The Indiana Health Coverage Programs announced that it has received approval from the Centers for Medicare & Medicaid Services (“CMS”) to implement a statewide provider certification and enrollment moratorium for numerous Home- and Community-Based Services (“HCBS”) 1915(c) waiver providers. The moratorium becomes effective August 1, 2026, and initially will remain in effect for six months, although Indiana may seek six-month extensions.
Unlike many Medicaid enrollment moratoria that apply to a single provider type or geographic area, Indiana’s action applies across multiple HCBS waiver programs and a broad range of waiver services. The moratorium also affects changes of ownership, expansion into additional counties and the addition of certain waiver services by existing providers.
Background
The moratorium applies to providers serving Indiana’s:
- PathWays for Aging Waiver;
- Health and Wellness Waiver;
- Traumatic Brain Injury Waiver;
- Community Integration and Habilitation Waiver; and
- Family Supports Waiver.
The affected services include many of the core HCBS services provided throughout Indiana, including attendant care, respite, residential habilitation, structured family caregiving, transportation, caregiver coaching, home and community assistance, wellness coordination and numerous other waiver services.
The moratorium is scheduled to take effect August 1, 2026, for an initial six-month period. Indiana may seek additional six-month extensions from CMS.
Federal Authority
Indiana cites 42 C.F.R. § 455.470 as the legal authority supporting the moratorium. That regulation permits a state Medicaid agency, with CMS approval, to impose a temporary enrollment moratorium when the state identifies provider types that present a significant risk for fraud, waste or abuse and the Department of Health & Human Services has identified those provider types as presenting elevated program integrity risks.
What The Moratorium Does
Beginning August 1, 2026, the moratorium generally prohibits:
- New provider certification applications for covered HCBS services;
- New Medicaid enrollment for covered HCBS providers;
- Certain changes of ownership involving affected providers;
- Expansion into additional counties; and
- Addition of covered waiver services by existing HCBS providers.
The moratorium does not apply to every waiver service. Services such as assisted living, adult day services, supported employment, therapies, home modifications, vehicle modifications and several other waiver services remain outside the moratorium.
Treatment of Pending Applications
The bulletin establishes different procedures depending upon the waiver involved.
For the Health and Wellness, PathWays and Traumatic Brain Injury waivers, certification applications already under review will continue to be processed. Applications awaiting review or submitted after implementation of the moratorium will expire and applicants may reapply after the moratorium is lifted.
For the Community Integration and Habilitation and Family Supports waivers, applications currently under review will expire, while applications in provisional approval status will be held until the moratorium ends.
Providers with enrollment applications that have not completed all required screening before August 1, 2026, likewise risk denial and will need to reapply after the moratorium is lifted.
Exceptions
Indiana will consider limited exceptions where necessary to ensure adequate access to waiver services.
Applicants requesting an exception must satisfy all provider qualification requirements and submit a narrative demonstrating how approval would address an identified access issue within the affected service area.
Key Takeaways
- Providers should immediately determine whether any pending certification or enrollment applications may be affected before the August 1 effective date.
- Existing providers contemplating ownership changes, geographic expansion or the addition of covered waiver services should evaluate whether those transactions may now be delayed by the moratorium.
- Organizations considering entry into Indiana’s HCBS market should carefully review whether their proposed services fall within the moratorium or one of the listed exceptions.
- Finally, providers should recognize that Indiana has established an exception process intended to address member access concerns. Organizations serving underserved geographic areas or specialized populations may wish to evaluate whether an exception request is appropriate.
If you have any questions regarding this, please contact:
- Sean Fahey at (317) 977-1472 or sfahey@hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
