Self-Direction and FMS in Indiana
All states: self-direction map
In short: INCharge lets people on five Medicaid waivers hire their own workers; Palco is the single statewide fiscal/employer agent since January 2026.
Indiana self-direction at a glance
| Self-directed programs | INCharge Self-Directed Services on five waivers: Health and Wellness, PathWays for Aging, Traumatic Brain Injury, Family Supports, and Community Integration and Habilitation |
|---|---|
| FMS model | Vendor fiscal/employer agent |
| FMS vendors | One statewide vendor: Palco, Inc. |
| Who is the employer | The individual or a representative is the employer of record |
| Can family be paid | Yes, with limits. Not a spouse, a parent of a minor child, a legal guardian or the Representative for Self-Direction. |
| EVV for self-directed workers | Not confirmed. We did not find a published EVV requirement. Time goes through Palco timesheets. |
| Budget authority | Yes. Each self-directed service has its own budget, and the employer sets wages inside a state range. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Indiana offer self-direction?
Indiana offers self-direction on five Medicaid 1915(c) waivers under one program name, INCharge Self-Directed Services. INCharge applies to dates of service on or after January 1, 2026. On every waiver the individual, or a representative acting for them, hires and manages the workers and also manages a budget for each self-directed service. The Family and Social Services Administration (FSSA) lists the five waivers on its INCharge page.
- Health and Wellness Waiver: serves people who need a nursing facility level of care and are not in PathWays. It is run by FSSA's Bureau of Disabilities Services (BDS), and waiver case managers support self-direction. The individual has employer authority and budget authority. Services that can be self-directed are Attendant Care, Skilled Respite (the state page lists it as Respite) and Home and Community Assistance.
- Indiana PathWays for Aging Waiver: serves Medicaid members age 60 and over. It is a managed care program run by FSSA's Office of Medicaid Policy and Planning through three managed care entities (Anthem, Humana and UnitedHealthcare), and the member's service coordinator supports self-direction. The member has employer authority and budget authority. Services are Attendant Care, Skilled Respite and Home and Community Assistance.
- Traumatic Brain Injury Waiver: serves people with a traumatic brain injury. It is run by BDS. The individual has employer authority and budget authority. Services are Attendant Care, Skilled Respite and Home and Community Assistance.
- Family Supports Waiver: serves people with intellectual and developmental disabilities. It is run by BDS. The individual has employer authority and budget authority, and the self-directed budget sits inside the waiver's annual budget cap. Services are Participant Assistance and Care, Respite and Workplace Assistance.
- Community Integration and Habilitation Waiver: serves people with intellectual and developmental disabilities. It is run by BDS. The individual has employer authority and budget authority. Services are hourly Residential Habilitation and Support, Respite and Workplace Assistance. Self-directed Residential Habilitation and Support cannot be used where staffing is shared.
Employer authority means the individual recruits, hires, schedules and supervises the workers. Budget authority means the individual also manages a set amount of money for the service. The INCharge Self-Direction Manual (November 2025) says each self-directed service has its own budget, built from the authorized hours times the agency rate, less 10 percent for administration. Employer taxes and workers' compensation, about 12 percent of wages, come out of that budget, and money cannot move from one service to another.
Two more rules shape how the option is used. A person cannot split one service between self-direction and an agency, so Attendant Care, for example, must be all self-directed or all agency, though other services can stay with an agency. Case managers and PathWays service coordinators must offer self-direction information when a person enters the waiver and at each annual review, start with the Self-Direction Exploration Tool, and check in face to face every 90 days.
Who handles financial management services (FMS) in Indiana?
One company handles financial management services for INCharge on all five waivers: Palco, Inc. Indiana uses a vendor fiscal/employer agent model, which means Palco runs payroll and taxes while the individual or a representative stays the legal employer of the workers. The state manual says Indiana currently uses one enrolled FMS organization, so there is no second vendor to pick. That includes PathWays members in managed care.
A fiscal/employer agent is the organization that handles the paperwork side of being an employer. The state manual describes the FMS as a statewide vendor fiscal/employer agent under IRS Code section 3504. Palco obtains the employer identification number for the employer and handles payroll, tax withholding and workers' compensation as the employer's agent.
- Legal employer: the individual or member is the employer of record, or a representative who directs the work on their behalf takes that role.
- Representatives: Palco's INCharge FAQ says the Representative for Self-Direction is an unpaid role, and the representative cannot be hired as the person's self-directed worker.
- Vendor by program: Palco is the FMS for the Health and Wellness, PathWays for Aging, Traumatic Brain Injury, Family Supports, and Community Integration and Habilitation waivers.
- Claims: the manual says only the FMS can submit claims and receive payment from the state for self-directed services. We did not find how billing works for PathWays members, whose services run through managed care entities. Ask the member's service coordinator or Palco.
- How long: Palco replaced PPL, the earlier FMS. Palco's transition letter says its first pay period started December 14, 2025 and its first payday was January 9, 2026.
Employers set each worker's wage inside a range the state sets for each service. The manual gives a minimum of 15.00 dollars an hour for non-nursing services. Maximums include 30.00 dollars for Attendant Care and for Participant Assistance and Care, 31.00 dollars for hourly Residential Habilitation and 27.00 dollars for Home and Community Assistance. The state has not set aside extra money for overtime, so hours over 40 a week for one worker must be paid from the existing self-directed budget.
Who can be a paid caregiver under self-direction in Indiana?
Individuals can hire friends, neighbors and family members, but Indiana bars four groups from being self-directed workers. A spouse, a parent of a minor child, a legal guardian and the unpaid Representative for Self-Direction cannot be hired. The same rule applies on all five waivers.
- Who is barred: the state manual calls spouses and parents of minor children legally responsible individuals and says they cannot be hired. Legal guardians cannot be hired either. Other family members can.
- Worker requirements: a self-directed worker must be at least 18 and pass a limited criminal history check. Workers who provide Attendant Care or Participant Assistance and Care must hold CPR certification.
- Family Supports and Community Integration and Habilitation waivers: workers must also complete HCSP training and be listed on the HCSP Registry.
- Hours: we did not find a weekly hour cap for a self-directed worker. The manual says only that hours over 40 a week for one worker must fit inside the existing budget.
The rule is different when a relative is paid through a provider agency instead of through INCharge. A state bulletin, BT202614, says relatives and legal guardians of adults can be paid caregivers for Attendant Care through an agency on the Health and Wellness and Traumatic Brain Injury waivers, up to 40 hours a week for each paid relative or guardian. Spouses and parents or guardians of minors are excluded there too. Do not assume the agency rule and the self-direction rule are the same.
Does EVV apply to self-directed workers in Indiana?
We did not find a published electronic visit verification (EVV) requirement for INCharge workers. None of the self-directed procedure codes added on January 1, 2026 appears on Indiana's table of service codes that require EVV, and the state manual describes timesheets only. What is confirmed is that the employer must review and sign each timesheet before the FMS processes it for pay.
Important: Not finding an EVV requirement is not the same as finding an exemption. No source we read says INCharge workers are exempt from EVV. Confirm with FSSA or Palco before you build a process around either answer.
- How time is recorded: the state manual describes a web-based FMS timesheet portal where workers submit their time and the employer reviews and signs the timesheet before it goes back to the FMS. Palco's transition letter says its online timesheet portal, Connect, is used by all self-directing employers and workers. Palco's forms page also publishes paper timesheets for Indiana.
- The state's EVV code list: the Service Codes That Require EVV table we checked was published December 9, 2025. The self-directed codes are not on it.
Three points could not be confirmed either way. We did not find whether the Connect portal captures EVV data for Indiana workers, whether any self-directed visits are sent to the state's EVV aggregator, or whether live-in workers are treated differently. For any of these, ask BDS Help at bds.help@fssa.in.gov or Palco Customer Support at 866-710-0456.
What is changing next for self-direction in Indiana?
We did not find a dated upcoming change to self-direction in Indiana as of our last check on October 13, 2026. The large changes are already in place: INCharge and Palco both started with the 2026 service year, and waiver amendments took effect August 1, 2026. Two items from those amendments are still worth watching.
- Live-in caregiver rate: FSSA's waiver approval announcement says the federal Centers for Medicare and Medicaid Services approved amendments to all five waivers effective August 1, 2026. A proposed rate reduction for live-in caregivers (Attendant Care, Participant Assistance and Care, and hourly Residential Habilitation) was removed before approval. The state says it will revisit that rate in a future amendment cycle. No date has been given.
- Paid relatives and legal guardians: fact sheets published before the amendments were approved, such as the Family Supports Waiver fact sheet, proposed limiting payment to relatives and legal guardians to named services, with a 40 hour weekly cap across services. The amendments were approved, but we did not confirm that these terms are in the approved waivers as proposed. Check the approved waiver documents or ask the case manager before relying on them.
For background, the older consumer-directed attendant care and participant-directed home care codes on the Health and Wellness and PathWays waivers ended December 31, 2025, under bulletin BT2025169. Self-directed codes replaced them on January 1, 2026. Self-direction on the Traumatic Brain Injury Waiver began on that date.
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Who to ask about self-direction in Indiana
Questions about self-direction in Indiana are best put to the state. Start with INCharge Self-Directed Services (FSSA DDARS). Published contact: State policy questions: BDS Help, bds.help@fssa.in.gov. FMS questions: Palco Customer Support 866-710-0456, customersupport@palcofirst.com.
Indiana self-direction sources
- Indiana FSSA: INCharge Self-Directed Services
- INCharge Self-Direction Manual (November 2025)
- Palco: INCharge Self-Directed Services FAQ
- Palco: Indiana transition letter
- Indiana Medicaid bulletin BT2025169 (end of consumer-directed codes)
- Indiana Medicaid bulletin BT202614 (Health and Wellness and Traumatic Brain Injury waivers)
- Indiana Medicaid bulletin BT202613 (Community Integration and Habilitation Waiver)
- Indiana FSSA: 2026 waiver approval announcement
- Indiana Medicaid: Service Codes That Require Electronic Visit Verification
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- Indiana EVV requirements
Other states with one statewide FMS vendor
Arkansas, Connecticut, District of Columbia, Iowa, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Vermont, Washington, West Virginia, Wyoming. See every state on the self-direction map.
Page history
- October 13, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
