Indiana home care rules

Indiana's Department of Health licenses personal services agencies (non-medical home care) and home health agencies. Medicaid home care for people 60 and older runs through the PathWays for Aging program and its three health plans, Anthem, Humana and UnitedHealthcare, and the state's Office of Medicaid Policy and Planning certifies providers for the PathWays, Health and Wellness and Traumatic Brain Injury waivers. Since August 1, 2026, a statewide moratorium has stopped new certifications and enrollments for many waiver services, including Attendant Care and Home and Community Assistance.

109 official documents·collected September 22, 2026·checked against them September 22, 2026

License for non-medical home care?YesPersonal services agency license from the Indiana Department of Health · 1 year · $250. Covers attendant care, homemaker and companion services given in the client's home for pay. Individuals serving only family, or no more than 3 people per residence and 7 at a time, are exempt.

License for home health?YesHome health agency license from the Indiana Department of Health · renewed every year · $250. Since July 1, 2026, Indiana Medicaid also requires home health agencies to be enrolled with Medicare (some have until June 30, 2027).

EVVRequiredPersonal care since Jan. 1, 2021; home health since Jan. 1, 2024. Claims without matching EVV data are denied.

Medicaid health plans3 for PathWaysAnthem, Humana and UnitedHealthcare run PathWays for Aging (age 60 and older). MDwise left Indiana Medicaid on Jan. 1, 2026.

Compare states Federal rules →

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Act nowBulletin BT2026124, July 23, 2026 · in effect from Aug. 1, 2026

New waiver certifications are frozen for most services, including Attendant Care

CMS approved a statewide moratorium on certifying and enrolling providers for PathWays, H&W, TBI, CIH and Family Supports waiver services. It covers Attendant Care, Home and Community Assistance, respite, Structured Family Caregiving and more. Existing agencies also cannot change ownership, add counties or add services that fall under it. It runs for six months from Aug. 1, 2026, and the IHCP may extend it six months at a time.

What to do: Hold off on plans to add counties, services or new owners for these services. If your area has an access gap, you can ask for an exception by email to OMPPProviderRelations@fssa.in.gov, with a narrative explaining how you would meet the access need. You must meet all provider qualifications.

BT2026124 HCBS provider certification and enrollment moratorium ↗our copy

Act nowBulletin BT202647, March 31, 2026 · required from July 1, 2026

Home health agencies must be Medicare-enrolled to stay in Indiana Medicaid

From July 1, 2026, IHCP home health agencies must be enrolled with Medicare. Under Senate Enrolled Act 222 (2026), an agency that sent its CMS-855A before April 1, 2026, or started with a CMS-approved accrediting organization, can stay enrolled, but must finish Medicare enrollment by June 30, 2027. Agencies that did neither are deactivated.

What to do: If you are relying on the extension, keep the dated proof of your Medicare filing and track your Medicare survey so you finish before June 30, 2027.

BT202647 Home health Medicare enrollment requirement clarified ↗our copyBT202595 Home health agencies must enroll with Medicare by July 1 2026 ↗our copy

Read this monthFSSA notice of CMS approval · effective Aug. 1, 2026

Waiver amendments took effect August 1; the live-in caregiver rate cut was dropped

CMS approved amendments to the H&W, TBI, PathWays, CIH and Family Supports waivers, effective Aug. 1, 2026. FSSA removed the proposed lower rate for Attendant Care given by live-in caregivers (Bulletin BT202673) and rescinded that bulletin. For H&W, relatives and legal guardians can now be paid only for certain services, and each can be paid for no more than 40 hours a week across Attendant Care, Home and Community Assistance and Skilled Respite.

What to do: No change to live-in Attendant Care rates for now; FSSA says it will revisit them in a future amendment cycle. Read the H&W fact sheet if relatives or guardians work for you as paid caregivers.

2026 Waiver Approval Announcement ↗our copyHealth and Wellness Waiver Fact Sheet (2026-08) ↗our copyBT202673 Proposed live-in caregiver rates ↗our copy

Read this monthBulletin BT202687, May 28, 2026 · in effect from July 1, 2026

Members can ask for their service records and an itemized bill

Under House Enrolled Act 1277, HCBS waiver providers must give a member or guardian the service delivery records on request (up to once a quarter) and a plain-language itemized statement of services billed (up to twice a year). You must complete each request within 30 calendar days.

What to do: Decide who handles these requests and make a simple plain-language statement template.

BT202687 Document delivery requirements for HCBS waiver providers ↗our copy

For the recordBulletin BT202666, May 7, 2026

Either license works again for Attendant Care enrollment

In February the IHCP said Attendant Care and Home and Community Assistance providers would need a PSA license from March 25, 2026. In May it withdrew that: a PSA license or a home health agency license is accepted for new enrollments and recertifications. Either license must stay current, and you must upload the renewed license before the old one expires.

What to do: Check the expiration date of the license on file with the IHCP and upload the renewed license before it lapses.

BT202666 Licensure requirement rescinded for certain waiver providers ↗our copyBT202622 Licensure requirements for waiver provider enrollment ↗our copy

Deadlines coming up

Dates taken from the rules and notices as we read them.

99days

December 31, 2026

Yearly dementia training for home health aides due

Aides employed at least one year complete 3 hours of approved dementia training before December 31 each year (Indiana Code 16-27.5-5-10).

Indiana Code Title 16 Health - 2026 edition ↗our copy

280days

June 30, 2027

Last day to finish Medicare enrollment for home health agencies using the extension

Agencies that began Medicare enrollment before April 1, 2026 are deactivated from Indiana Medicaid if not finished by this date.

BT202647 Home health Medicare enrollment requirement clarified ↗our copy

The brief

Every state follows the same outline, so you always know where to look. Open a section for the detail.

Who regulates you

Licensing: Indiana Department of Health (IDOH): personal services agencies (PSA) and home health agencies (HHA). Changes go to PSA@health.IN.gov (PSA) or HCBC@health.IN.gov (home health and hospice).
Medicaid: The Family and Social Services Administration (FSSA) is Indiana's Medicaid agency, and its Office of Medicaid Policy and Planning (OMPP) oversees Medicaid home and community-based services (HCBS). Indiana Medicaid is called the Indiana Health Coverage Programs (IHCP). Gainwell Technologies answers IHCP provider calls at 800-457-4584.
Waiver certification: OMPP certifies providers for the PathWays for Aging, Health and Wellness (H&W) and Traumatic Brain Injury (TBI) waivers through its HCBS Certification Portal. The Bureau of Disabilities Services (BDS) handles the Community Integration and Habilitation (CIH) and Family Supports waivers.
Aides: IDOH keeps the aide registry. Home health aides register under Indiana Code 16-27.5-5, in the way the Certified Health Care Professions Commission prescribes.
Adult protection: Adult Protective Services (APS), state hotline 800-992-6978

Licensing

Non-medical care: Personal services agency license under Indiana Code 16-27-4. "Personal services" means attendant care, homemaker and companion services given at the client's home. An agency may not use "health" or "nursing" in its name.
Who is exempt: An individual who serves only family, or no more than 3 people per residence and no more than 7 at a time; local health departments; and some DDARS-approved supported living providers. A licensed home health agency does not need a separate PSA license to run personal services.
Term and fee: Both licenses last one year and cost $250 (initial or renewal). IDOH's instruction letters say to send the renewal at least 60 and no more than 90 days before the license expires; a June 2025 IDOH newsletter recommends 30 to 60 days (see "Where the official documents disagree"). IDOH no longer sends renewal reminders.
Home health: Home health agency license under Indiana Code 16-27-1 and 410 IAC 17. It covers agencies that provide nursing services. You cannot admit patients until IDOH issues a provisional license, and review can take 30 to 60 days.
Branches and out-of-state: A PSA branch must be within 120 miles of the parent office. An out-of-state PSA needs Secretary of State authorization and an Indiana branch office.

Sources:Indiana Code Title 16 Health - 2026 edition ↗our copyPSA Initial License Application Instruction Letter 2022 ↗our copyPSA Renewal Application form SF 53591 ↗our copyHHA Initial Licensure and Federal Certification Instruction Letter 2025 ↗our copy410 IAC 17 Home Health Agencies (IDOH copy 2021) ↗our copyIDOH Home and Community-Based Care Newsletter 2025-01 June 2025 ↗our copy

Your workers

Background checks: Apply for a national or expanded criminal history check no more than 3 business days after a worker starts serving clients at home. You may not keep them on home visits past 21 calendar days without the result. Indiana Code 16-27-2-5 lists the convictions that bar employment. IDOH accepts only Indiana State Police (IdentoGO/IDEMIA) or Safe Hiring Solutions checks.
PSA staff: Before an attendant care worker does a task without direct supervision, evaluate them on that task, train and re-evaluate where needed, and keep signed, dated records (Indiana Code 16-27-4-16). Workers with direct client contact need a tuberculosis (TB) test.
Home health aides: Must be on the IDOH registry (2-year registration, no fee). At least 12 hours of in-service training each calendar year. Aides caring for people with dementia need 6 hours of approved dementia training within 60 days of hire, then 3 hours each year.
Waiver direct care staff: At least 18 (455 IAC 2-6-3). CPR certification and first aid training before any face-to-face contact with clients. The rule text asks for a current negative TB test or chest x-ray completed each year; FSSA's January 2026 bulletin asks for a TB test at hire, yearly TB education and a new test after known exposure (see "Where the official documents disagree"). The safest course is to meet both.
Reporting abuse: Anyone who believes an adult is endangered must report it (Indiana Code 12-10-3-9). Waiver providers under 455 IAC 2-8-2 report unusual occurrences to the Division of Disability, Aging and Rehabilitative Services (DDARS) and, where it applies, to APS; for suspected abuse, neglect or exploitation they suspend the staff involved while they investigate. Licensed agencies report abuse, neglect and misappropriation to IDOH's complaint department.
Pay passthrough: Since July 1, 2025, Attendant Care providers in the H&W, TBI and PathWays waivers must spend at least 70% of the hourly rate on compensation for the direct care worker (wages and employee-related expenses count). For Structured Family Caregiving it is 60% of the daily rate. Providers had to sign an attestation and must keep records for audits.

Sources:Indiana Code Title 16 Health - 2026 edition ↗our copyIndiana Code Title 12 Human Services - 2026 edition ↗our copy455 IAC 2 Home and Community Based Services (FSSA copy 2022) ↗our copyIDOH Home and Community-Based Care Newsletter 2025-01 June 2025 ↗our copyBT202517 CPR and first aid for HCBS direct service staff ↗our copyBT202609 TB test requirements for direct care HCBS ↗our copyBT2025105 Direct caregivers for personal care services policy ↗our copyBT202639 Home health aide training for G-tube and J-tube feedings ↗our copy

Getting paid

Programs: PathWays for Aging waiver (age 60 and older, managed by health plans); Health and Wellness, TBI, CIH and Family Supports waivers; home health under the IHCP
Three steps: Get certified by OMPP, then enroll with the IHCP within 90 days, then (for PathWays) enroll with the health plans you want to work with: Anthem, Humana and UnitedHealthcare. The IHCP encourages enrolling with all three. Your IHCP enrollment date matches your certification date.
License for waiver care: Attendant Care and Home and Community Assistance need a PSA license. The IHCP also accepts a home health agency license (BT202666, May 7, 2026), but the August 2026 PathWays waiver lists only a licensed PSA (see "Where the official documents disagree"). Respite given as home health aide or nursing services needs a home health agency license.
Rates: The July 2025 passthrough bulletin lists the state's Attendant Care rate as $34.36 an hour. A proposed lower rate for live-in caregivers was removed from the August 2026 waiver amendments.
Keeping certified: OMPP compliance review every three years through the Certification Portal, with notice three months before it is due. Give 30 days' written notice before ending waiver services, and keep serving until a new provider is in place.
Home health: Home health agencies must be enrolled with Medicare to stay in Indiana Medicaid (from July 1, 2026). Agencies that began Medicare enrollment before April 1, 2026 have until June 30, 2027 to finish.

Sources:IHCP Module - OMPP HCBS Waiver PathWays for Aging (2025-08) ↗our copyIHCP Module - Member Eligibility and Benefit Coverage (2024-10) ↗our copyHCBS Provider Enrollment Quick Reference PathWays ↗our copyBT202577 HCBS waiver certification and enrollment guidelines ↗our copyBT202666 Licensure requirement rescinded for certain waiver providers ↗our copyOMPP Service Standard - Attendant Care ↗our copyOMPP Service Standard - Respite Services ↗our copyBT2025105 Direct caregivers for personal care services policy ↗our copy2026 Waiver Approval Announcement ↗our copyBT2024200 HCBS provider certification renewal process ↗our copy455 IAC 2 Home and Community Based Services (FSSA copy 2022) ↗our copyBT202628 Termination of services H&W TBI PathWays ↗our copyBT202595 Home health agencies must enroll with Medicare by July 1 2026 ↗our copyBT202647 Home health Medicare enrollment requirement clarified ↗our copyPathWays for Aging 1915c Waiver (2026-08) ↗our copy

EVV

Who: Personal care services (since January 1, 2021) and home health services (since January 1, 2024) on the IHCP's list of service codes that require EVV
Claim denials: Claims without matching EVV data have been denied since April 1, 2024 for personal care and July 1, 2024 for home health. The home health denials cover both fee-for-service and health plan claims.
System: Sandata, the state's system, is free. You may use an approved alternate vendor instead. Alternate vendors pay a one-time $3,360 setup fee to connect.
Billing rules: Do not change clock-in or clock-out times to fit billing units. Bill whole units only: for a 15-minute unit you need at least 8 minutes. Pick the right payer ID for the member's health plan.
Help: inxixevv@gainwelltechnologies.com or 800-457-4584, option 5

Sources:EVV FAQs ↗our copyBT202422 Final EVV implementation timeline ↗our copyBT202444 Final EVV home health implementation timeline ↗our copyBT2024129 EVV and rounding units ↗our copyBT202484 Correct Payer ID for EVV records ↗our copyEVV Preparation Guide ↗our copy

What changed recently

Aug 2026: Statewide moratorium on new HCBS waiver certifications and enrollments for many services, including Attendant Care, from Aug. 1, 2026. Waiver amendments took effect Aug. 1, 2026; the proposed live-in caregiver rate cut was dropped.
Jul 2026: HCBS waiver providers must give members their service records and itemized statements on request, within 30 days. Home health agencies must be Medicare-enrolled to stay in Indiana Medicaid.
May 2026: The IHCP again accepts either a PSA or a home health agency license for Attendant Care and Home and Community Assistance, reversing a February 2026 notice
Jan 2026: H&W and TBI waiver changes: new self-directed options, hourly Attendant Care notes, paid relatives limited to 40 hours a week. The PathWays Dual Care program launched. MDwise left Indiana Medicaid.

Sources:BT2026124 HCBS provider certification and enrollment moratorium ↗our copy2026 Waiver Approval Announcement ↗our copyBT202687 Document delivery requirements for HCBS waiver providers ↗our copyBT202595 Home health agencies must enroll with Medicare by July 1 2026 ↗our copyBT202666 Licensure requirement rescinded for certain waiver providers ↗our copyBT202622 Licensure requirements for waiver provider enrollment ↗our copyBT202614 CMS approves H&W and TBI waiver amendment ↗our copyBT202686 PathWays Dual Care enrollment coverage and billing ↗our copyIHCP Module - Member Eligibility and Benefit Coverage (2024-10) ↗our copy

Where the official documents disagree

Sometimes two official documents say different things. Here is what we went with, why, and what each document says, so you can judge for yourself.

Documents disagree

Attendant Care license: PSA only, or home health license too?

What this page uses: For H&W and TBI, a personal services agency license or a home health agency license is accepted for Attendant Care and Home and Community Assistance. For PathWays, the IHCP accepts either license at enrollment, but the PathWays waiver lists only a licensed personal services agency.

The IHCP's May 2026 bulletin accepts either license for these services and withdrew the February 2026 PSA-only requirement. The August 2026 H&W and TBI waivers agree. But the August 2026 PathWays waiver, which is newer, lists only a licensed personal services agency, and the state declined to add home health agencies back. Indiana Code 16-27-4-6(j) says a licensed home health agency may run personal services without a separate PSA license. If you serve PathWays members on a home health license alone, confirm with OMPP and your health plans first.

BT202666 Licensure requirement rescinded for certain waiver providers ↗: "Effective immediately, the IHCP will resume accepting either a valid personal services agency license or a home health agency license for new enrollments and recertifications for the Attendant Care and Home and Community Assistance HCBS waiver providers"
BT202622 Licensure requirements for waiver provider enrollment ↗: "beginning March 25, 2026, a personal services agency license will be required for new enrollments and recertifications under these specialties." (later rescinded)
PathWays for Aging 1915c Waiver (2026-08) ↗: "The removal of Licensed Home Health Agency in the Provider Specifications section for these services was effectuated with the December 31, 2025 waiver amendment. The state is not revising the waiver in response to these comments."
Health and Wellness Waiver (2026-08) ↗: "Providers furnishing traditional (non-self-directed) Attendant Care services must be licensed as a Personal Services Agency. However, for purposes of HCBS service delivery, Home Health Agency licensure is considered sufficient to meet this requirement."
Traumatic Brain Injury Waiver (2026-08) ↗: "Providers furnishing traditional (non-self-directed) Attendant Care services must be licensed as a Personal Services Agency. However, for purposes of HCBS service delivery, Home Health Agency licensure is considered sufficient to meet this requirement."

Documents disagree

TB tests for waiver direct care staff: every year, or at hire?

What this page uses: The rule's yearly TB test or chest x-ray, plus the bulletin's test at hire before face-to-face contact and yearly TB education.

The rule text (455 IAC 2-6-3 and 2-14-1) asks for an annual negative TB test or chest x-ray; 2-14-1 adds that it is updated in line with CDC recommendations. FSSA's January 2026 bulletin applies 2-14-1 that way and asks for a test at hire, yearly TB education and a retest after known exposure. Where a rule and guidance differ, we lead with the rule, because the rule text has not changed. Doing both satisfies either reading. If in doubt, ask OMPP through the Certification Portal.

BT202609 TB test requirements for direct care HCBS ↗: "A TB test is required for all direct care employees upon hire, prior to face-to-face interaction with clients." and "the agency will provide yearly TB education to direct care employees."
455 IAC 2 Home and Community Based Services (FSSA copy 2022) ↗: "Submit a copy of a current negative TB test or negative chest x-ray that is completed annually." (455 IAC 2-6-3)

Documents disagree

When to send a PSA or home health license renewal

What this page uses: At least 60 and no more than 90 days before the license expires, as IDOH's instruction letters say. Sending it about 60 days ahead fits both documents.

IDOH's licensing instruction letters (PSA 2022, home health June 2025) give a 60-to-90-day window. IDOH's June 2025 newsletter only recommends 30 to 60 days. The letters are the specific instructions for each license, so the page follows them.

HHA Initial Licensure and Federal Certification Instruction Letter 2025 ↗: "The documentation and licensure fee must be submitted at least 60 days, but not sooner than 90 days before the expiration date of the current license."
PSA Initial License Application Instruction Letter 2022 ↗: "The documentation and licensure fee must be submitted at least 60 days prior, but not sooner than 90 days before the expiration date of the current license."
IDOH Home and Community-Based Care Newsletter 2025-01 June 2025 ↗: "IDOH recommends that renewals are submitted 30-60 days in advance of expiration to prevent lapses in licensure"

Questions agencies ask

Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.

Try:

Do I need a license to run a non-medical home care agency in Indiana?

Yes, a personal services agency license.

Indiana Code 16-27-4 requires a license from the Indiana Department of Health to provide attendant care, homemaker or companion services in clients' homes for pay. The license costs $250 and lasts one year. Operating or advertising an unlicensed personal services agency is a Class A misdemeanor.

Indiana Code Title 16 Health - 2026 edition ↗our copyPSA Initial License Application Instruction Letter 2022 ↗our copy