax: (317)232-1240
Caregiver Eligibility Respite may be provided by a relative, but not by the legally responsible person or a legal guardian (i.e.,
parent of a minor child, spouse, attorney-in-fact (POA), health care representative).
Enrollment Limit 200: Year ending in 12/31/2016

How to Apply Division of Aging, Home and Community-Based Services Waivers

402 West Washington Street, Room W382, MS07, P.O. Box 7083, Indianapolis, IN 46027
You may apply online or in person at a local office, or call 1-800-403-0864 to request an application.
Contact Information Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at
317-232-4650 or by email at daproviderapp@fssa.in.gov
More information available online at: www.in.gov/fssa/ddrs
Link to Waiver http://www.in.gov/fssa/files/TBI_Waiver_Renewal_2013-01-01.pdf
Application
Expiration Date 12/31/2017
Date of Last Update 09/14/2015

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org
INDIANA

Community Integration and Habilitation (0378.R03.00)

State Operating Agency: Division of Disability and Rehabilitative Services (DDRS), Bureau of Developmental
Disabilities Services (BDDS)

Description Participants may choose to live in their own home, family home, or community setting appropriate to
their needs. The waiver services include adult day care; case management; prevocational; rent and
food for unrelated live-in caregiver; residential habilitation and support; respite; supported
employment follow along; occupational, physical, psychological, speech/language, and recreational
therapy; behavioral support; community or facility based habilitation-group or individual; community
transition; electronic monitoring; environmental modifications; facility based support services; family
and caregiver training; intensive behavior intervention; music therapy; PERS (personal emergency
response system); specialized medical equipment and supplies; structured family caregiving,
transportation; wellness coordination; and workplace assistance.
Waiver Type 1915(c)
Target Population- Individuals of all ages diagnosed with autism, developmental disability (DD) or intellectual disability
Eligibility (IID), cerebral palsy, epilepsy or other conditions closely related to intellectual disability. Other
condition (other than a sole diagnosis of mental illness) is an impairment similar in general intellectual
functioning or adaptive behavior, or requires treatment or services similar to those required for a
person with an intellectual disability. The IID, DD or other related condition must have an onset prior to
age 22, be expected to continue and result in substantial functional limitations in at least three (3) of
these major life activities: a) Self-care; b) Understanding and use of language; c) learning; d) mobility; e)
self-direction; f) capacity for independent living; and g) economic self-sufficiency.
Level of Care Individuals require level of care available in an Intermediate Care Facility for Individuals with
Intellectual Disabilities (ICF/IID).
Respite Services Respite are provided to participants unable to care for themselves that are furnished on a short-term
basis in order to provide temporary relief to those unpaid persons normally providing care. Respite can
be provided in the participants home or place of residence, respite caregivers home, a camp setting,
an approved day habilitation facility, or a non-private residential setting (such as a respite home).
Activities may include: assistance with toileting, feeding, daily living skills including assistance accessing
the community and community activities, grooming and personal hygiene; meal preparation, serving
and cleanup; administration of medications; supervision; individual services; and group services.
Respite Provider To apply to be a Provider: Director of Provider Relations of DDRS - Division of Disability and
Eligibility Rehabilitative Services at 402 W. Washington St., RM 453, MS 18 Indianapolis, IN 46207 - 7083
BDDSprovider@fssa.IN.gov Phone: 1-800-545-7763 Fax: 317-232-1240
Caregiver Eligibility Respite may be provided by a relative, legal guardian, or legally responsible person.
Enrollment Limit 9901: Year ending in 09/30/2016
How to Apply You may apply for by calling the local Bureau of Developmental Disabilities Services (BDDS) District
Office to request an Application for Developmental Disabilities Services or by visiting the DDRS website.
Contact Information See the state map (http://www.in.gov/fssa/ddrs/4088.htm ) or call 1-800-545-7763 to locate your local
office. Waiver application forms may also be accessed at: http://www.in.gov/fssa/ddrs/3349.htm .
Link to Waiver http://www.in.gov/fssa/files/CHIW.pdf
Application
Expiration Date 09/30/2019

Date of Last Update 09/14/2015

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org
INDIANA

Family Supports (0387.R03.00)

State Operating Agency: Division of Disability and Rehabilitative Services (DDRS), Bureau of Developmental
Disabilities Services (BDDS) and the Bureau of Quality Improvement Services (BQIS)

Description This waiver provides access to meaningful and necessary home and community-based supports,
implements supports in a manner that respects the participants personal beliefs and customs, ensures
that services are cost-effective, facilitates the participants involvement in the community where
he/she lives and works, facilitates the participants development of social relationships in his/her home
and work communities, and facilitates the participants independent living.
Waiver services include: adult day care; case management; prevocational; respite; occupational,
physical, psychological, speech/language, and recreational therapy; behavioral support services;
community based and facility based habilitation-group or individual; extended services; facility based
support services; family and caregiver training; intensive behavioral intervention; music therapy;
participant assistance and care; PERS (personal emergency response system); specialized medical
equipment and supplies; transportation; and workplace assistance.
Waiver Type 1915(c)
Target Population- Individuals of all ages diagnosed with Autism, a Developmental Disability (DD), or Intellectual Disability
Eligibility (IID). Other developmental disabilities eligible include cerebral palsy, epilepsy, autism, or other
conditions closely related to intellectual disability. The other condition (other than a sole diagnosis of
mental illness) is a condition that results in similar impairment of general intellectual functioning or
adaptive behavior or requires treatment or services similar to those required for a person with an
intellectual disability. The IID, DD or other related condition must have an onset prior to age 22, be
expected to continue and result in substantial functional limitations in at least three (3) of the following
areas of major life activities: a) Self-care; b) Understanding and use of language; c) Learning; d)
Mobility; e) Self-direction; f) Capacity for independent living; and g) Economic self-sufficiency.
Level of Care Individuals require level of care available in an Intermediate Care Facility for Individuals with
Intellectual Disabilities (ICF/IID).
Respite Services Respite Care services are provided to participants unable to care for themselves that are furnished on a
short-term basis in order to provide temporary relief to those unpaid persons normally providing care.
Respite Care can be provided in the participants home or place of residence, in the respite caregivers
home, in a camp setting, in a DDRS approved day habilitation facility, or in a non-private residential
setting (such as a respite home).
Reimbursable activities include: assistance with toileting, feeding, daily living skills including assistance
with accessing the community and community activities, grooming and personal hygiene; meal
preparation, serving and cleanup; administration of medications; supervision; individual services; and
group services (Unit rate divided by number of participants served).
Respite Provider To apply to be a Provider: Director of Provider Relations of DDRS - Division of Disability and
Eligibility Rehabilitative Services at 402 W. Washington St., RM 453, MS 18 Indianapolis, IN 46207 - 7083
BDDSprovider@fssa.IN.gov Phone: 1-800-545-7763 Fax: (317)232-1240
Caregiver Eligibility Respite Services may be provided by legally responsible person, relative or legal guardian.
Enrollment Limit 14,171: Year ending 03/31/2016
How to Apply Contact your local Bureau of Developmental Disabilities Services (BDDS) Office and request an
Application Packet to apply for the FSW. Information on how to find your local district available at:
BDDS District Field Services Locations and Maps
Contact Information Locate your local BDDS offices: http://www.in.gov/fssa/files/BDDS.pdf or call 1-800-545-7763.
Link to Waiver http://www.in.gov/fssa/files/FSW.pdf
Application

Expiration Date 03/31/2020

Date of Last Update 10/21/2015

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org
INDIANA

PRTF Waiver (03.R02.00)

State Operating Agency: Division of Mental Health and Addiction (DMHA), Office of Medicaid Policy and Planning
(OMPP)
Description This waiver offers services solely for the transition of eligible children and youth from the Community
Alternative to Psychiatric Residential Treatment Facility (CA-PRTF) Demonstration Grant following
expiration of the Grant. This transition waiver promotes transformation of Indianas behavioral health
system to provide intensive community based care for children with high needs whose families,
caretakers, and/or community would be able and willing to maintain the youth in a community setting
with adequate and appropriate interventions and support. Services include: habilitation, respite,
consultative clinical and therapeutic services, flex funds, non-medical transportation, training and
support for unpaid caregivers, wraparound facilitation/care coordination and wraparound technician.
Waiver Type 1915(c)
Target Population- For individuals diagnosed with either a Mental Illness (age 18-20 years) or Serious Emotional
Eligibility Disturbance (Age 6-17 years). No new individuals will be accepted for the PRTF Waiver. Prior eligible
participants continue to be eligible provided they continue to meet the target population eligibility.
Level of Care Individuals require level of care available in a Psychiatric Residential Treatment Facility (PRTF).

Respite Services Respite is provided to participants unable to care for themselves and is furnished on a short-term basis
due to the absence or need for relief of those persons who normally provide care for the participant. It
may be planned and provided on a routine basis (such as daily, weekly, monthly, or semi-annually) or
may be unplanned when a caregiver has an unexpected situation requiring assistance in caring for the
participant. Respite may be provided as an emergency in response to a crisis situation in the family.
Respite may be provided in the participants home or place of residence, or any facility licensed by the
Indiana FSSA, Division of Family Resources or by the Indiana Department of Child Services. Respite
must be provided in the least restrictive environment available and ensure the health and welfare of
the participant. Participants needing consistent 24-hour supervision with regular monitoring of
medications or behavioral symptoms should be placed in a facility under the supervision of a
psychologist, psychiatrist, physician or nurse who meets respective licensing or certification
requirements of his/her profession in the state of Indiana.
Respite is provided on an hourly basis for less than 7 hours in any one day; or at the daily rate for 7 to
24-hours in any one day. Crisis Respite is provided for a minimum of 8 to 24 hours billable at a daily
rate. Twenty-four hour Respite cannot exceed 14 consecutive days. Respite cannot be provided as a
substitute for regular childcare to allow the parent/guardian to hold a job or attend school.
Respite Provider For information about becoming a provider please contact DMHA by calling: (317) 232-7800 or 1-800-
Eligibility 901-1133 or visiting http://www.in.gov/fssa/dmha/2756.htm
Caregiver Eligibility Respite services may be provided by a relative, but not a legal guardian or legally responsible person.
Enrollment Limit 173: Year ending in 09/30/2016
How to Apply Waiver participants were enrolled in the CA-PRTF Grant as of September 30, 2012. No additional
individuals may apply for or receive waiver services through the PRTF Transition Waiver.
Contact Information For additional information about the waiver please contact DMHA by calling (317) 232-7800 or
1-800-901-1133 or visiting http://www.in.gov/fssa/dmha/6643.htm .
Link to Waiver http://www.in.gov/fssa/dmha/files/1915c_PRTF_Transition_Waiver_CMS_Application%281%29.pdf
Application
Expiration Date 09/30/2017

Date of Last Update 10/21/2015

Home and Community-Based 1915(c) Medicaid Waivers for Respite Support - 2015
ARCH National Respite Network and Resource Center
www.archrespite.org