Indiana’s Medicaid provider freeze is now in effect. What HCBS providers and families should know
Indiana’s six-month statewide moratorium on certification and enrollment for many home- and community-based Medicaid providers took effect August 1, 2026. The policy limits new agencies and some expansion activity across five Medicaid waiver programs while the state increases oversight after reporting $198,031,230.18 in extrapolated improper payments from audits of five attendant-care providers.
The moratorium affects services used by people with disabilities, traumatic brain injuries, older adults and others who receive Medicaid support at home or in community settings. The policy itself does not automatically end a current member’s Medicaid eligibility or existing service authorization, but members and families should report any access problem through their waiver or managed-care support channel.
What changed August 1
The Indiana Health Coverage Programs said the Centers for Medicare and Medicaid Services approved a statewide provider certification and enrollment moratorium for certain home- and community-based services under Indiana’s 1915(c) waivers. The initial moratorium lasts six months. Indiana may extend it in additional six-month increments only with CMS approval.
The affected waivers are:
- Community Integration and Habilitation
- Family Supports
- Health and Wellness
- Traumatic Brain Injury
- Indiana PathWays for Aging
The pause generally blocks certification and Medicaid enrollment for providers seeking covered waiver services. It also applies to certain changes of ownership, expansion into additional counties and additions of covered waiver services by existing HCBS agencies.
Services covered by the moratorium
The bulletin’s covered-service list includes attendant care, home and community assistance, respite, transportation, home-delivered meals, residential habilitation, structured family caregiving and workplace assistance.
Other listed services include adult family care, behavior-management services, caregiver coaching, day habilitation, extended services, facility-based support, family and caregiver training, participant assistance and care, personal emergency response systems, recreational therapy, wellness coordination and several residential support services.
The exact waiver and service combination matters. A service may be subject to the moratorium in one waiver context and have different rules in another, so providers should check the applicable service list before assuming an application or expansion is covered.
Services outside this specific moratorium
The bulletin says the moratorium does not apply to adult day services, assisted living, case or care management, benefits counseling, career exploration and planning, community transition, home modification and assessment, integrated health care coordination, nutritional supplements, occupational therapy, pest control, physical therapy, prevocational services, psychological therapy, remote supports, specialized medical equipment and supplies, speech and language therapy, structured day programs, supported employment or vehicle modifications.
That does not mean every listed service is unaffected in every operational respect. It means those services are outside this specific provider certification and enrollment pause.
Pending applications will be treated differently
Indiana’s rules depend on the waiver and the status of the application.
For the Health and Wellness, PathWays and Traumatic Brain Injury waivers, certification applications already under review in the Office of Medicaid Policy and Planning’s HCBS Certification Portal will be processed. Applications awaiting review and new applications will expire, and applicants may reapply after the moratorium is lifted.
For the Community Integration and Habilitation and Family Supports waivers, applications under review will expire. Applications in provisional-approval status will be held until the moratorium period ends, after which providers may reapply if necessary.
For IHCP enrollment, all screening requirements had to be completed before August 1, 2026, for an applicant to be enrolled during the moratorium. Open enrollment applications without completed screening by that date will be denied, although applicants may reapply after the moratorium is lifted.
Exceptions are limited to access concerns
Indiana will consider limited exceptions when they are needed to maintain sufficient member access to waiver services in an area of need. A provider agency seeking an exception must meet all provider qualification requirements and submit a narrative explaining how approval would address the access concern.
The IHCP bulletin directs providers and applicants to submit exception requests to the Office of Medicaid Policy and Planning at OMPPProviderRelations@fssa.in.gov.
Why Indiana imposed the freeze
The moratorium follows an April 23 announcement from the Indiana Family and Social Services Administration about audits of five home- and community-based services attendant-care providers. FSSA reported $198,031,230.18 in extrapolated improper payments, including interest, for the review period from January 1, 2022, through March 31, 2025.
Auditors reviewed 625 claim lines using statistically valid random sampling. FSSA said the reviewed claims included findings involving missing criminal-background checks, noncovered clinical tasks, insufficient documentation and mismatches between services billed and authorizations.
The $198 million figure is an extrapolation from the audit sample. It is not a finding that every provider or worker involved committed criminal fraud. FSSA said providers retain reconsideration and appeal rights during the audit process.
WFYI/IPB News reported that state officials described the moratorium as part of a broader effort to improve oversight and address fraud, waste and abuse. The report also included support for stronger accountability from disability advocates, along with concerns about the number of provider agencies and an ongoing shortage of direct-care workers.
What members, families and providers should watch
Members should not assume that the moratorium itself ends an existing benefit. But the policy may affect the availability of new agencies, new counties, added covered services or ownership changes, which could matter when a member is seeking a new provider or when an existing service arrangement changes.
Families and members who experience a disruption, difficulty finding an approved provider or a change in access should contact their waiver support channel or managed-care support organization and ask how the issue will be handled.
Providers and applicants should determine whether their certification application was under review, awaiting review or provisionally approved; whether enrollment screening was complete by August 1; and whether a planned ownership change, county expansion or added service falls within the moratorium. Agencies that can document a member-access concern may consider the limited exception process, but they still must meet Indiana’s provider qualifications.
Indiana’s next steps include continued oversight of existing providers, review of any access-based exception requests and a decision about whether to seek a CMS-approved extension after the initial six-month period.
Sources
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