Indiana’s IDD service and billing environment is one of the most actively changing in the country in 2026. The state’s two primary developmental disability waivers hit maximum capacity at the end of 2025. Case Management Organization contracting was restructured with a new five-CMO model taking effect August 1, 2026. Waiver amendments with the same effective date introduced documentation tightening, service definition changes, and new eligibility assessment tools. And a full Waiver Redesign is scheduled for July 2027, meaning the changes happening now are preparation for a more comprehensive overhaul to come.
For IDD service providers billing through Indiana Medicaid, staying current with these changes is not a background task. It is an active operational requirement that affects authorization management, billing codes, case management documentation, and the client populations your agency can serve.
Indiana’s IDD Waiver Structure
Indiana’s Family and Social Services Administration administers two primary waivers for individuals with intellectual and developmental disabilities through the Bureau of Disabilities Services:
The Community Integration and Habilitation waiver, known as CIH, is Indiana’s comprehensive IDD waiver, requiring an ICF/IID level of care determination. The CIH waiver is a combination of the former Autism and Developmental Disability Waivers and provides services that enable persons to remain in their homes or in community settings and assists transitions from institutions into community settings. CIH supports a wide range of services including community integration, residential supports, day habilitation, supported employment, behavioral supports, respite, and transportation. Medicaidwaiver
The Family Supports Waiver, known as FSW, provides a more limited set of non-residential supports. The FSW provides limited, non-residential supports to individuals with developmental disabilities who live with their families or in other settings with informal supports. FSW is designed for individuals who have informal support networks and need supplemental services rather than comprehensive waiver-funded supports. Government of Indiana
Indiana also administers the Health and Wellness waiver for individuals 59 and under with physical disabilities requiring nursing facility level of care, the Traumatic Brain Injury waiver, and the PathWays for Aging program for elderly individuals requiring long-term care. Providers serving clients across multiple waiver types must maintain current knowledge of the billing rules and service definitions specific to each.
The 2025 Capacity Crisis and Its 2026 Impact
One of the most significant operational realities Indiana IDD providers faced entering 2026 was waiver capacity. The Family Supports and CIH waivers hit their maximum capacity in December 2025. No new slots were released until at least July 2026. As of February 2026, people invited to begin the process of receiving the Family Supports or CIH waiver were placed on a new waiting list. The Arc of Indiana
This capacity freeze had direct implications for provider operations. Agencies that had been building their client pipeline anticipating new CIH and FSW admissions found that referrals could not convert to enrolled clients during the freeze period. Providers managing transition-age youth entering adult services faced delays in establishing new waiver eligibility. And the freeze created pressure on existing slots, because individuals already enrolled were not being displaced to make room for those waiting.
The earliest new slots for Indiana’s two developmental disability waivers, which hit capacity in late 2025, were expected to be released no sooner than July 1, 2026. Providers should confirm with their local BDS office whether new capacity has been released and what the current invitation process looks like for individuals on the waitlist. Tender Home Care
The August 2026 Waiver Amendments
FSSA’s Bureau of Disabilities Services proposed waiver amendments to the CIH, FS, Health and Wellness, and TBI waivers with a projected effective date of August 1, 2026. These amendments are described explicitly as groundwork for Waiver Redesign rather than the redesign itself, meaning additional and more comprehensive changes are coming. Documentation rules will be tightening across multiple services, such as case notes being completed within seven calendar days of an event. AxisCare
Key changes from the August 2026 amendments that IDD providers need to track include:
Service definition updates: Several service definitions were modified to clarify purposes, allowable activities, and reimbursable components. Day Habilitation, Remote Supports, and Wellness Coordination all received clarifying amendments that providers need to review against their current documentation practices.
Eligibility assessment changes: New assessment tools will be age appropriate and used to determine eligibility for individuals with intellectual disabilities. Initial assessments using the new tool will be completed by state staff, while re-determinations will still be handled by waiver case managers. Providers should understand how the new assessment tools affect eligibility documentation for current and prospective clients. Tchhs
Self-direction updates: Self-direction is now available under all waivers, with about 10 percent of participants across all waivers currently self-directing. For providers serving self-directed clients, the documentation and billing requirements associated with self-direction apply across a broader range of waiver programs than before. Tchhs
Documentation tightening: The seven calendar day case note completion requirement is one of several documentation discipline changes embedded in the August amendments. Providers whose current documentation workflows allow notes to age beyond a week need to update their processes and supervisor accountability practices before the effective date.
The CMO Restructuring
Case management in Indiana’s IDD waivers runs through contracted Case Management Organizations rather than being delivered directly by FSSA. BDS announced that the number of CMOs serving Medicaid waivers would be reduced to five and would be consistent across all four waivers. People receiving services from a CMO that will not continue must select a new CMO by July 15, 2026. The Arc of Indiana
For IDD service providers, the CMO restructuring has several operational implications. Clients whose CMOs were not selected in the contracting process needed to select new organizations, which may have involved case manager transitions that affected service coordination and documentation continuity. Providers who work closely with specific case managers or CMOs on care coordination need to confirm which CMO is serving each client under the new structure and ensure that service authorizations and plan documentation are current under the new CMO relationship.
The Office of Medicaid Policy and Planning has also approved amendments to the CIH, FS, H&W, and TBI waivers that will take effect in August 2026, including changes to case management organization allowable activities and responsibilities that align CMO service definitions with the upcoming Waiver Redesign. The Arc of Indiana
The Waiver Redesign on the Horizon
All of the changes happening in 2026 are preparation for Indiana’s Waiver Redesign, scheduled for July 2027. The Waiver Redesign will cover the A&D, H&W, FSW, and CIH waivers, with a mix of existing services to be available across waivers and service outcomes focused on inclusion, connection, and community. Tchhs
Providers should understand that the August 2026 amendments are not the end state. The service definitions, documentation requirements, and billing structures that apply after August 2026 will change again in July 2027 when the full redesign takes effect. Agencies that build flexible documentation and billing processes that can accommodate change efficiently are better positioned for this environment than those whose procedures are rigid and require significant manual work to update.
What Indiana Providers Need From Their Billing System
The active change environment in Indiana’s IDD waiver system creates specific requirements for any billing platform serving Indiana providers:
Real-time authorization tracking: As CMO contracting changes shift which organizations are managing client authorizations, billing systems need to reflect current authorization structures accurately. Claims submitted against stale or incorrect authorization records will be denied. Vertex Billing Manager tracks authorizations in real time and surfaces errors before claims are submitted.
Documentation compliance support: The seven-day case note requirement and other documentation tightening in the August amendments require that case managers complete documentation within specific timeframes. Vertex Case Manager compliance reminders can be configured to surface overdue notes within the required window rather than waiting until the billing cycle reveals documentation gaps.
State-specific billing updates: As Indiana’s waiver amendments modify service definitions and billing codes, a billing platform that maintains Indiana-specific billing logic at the vendor level absorbs these changes systematically rather than requiring agency staff to update code configurations manually.
Connect with the Vertex Systems team to discuss Indiana-specific billing support and how the platform handles the ongoing waiver changes affecting IDD providers in the state.
