Indiana Introduces New HCBS Waiver Assessment Tool

Families across Indiana who rely on Home and Community Based Services may begin hearing about an important update to how eligibility and support needs are assessed for developmental disability services. The Indiana Family and Social Services Administration has begun implementing a new standardized assessment tool as part of the state’s broader effort to modernize the Medicaid waiver system.

The change affects individuals served through the Family Supports Waiver and the Community Integration and Habilitation Waiver, two programs administered by the Indiana Bureau of Disabilities Services that provide funding for services that help people live and participate in their communities rather than in institutional settings.

A New Assessment Tool: interRAI

Beginning January 1, 2026, Indiana began transitioning to the interRAI assessment system for determining level of care and documenting support needs for individuals applying for or renewing services under the FSW and CIH waivers. State officials say the purpose of the new tool is to create a more consistent and comprehensive way to evaluate developmental needs, health considerations, and daily functioning across the state.

The interRAI framework is used internationally and is designed to support evidence based decision making in health and human services. The system gathers structured information about a person’s functional abilities, developmental progress, and support needs so that services can be aligned with their individual circumstances (interRAI, n.d.).

Indiana will use age specific versions of the assessment:

• Early Years for children from birth to age three

• Child and Youth for ages four through seventeen

• Intellectual Disabilities for adults age eighteen and older

  
  

While the assessment tool itself is changing, the Indiana Family and Social Services Administration notes that eligibility standards for the waivers themselves are not being changed. Instead, the state is modifying the way information is collected and documented when determining a person’s level of care (Indiana FSSA, 2026).

What Families May Notice

Because interRAI is a structured assessment tool, families may notice that questions and documentation processes look different from past assessments. The new format is designed to capture detailed information about daily functioning, developmental needs, health factors, and behavioral supports.

Some questions may focus on very recent experiences or observable tasks. In those cases, families may find it helpful to describe what a typical day looks like over time, especially if a short window of time does not reflect ongoing challenges or support needs.

Another important factor is understanding how support systems influence daily functioning. When individuals are successful with strong supports in place, it can sometimes be difficult for a standardized assessment to capture the level of help required to maintain that stability. Providing clear examples of how assistance, supervision, or services contribute to everyday success can help create a more accurate picture of support needs.

Part of a Broader System Update

The new assessment tool is part of Indiana’s broader waiver modernization effort sometimes referred to as the “Waiver Reset,” which is expected to take effect in 2027. According to the Indiana Family and Social Services Administration, the initiative is intended to strengthen how services are evaluated and delivered across the state’s disability service system (Indiana FSSA, 2026).

For individuals already receiving services, the interRAI assessment will typically be introduced at the next scheduled reassessment rather than requiring immediate reassessment for everyone at once.

Continuing to Support Individuals and Families

Changes to assessment processes can feel uncertain, particularly when services play such an important role in daily life. While the state emphasizes that eligibility criteria are not changing, the way needs are documented may evolve as the new system becomes fully implemented.

Providers, therapists, advocates, and case managers can all play an important role in helping individuals and families communicate their needs clearly during the assessment process.

At Sycamore Services, we remain committed to walking alongside individuals and families through every stage of life. As this new assessment process continues to roll out across Indiana, we will continue sharing updates and helping the people we serve navigate changes within the system.

References

Centers for Medicare and Medicaid Services. (2023). Home and community based services 1915(c) waivers. https://www.medicaid.gov/medicaid/home-community-based-services

Indiana Family and Social Services Administration. (2026). Bureau of Disabilities Services interRAI implementation fact sheet. https://www.in.gov/fssa/ddars

Indiana Family and Social Services Administration. (2026). BDS Waiver Reset initiative. https://www.in.gov/fssa/ddars/bds-waiver-redesign

interRAI. (n.d.). About interRAI assessment systems. https://interrai.org/about-interrai/