Indiana Resumed Medicaid Waiver Eligibility Determinations

The state has restarted evaluations for disability services after pausing the process to review assessment consistency.

Updated on Oct. 6, 2026 in Special Needs

Isometric editorial illustration of a stable stack of geometric blocks, representing the restoration of administrative assessment systems. — The Indiana Family and Social Services Administration has restarted Medicaid waiver level-of-care determinations following a temporary review of eligibility assessment protocols. AI Illustration. Upload story photo >

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The Indiana Family and Social Services Administration (FSSA) has resumed level-of-care determinations for Medicaid waivers following a temporary suspension. This change impacts residents currently awaiting eligibility decisions for disability services in the state.

Why it matters

Officials paused the process in August to ensure that case managers were using the interRAI algorithm consistently, following internal estimates that suggested an approval rate closer to 90%. This review aims to improve the accuracy and fairness of how the state evaluates the needs of individuals seeking support.

State officials conducted an internal review of the interRAI assessment algorithm, which has been used to determine waiver eligibility since January 2026. The findings prompted the agency to re-evaluate how assessments are performed to align with the expected 90% approval benchmark.

The players

Indiana Family and Social Services Administration

The state agency responsible for overseeing and managing disability Medicaid waiver programs.

The Arc of Indiana

An advocacy organization that supports individuals with developmental disabilities and their families.

The details

The Medicaid waiver eligibility process utilizes the interRAI algorithm to standardize the assessment of care needs for individuals with disabilities. To address implementation concerns, the FSSA is now requiring that new assessments involve both trained assessors and mentors working directly alongside assigned case managers. Additionally, the agency is rescinding previous denials that were in the appeals process to allow for these updated, supervised evaluations.

January 2026: Case managers began using the interRAI algorithm for assessments.
August 31, 2026: The FSSA paused all level-of-care determinations.
September 30, 2026: The Arc of Indiana filed a records request regarding the process.
October 5, 2026: The agency officially resumed level-of-care determinations.

Health Landscape

The adoption of the interRAI assessment system marks a transition toward standardized, data-driven eligibility for Medicaid disability services in Indiana. The recent pause highlights the ongoing challenges state health agencies face when integrating algorithmic tools into complex care management workflows.

Individuals with pending denials should monitor communication from the state as the FSSA rescinds those decisions for reassessment. If you are currently in the waiver application process, it is worth discussing the status of your evaluation with your case manager.

The takeaway

The FSSA is resetting its review process to ensure that disability waiver determinations are conducted accurately and consistently. Residents should maintain communication with their case managers to confirm whether their pending applications or appeals require a new assessment.