Indiana - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Indiana, Respite Care Services provide short-term relief for unpaid primary caregivers of Medicaid waiver participants. Because Indiana does not issue a traditional, standalone "Respite Care Agency" license through the Department of Health for in-home services, providers must instead obtain Home- and Community-Based Services (HCBS) Certification through the Family and Social Services Administration (FSSA). Depending on the target population, this certification is processed either through the Office of Medicaid Policy and Planning (OMPP) for aging waivers or the Bureau of Disabilities Services (BDS) for developmental disability waivers, followed by formal enrollment in the Indiana Health Coverage Programs (IHCP).

The single biggest structural barrier to entry for new respite providers in Indiana is the statewide HCBS Provider Certification and Enrollment Moratorium. When active (such as the six-month moratorium cited as effective August 1, 2026), this structural gate completely blocks the state from accepting or processing new HCBS provider certification and enrollment applications unless a specific, state-defined exception is granted. Providers cannot bypass this moratorium to enter the network.

1. Service Definition and Scope

Respite Care Services in Indiana offer substitute support and supervision for waiver participants when their primary unpaid caregiver is unavailable. These services ensure the participant's health and safety are maintained without interruption.

Services must be strictly aligned with the participant's Individualized Service Plan (ISP) and are authorized based on assessed needs for caregiver relief. Respite cannot be used as a substitute for regular daycare or employment support.

• In-home respite: Care provided directly in the participant's primary residence.
• Out-of-home respite: Care provided at a qualified, state-approved facility or provider-operated setting.
• Planned respite: Scheduled relief designed to support the primary caregiver's self-care and personal needs.
• Emergency respite: Crisis-based temporary care deployed due to caregiver hospitalization, emergencies, or urgent needs.
• Personal assistance: Support with Activities of Daily Living (ADLs), medication reminders, mobility support, and basic health monitoring during the respite period.

2. Regulatory and Oversight Agencies

Respite providers in Indiana are regulated by divisions under the Indiana Family and Social Services Administration (FSSA). The specific oversight division depends entirely on which Medicaid waiver the provider intends to serve.

Providers must interact with both the certification divisions and the Medicaid payment authority to maintain compliance and active billing status.

• Indiana Family and Social Services Administration (FSSA): The umbrella agency overseeing all Medicaid waivers and HCBS programs in the state (https://www.in.gov/fssa/).
• Office of Medicaid Policy and Planning (OMPP): Administers Medicaid funding, manages the OMPP HCBS Certification Portal, and oversees the PathWays for Aging waiver (https://www.in.gov/fssa/ompp/).
• Bureau of Disabilities Services (BDS): Formerly BDDS, this division under DDRS oversees the Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver, approving DD respite providers (https://www.in.gov/fssa/ddrs/).
• Division of Aging (DA): Manages aging programs and coordinates with OMPP for the PathWays for Aging waiver (https://www.in.gov/fssa/da/).
• Indiana Department of Health (IDOH): Licenses physical facilities if out-of-home overnight respite is provided in a clinical or residential facility, such as a hospital or residential care facility (https://www.in.gov/health/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana imposes strict structural prerequisites before an agency can even submit an HCBS certification application. Failing to meet these preconditions means the OMPP or BDS portals will reject the application outright.

The most critical barrier is the state's enrollment moratorium, which halts all new market entrants when active. Additionally, corporate and tax registrations must be finalized before interacting with FSSA.

• HCBS Enrollment Moratorium: A statewide moratorium on new HCBS provider certifications and enrollments (cited as effective August 1, 2026, for six months) blocks new applications unless a state-approved exception applies.
• Business Registration: Applicants must register their business entity with the Indiana Secretary of State and obtain Articles of Incorporation before applying.
• NPI and EIN: The agency must obtain a Type 2 National Provider Identifier (NPI) and an IRS Employer Identification Number (EIN).
• OMPP Portal Account: PathWays waiver providers must create a unique agency account on the OMPP HCBS Certification portal using an email address that is unique to the agency.
• Facility Licensure: If providing out-of-home facility-based respite, the physical location must hold the appropriate IDOH license (e.g., hospital or residential care) prior to applying for HCBS certification.

4. Licensure and Certification Requirements

Because Indiana does not issue a standalone "Respite Care License" for in-home services, providers must achieve HCBS Certification. This is the functional equivalent of licensure for waiver providers.

Certification is divided by waiver population. Aging and TBI waiver providers use the OMPP portal, while developmental disability waiver providers seek approval directly from BDS.

• OMPP Certification: Required for the PathWays for Aging, Health & Wellness, and Traumatic Brain Injury (TBI) waivers, processed entirely through the OMPP Certification Portal.
• BDS Provider Approval: Required for the Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver.
• Insurance Requirements: Providers must submit quotes, templates, or active certificates for General Liability and Professional Liability Insurance.
• Policy Manuals: Agencies must submit operational policies including participant intake, emergency procedures, and incident reporting.
• Reverification: Provider approval is time-limited and must be periodically reverified (typically every 3 to 4 years, depending on the specific waiver rules).

5. Medicaid Provider Enrollment

After obtaining HCBS Certification from OMPP or BDS, the agency must formally enroll in the Indiana Health Coverage Programs (IHCP). Certification alone does not allow an agency to bill Medicaid.

Enrollment is processed through the IHCP Provider Healthcare Portal. For managed care waivers, this step is followed by contracting with individual health plans.

• IHCP Provider Healthcare Portal: The mandatory state system used to submit the final Medicaid enrollment application after HCBS certification is achieved (https://provider.indianamedicaid.com/).
• Certification Letter: Applicants must upload their official OMPP or BDS waiver service certification letter as proof of eligibility to enroll.
• Unique Provider ID: Each physical location for each HCBS waiver entity must be individually enrolled in IHCP and assigned a unique provider ID.
• Application Fee: Providers must pay the federal Medicaid application fee or provide proof of payment to Medicare or another state's Medicaid program, unless a waiver applies.
• Managed Care Contracting: For the PathWays for Aging waiver, providers must subsequently credential and contract with Managed Care Entities (MCEs) like Humana Healthy Horizons to receive reimbursement.

6. Staffing, Training and Background Checks

Direct care staff providing respite must meet specific background and training standards outlined in the Indiana Administrative Code (460 IAC 6).

Unlike some residential services that require strict annual hour counts, waiver respite services rely on competency-based training with specific mandated topics.

• Criminal Histories: All direct care staff must pass comprehensive background checks in accordance with 460 IAC 6-10-5 prior to client contact.
• Direct Care Staff Qualifications: Staff must meet standards under 460 IAC 6-14-5, which includes CPR/First Aid certification and the demonstrated ability to follow the participant's ISP.
• Initial Training: Agencies must train respite staff on participant rights, incident reporting, and the specific care needs of the individual before providing services.
• Annual Training: Waiver services require competency-based training with an annual in-service covering three state-named topics (unlike Supervised Group Living, which requires 24 hours annually).
• Supervision Protocols: The agency must maintain and train staff on protocols for personal assistance, medication reminders, and continuous supervision during the respite period.

7. Documentation, Policies and Records

OMPP and BDS require comprehensive, agency-specific documentation during the certification phase. Generic templates or blank documents will result in immediate application rejection.

Once operational, providers must maintain strict chronological records of all services delivered to survive state audits and claims reviews.

• Articles of Incorporation: Proof of legal business registration from the Indiana Secretary of State must be uploaded.
• Respite Care Policy Manual: Must include detailed procedures for caregiver relief planning, emergency response, and participant rights protections.
• Chronological Records: Providers must maintain chronological documentation of all respite care services delivered, detailing start/stop times and tasks performed, to support claims.
• HIPAA and Grievance Policies: Written protocols for maintaining confidentiality and handling participant or family complaints must be submitted.
• Organizational Chart: A completed organizational chart detailing agency structure and leadership must be provided; blank charts are automatically rejected.

8. Billing, Rates and Claims

Respite services are billed to IHCP or the participant's Managed Care Entity (MCE) based on units of service. Rates are established by FSSA and vary by waiver and delivery method.

Because respite is designed as short-term relief, strict annual caps apply to the number of hours or dollars a participant can utilize.

• Unit Billing: Respite care is typically billed by the unit (e.g., 15-minute increments, hourly, or daily) depending on the specific waiver's billing guidelines.
• Prior Authorization: All respite hours must be explicitly authorized in the participant's Individualized Service Plan (ISP) by the care manager before any billing occurs.
• MCE Claims: For the PathWays for Aging waiver, claims are submitted directly to the participant's contracted health plan (e.g., Humana, Anthem, UHC).
• Fee-for-Service Claims: For BDS waivers (FSW, CIH), claims are submitted directly through the IHCP Provider Healthcare Portal.
• Service Limits: Respite is capped at a specific number of hours or a maximum dollar amount annually per participant to ensure it remains a short-term relief service.

9. Approval Sequence and Timeline

The approval process in Indiana is strictly sequential. Providers must clear the certification hurdle before they can touch the Medicaid enrollment portal.

Timelines are highly dependent on the state's application volume and whether a moratorium is currently in effect.

• Step 1: Business Formation: Register with the Indiana Secretary of State and obtain an NPI and EIN (typically 1-2 weeks).
• Step 2: OMPP/BDS Certification: Submit policies and documents through the OMPP HCBS Certification Portal or BDS (timeline varies; blocked entirely if a moratorium is active).
• Step 3: Initial Review Feedback: OMPP conducts an initial review and provides feedback for any corrections needed on uploaded documents.
• Step 4: IHCP Enrollment: Submit the Medicaid enrollment packet via the IHCP portal once the certification letter is received (typically takes 30-60 days for processing).
• Step 5: MCE Credentialing: Contract with PathWays health plans, which can take an additional 60-90 days post-IHCP enrollment.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors in the OMPP portal. Reviewers are strict about document formatting and agency-specific details.

During ongoing compliance surveys, state surveyors focus heavily on staff training records and the chronological documentation of care.

• Copied Policies: Applications are immediately denied if submitted policies contain a different agency's name.
• Multiple Uploads: Uploading full operational manuals multiple times instead of separating out the specific required policies causes the application to expire.
• Expired Documents: Submitting expired background checks or outdated licensures during the certification process results in rejection.
• Blank Forms: Uploading blank organizational charts or blank templates instead of completed, customized documents will halt the review.
• Unapproved Locations: Failing to separately certify and enroll each physical location for the HCBS waiver entity leads to claims denials.

11. Key Contacts and Resources

Providers should bookmark these official state resources for the most current manuals, portals, and division contacts.

Rely only on official .gov websites and authorized MCE portals for policy updates and billing guidance.

• OMPP HCBS Certification Portal: The primary gateway for aging waiver certification (https://omppproviders.fssa.in.gov/).
• Indiana FSSA Division of Aging: Oversees aging programs and grants (https://www.in.gov/fssa/da/ | Phone: 1-800-713-9023).
• Indiana Bureau of Disabilities Services (BDS): Oversees DD waivers and provider approvals (https://www.in.gov/fssa/ddrs/).
• IHCP Provider Healthcare Portal: The system for Medicaid enrollment and fee-for-service claims (https://provider.indianamedicaid.com/).
• Humana Healthy Horizons in Indiana: Example of a PathWays MCE contact for credentialing (INMedicaidProviderRelations@humana.com).

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