Understanding the PathWays and Health & Wellness Waiver Process
Navigating Indiana’s Medicaid waiver process can involve referrals, eligibility decisions, waiting periods, invitations, counseling, and care management. ABC Homecare Services provides this guide to help individuals and families understand the general steps involved and prepare for the next stage of their care journey.
The process may differ depending on your Medicaid coverage, the applicable waiver pathway, and your individual circumstances. The following seven stages provide a general overview of the process and the roles of the organizations involved.
Stage 1
Submit a Referral
Getting started begins with contacting ABC Homecare Services through our website or by phone at 219-301-2520. Our team can discuss our non-medical in-home care services and explain how to inquire about support.
For individuals pursuing an Indiana Medicaid waiver, the appropriate referral and intake procedures must also be followed.
What to expect:
- Submit a referral through ABC’s website or contact our office.
- Explain your support needs and ask about our available services.
- Follow the applicable program’s referral and intake instructions.
- Ask the responsible agency which documentation or screening steps may be required.
What happens next?
The referral and eligibility process depends on the applicable program. ABC can explain its services, but the responsible agencies and designated organizations handle Medicaid eligibility decisions and waiver-related procedures.
Stage 2
Await Your Program Decision
After the applicable referral, screening, or assessment steps, you may need to wait for an official decision or notification.
Depending on the specific program and current procedures, MAXIMUS or another designated organization may be involved in reviewing eligibility or communicating a determination. The responsible agency will explain the applicable process.
What to expect:
- Monitor mail and other designated communication channels.
- Review official notifications carefully.
- Follow instructions regarding additional documentation or next steps.
- Ask the responsible organization about your application status when needed.
Depending on the applicable program, a decision may affect whether you proceed, remain on a waiting list, or have additional steps available to you. If a decision is unfavorable, review the notice for any applicable appeal rights and deadlines.
A referral or application does not guarantee approval or immediate access to services.
Stage 3
Respond to Your Invitation
If you receive an official invitation to proceed with a waiver program, read the letter carefully and follow the instructions provided.
The invitation may include forms, response requirements, deadlines, and information about the next steps.
What to expect:
- Review the invitation and all accompanying documents.
- Complete and return any required response forms.
- Follow the instructions and deadlines in the notice.
- Contact the issuing agency or designated representative if you need clarification.
Returning the required response is important when acceptance of an invitation is part of the applicable process. The exact requirements depend on the program and the instructions in your notification.
Stage 4
Work With an Options Counselor
An Options Counselor can help explain available options and the steps that may apply to your circumstances.
Your next steps may differ depending on whether you already have full Medicaid coverage or need assistance understanding how to obtain coverage. Where applicable, the counselor may also explain how to connect with a Managed Care Entity (MCE).
What to expect:
- Discuss your current Medicaid coverage and support needs.
- Ask which requirements apply to your situation.
- Learn whether additional enrollment or application steps are needed.
- Understand which agency or organization is responsible for the next stage.
Options Counseling provides guidance. It does not itself guarantee Medicaid coverage, waiver approval, or authorization of services.
Stage 5
Complete the Next Waiver Steps
After the applicable counseling or program guidance, you may need to complete additional steps to continue toward waiver enrollment.
The responsible Options Counselor or designated representative can explain what remains outstanding and how to proceed.
What to expect:
- Review the next steps provided by your counselor.
- Complete any outstanding forms or requirements.
- Ask which organization will coordinate the next stage.
- Confirm what must happen before services can be arranged.
The sequence and requirements depend on the applicable waiver pathway and your individual circumstances.
Stage 6
Establish the Appropriate Care Management Arrangement
Care management arrangements may differ depending on the waiver pathway.
For individuals enrolled in the PathWays for Aging program, the applicable Managed Care Entity may oversee care coordination and related responsibilities. For individuals following a Health & Wellness pathway, the process may involve working with an Options Counselor to identify an appropriate case management organization.
What to expect:
- Confirm which program and care management arrangement apply to your situation.
- Identify the organization responsible for coordinating your care.
- Discuss your needs and the services available under the applicable program.
- Confirm care plan, provider, and authorization requirements before services begin.
The responsible agency and care management organization handle their respective program and care coordination responsibilities. ABC Homecare Services does not determine Medicaid eligibility, approve waivers, or replace the assigned care management organization.
Stage 7
Connect With the Appropriate Providers
Once the applicable program requirements and service arrangements are in place, individuals and families can explore providers that offer the services they need.
Choosing an appropriate provider involves understanding the services included in the care plan, confirming provider requirements, and determining whether the provider can meet the individual’s needs.
What to consider:
- Whether the provider offers the services you need.
- Whether the provider meets applicable program participation requirements.
- Whether the services are included in the care plan and properly authorized.
- Provider availability and any steps required before services begin.
ABC Homecare Services offers non-medical in-home care services. Families can contact us to learn about our offerings and discuss whether our services may be appropriate for their circumstances.
Service availability and any Medicaid waiver arrangements depend on applicable program requirements, provider participation, and service authorization. Contacting ABC does not guarantee Medicaid coverage or authorization for a particular service.
How ABC Homecare Services Can Help
Understanding the waiver process is one part of finding appropriate support. Individuals and families may also need information about non-medical in-home care options and how to explore a suitable provider.
ABC Homecare Services serves individuals and families across Lake, LaPorte, and Porter Counties in Northwest Indiana.
Our team can answer questions about our services, explain how to arrange a consultation, and help you explore whether our non-medical in-home care offerings may meet your needs.
Call Us:
219-301-2520Frequently Asked Questions
Does submitting a referral guarantee Medicaid waiver approval?
What happens if my application is denied?
What if I am placed on a waiting list?
What does an Options Counselor do?
What is the role of a Managed Care Entity?
Does ABC Homecare Services approve Medicaid waivers?
Can I contact ABC before my waiver is approved?
Explore Your In-Home Care Options
If you are exploring support for yourself or a loved one, ABC Homecare Services can help you learn about our non-medical in-home care offerings and discuss the next steps.
Call 219-301-2520 or schedule a consultation to discuss your needs.