Previously closed slots for Indiana’s Medicaid waivers reopened on July 1. Those slots released by the state for the coming year will only cover about one-third of the 13,000 people still on the waitlist for home- and community-based health services.
The Indiana Family and Social Services Administration will release more than 2,600 slots for the Pathways waiver and about 1,800 slots for the Health and Wellness waiver, according to the agency’s deputy chief of staff, Marcus Barlow. He said FSSA will release those slots in July and August.
As of June, there were about 5,500 people on the Health and Wellness waitlist and about 7,900 on the Pathways waiver waitlist.
Barlow said in an email there are about 1,000 people who were in “inactive status” at the end of June.
“If they do not return to active status by Aug. 31, 2025, their slots will be vacated and reassigned to others on the waiting list,” Barlow said.
Tom Crishon, the Arc of Indiana’s Chief Legal Officer, said the number of people on the waitlist is “surging” and the waitlists are moving Indiana “backward.”
“And we can't afford to move backward,” Crishon said. “The big issue is that longer wait lists increase institutional placements because they cannot get services in the community.”
In July 2024, FSSA released new slots and reopened previously closed slots for the first time since the waitlist was announced in April 2024. By July, the agency said there were already 13,000 people waiting for services and the agency said it would process at least 900 people off the waitlist per month.
By February 2025, FSSA had reached capacity with the number of invitations they had sent out. That meant the state couldn’t invite anyone new off the waitlist until previous invitations have been declined or rescinded. At the time, there were still more than 10,000 people on the waitlists.
As the waitlists continue to grow, Crishon said so does the human cost.
“Not only are you delaying services, you're ultimately shorting lifespans,” Crishon said. “You're isolating people with disabilities, and you're increasing hardships to families.”
Crishon said the waitlists will likely lead to a higher rate of more expensive institutional care, which can be less adequate.
“Some of these individuals who need this high level of care that can be served into the Health and Wellness waiver that can be served in Pathways, are going to have to resort to institutional care,” Crishon said. “They're going to go into nursing homes. They're going to go into long-term stays in hospitals. That's the reality of it, because they're not going to be able to be served in the community without the waiver.”
READ MORE: Indiana ended Medicaid waiver waitlists before. As thousands wait, could it do it again?
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Despite the new slots, Crishon said advocates are still alarmed by the number of people waiting and what that means for access to services.
“The reality is, unfortunately, that people are going to be waiting for years,” Crishon said. “If you're hopping on a waitlist now, it's going to be a few years before you're able to get services. That's the scary part, right? Because people don't go to the Health and Wellness waiver, people don't go to the Pathways waiver because it's just a nice thing to have. It's critical for their care.”
Crishon said FSSA has implemented a change to how they process people at the beginning of their time on the waitlist to prevent people from waiting years to find out they aren’t eligible.
In order to be eligible for the two waivers, people have to complete a financial assessment and a level of care assessment. The waivers are considered “payers of last resort” for people who need care at a “nursing-facility” level of care.
Crishon said FSSA made a change to do an initial evaluation when someone is placed on the waitlists to determine if they would be eligible, which allows people to look for alternative services if needed.
In the past, FSSA said, while the number of people on the waitlists is higher than the number of slots available, not everyone will transfer from the waitlist to the waivers based on eligibility.
“If they're going back to people on the wait list and doing that initial kind of assessment, then that will ring less true,” Crishon said. “That won't be as accurate, that the people on the wait list may not be eligible or may not need the waiver because they're doing that step at the forefront now.”
Crishon said those on the waitlist should continue to keep documentation and consistent contact with their local FSSA office. He said people should try to reach out monthly "just to double check" on their status and if they've missed any communication from the office.
He also said it's important to respond to any mail or contact from FSSA as quickly as possible.
In addition, Barlow said FSSA has set aside 400 Pathways and 100 Health and Wellness slots for people who reside in assisted-living facilities “who become newly financially eligible.”
Barlow said the waitlists will remain in place, but he said FSSA will continue issuing slots from September 2025 through June 2026 as invitations are declined or rescinded.
Once a slot is filled, it is considered filled for the entire fiscal year. That means that those who don’t receive a slot this year would have to wait until July 2026 for new slots to open. Unless the state increases the number of slots through the state budget, the only slots that will open will be “vacated” slots, which occur when someone is no longer eligible, moves out of Indiana or dies.
Indiana lawmakers did not increase the number of slots this year, meaning the state has about 56,000 total slots between the two waivers — with about 40,000 of those slots dedicated to the Pathways waiver.
Abigail is our health reporter. Contact them at aruhman@wfyi.org or on Signal at IPBHealthRuhman.65.