Indiana's growing aging population and strong preference for home-based care create substantial demand for home health services across both Indianapolis metropolitan areas and rural communities. With approximately 1.1 million residents aged 65 and older, the state faces ongoing challenges in building and maintaining an adequate home health workforce.

Indiana maintains a comprehensive regulatory framework through the Indiana Department of Health (IDOH) for agency licensing and the Indiana Health Coverage Programs (IHCP) for Medicaid reimbursement. Recent changes to HCBS waiver programs, including the split of the Aged and Disabled Waiver into PathWays and Health and Wellness waivers in 2024, have reshaped the landscape. This guide covers everything agencies and caregivers need to know about providing home health services in Indiana.

Indiana Home Health Agency Licensing Requirements

Indiana Code 16-27 requires that every Indiana home health agency be licensed. The Indiana Department of Health (IDOH), Consumer Services and Healthcare Regulation division, is designated as the licensing authority for agencies providing skilled home health services.

Services covered. IDOH licenses agencies that provide nursing services, physical therapy, occupational therapy, speech therapy, medical social worker services, home health aide services, and other therapeutic services delivered to patients at their temporary or permanent residence.

Initial license application. Prior to operating a home health agency in Indiana, a license must be obtained from IDOH. To obtain a license, applicants must submit a completed Application for License to Operate a Home Health Agency (State Form 4008), supporting documentation, and a $250 licensure fee.

Required documentation. Applications must include a copy of Articles of Incorporation or Certificate of Assumed Business Name signed by the Secretary of State for doing business in Indiana, along with an SS-4 or comparable IRS document reflecting the corporation name and EIN number. Copies of current valid Indiana licenses, limited criminal history checks, and resumes for key staff are also required.

Background checks. Criminal history checks are required for agency owners and key personnel. Refer to the IDOH Criminal History Check Information for specific requirements.

Site inspection. IDOH conducts a site inspection to verify that the agency's operations, facilities, and procedures comply with state health and safety regulations under 410 Indiana Administrative Code 17.

License renewal. To renew an agency license, complete the renewal application and submit with the $250 licensure fee. In accordance with 410 IAC 17-11-3, renewal applications must be filed at least 60 days prior to, but not sooner than 90 days before, the current license expiration date.

Annual surveys. IDOH may conduct a state licensure survey at each licensed home health agency approximately once per year. The survey comprehensively reviews agency compliance with state rules.

Accreditation option. Many agencies voluntarily pursue accreditation by home health agency accreditation organizations. If accredited, the agency may substitute the accreditation survey for the state licensure on-site survey in calendar years when an accreditation survey is performed.

Contact information. Indiana State Department of Health, Division of Acute Care, 2 North Meridian Street, 4A, Indianapolis, IN 46204. Phone: (317) 233-7474 (Acute Care) or (317) 233-1325 (Main Switchboard).

Home Health Aide Certification Requirements

Indiana requires home health aides to be registered with the Indiana State Department of Health Aide Registry. The state maintains separate certifications for HHAs and CNAs, each with distinct training requirements.

Training requirements. HHA training programs must consist of classroom and supervised practical training totaling at least 75 hours, with at least 16 hours devoted to supervised practical training. This meets the federal minimum established by 42 CFR 484.80.

Classroom before clinical. The individual being trained must complete at least 16 hours of classroom training before beginning supervised practical training. This ensures foundational knowledge before patient contact.

Competency evaluation. After completing training, candidates must demonstrate competency through evaluation by a registered nurse, covering both written knowledge and practical skills.

Registry requirement. Practicing as a home health aide in Indiana requires state certification and registration. The Indiana State Department of Health Aide Registry maintains a registry for certified and registered home health aides, as well as nursing assistants.

Continuing education. To maintain HHA certification, 12 hours of continuing education are required annually. This ongoing training ensures aides maintain skills and stay current with care techniques.

Employer verification. Those who want to work in a licensed home health agency or hospice must be listed by name in the aides registry. Employers must verify registry status before hiring.

CNA Certification Requirements

Certified Nursing Assistants in Indiana follow a separate certification pathway with more extensive training requirements. Many agencies prefer or require CNA certification due to the broader scope of training.

Training requirements. CNA training programs in Indiana require 105 hours of total instruction, more extensive than the 75-hour HHA requirement. All training programs must be approved by IDOH and utilize the Indiana Nurse Aide Curriculum, which establishes minimum course standards.

Program approval. Health care facilities and independent entities may apply to operate training programs. All programs are approved based on compliance with federal regulations, state rules, and administrative standards.

Competency evaluation. CNAs must complete a state-approved nurse aide training program, pass the nurse aide competency evaluation consisting of both written and skills tests, and be listed in good standing on the Indiana Aides Registry.

Registry placement. The Indiana Department of Health manages the official registries for certified nurse aides, home health aides, and qualified medication aides. These registries include those who have successfully completed required training and testing.

CNA vs. HHA. HHA and CNA are separate certifications in Indiana. HHA training is 75 hours and focused on home settings. CNA training is 105 hours and qualifies individuals to work in a wider range of facilities, including nursing homes and hospitals.

Employment requirement. Those who want to work in a licensed nursing home, home health agency, or hospice must be listed by name in the aides registry.

Medicaid Reimbursement in Indiana

Indiana Medicaid, administered through the Indiana Health Coverage Programs (IHCP), provides home health coverage for eligible residents. The state maintains competitive reimbursement rates and has recently restructured its waiver programs.

Competitive rates. Indiana Medicaid's reimbursement rates are among the highest in the country. For example, Attendant Care is reimbursed at $34.36 per hour and Respite at $36.92 per hour. Rates vary by service type, waiver, and payer.

MCE contracts. Managed Care Entities (MCEs) must pay at least IHCP fee-schedule minimums and may negotiate above those amounts. Agencies should verify payer contracts to understand actual reimbursement.

2026 fee schedule updates. As announced in IHCP Bulletin BT2025156, the IHCP updated reimbursement rates for certain professional services effective January 1, 2026. The IHCP Fee Schedules application page includes Excel files with revised rates.

PathWays for Aging. For non-medical home care, most agencies now work with Indiana PathWays for Aging plans, the managed care program serving seniors aged 60 and older since July 2024.

Direct billing. Other waivers including Health and Wellness, TBI, CIH, and FSW are billed directly to the state via IHCP/Gainwell.

Provider enrollment. Agencies must enroll as Medicaid providers through IHCP to receive reimbursement. The enrollment process includes verification of licensing, background checks, and financial documentation.

Fee schedule access. Current fee schedules are available at in.gov/medicaid/providers/business-transactions/billing-and-remittance/ihcp-fee-schedules/

HCBS Waiver Programs

Indiana operates multiple 1915(c) Home and Community-Based Services (HCBS) waiver programs. A major restructuring in July 2024 split the former Aged and Disabled Waiver into two new programs.

July 2024 restructuring. On July 1, 2024, the Aged and Disabled Waiver split into the Health and Wellness Waiver for individuals aged 59 and under and the PathWays Waiver for individuals aged 60 and older.

Health and Wellness Waiver. This waiver serves individuals aged 59 and under who require nursing facility level of care. It is administered by the Division of Disability and Rehabilitative Services (DDRS) along with the Traumatic Brain Injury Waiver.

PathWays Waiver. The PathWays Waiver serves individuals aged 60 and older and is administered by the Office of Medicaid Policy and Planning (OMPP). Most non-medical home care agencies now work with PathWays for Aging managed care plans.

Additional waivers. Indiana also operates the Community Integration and Habilitation (CIH) Waiver and Family Supports Waiver (FSW), which are billed directly to the state.

2026 eligibility limits. For a single applicant in 2026, the HCBS Waiver asset limit is $2,000, and the income limit is $2,982 per month.

Provider resources. The DDRS HCBS Waivers provider module was published January 6, 2026. Updated information is disseminated through IHCP provider bulletins at in.gov/medicaid/providers and on the DDRS website at in.gov/fssa.

Electronic Visit Verification (EVV) Requirements

Per the 21st Century Cures Act, Indiana requires providers of personal care services and home health services to use an electronic visit verification system. The Indiana Health Coverage Programs (IHCP) administers EVV requirements.

Implementation timeline. Use of EVV to document personal care services has been required since January 1, 2021. EVV for home health services became required for dates of service on or after January 1, 2024.

Covered services. Home care services covered under Indiana's EVV requirements include personal care services, home health services, and other Medicaid-funded services. The IHCP maintains a list of applicable procedure code/modifier combinations on the Code Sets page.

System options. All home care providers in Indiana must use an EVV system. Providers can choose between the free Indiana EVV system offered through Sandata or an approved alternate EVV system.

Aggregator requirement. Alternative EVV systems must export data directly into the Sandata "Aggregator" to meet requirements for integration with CoreMMIS.

Data captured. The EVV system records location data only at the start and end of shifts, verifying time and location of home care visits.

Claims denial. The IHCP began denying non-EVV-compliant claims for personal care services on January 1, 2023. Non-compliance can result in reduced reimbursement rates, termination of Medicaid provider status, and denial of payment.

Exceptions. Limited exceptions may be available for services in rural areas with limited internet or cellular service, services by caregivers under 18, and services through telemonitoring or telemedicine. Providers must request and receive approval before exemption.

Resources. Visit in.gov/medicaid/providers/business-transactions/electronic-visit-verification/ for current requirements.

Medicare Home Health Coverage

With Indiana's growing elderly population, Medicare remains a crucial payer for home health services. Medicare certification allows agencies to serve beneficiaries and typically provides better reimbursement than Medicaid programs.

Eligibility requirements. To qualify for Medicare home health coverage, beneficiaries must be homebound, need skilled nursing care on an intermittent basis or require therapy services, have a physician certify the need and establish a plan of care, and receive services from a Medicare-certified home health agency.

2026 payment rates. CMS's Calendar Year 2026 Home Health Prospective Payment System Final Rule establishes updated payment rates, including case-mix adjustments under the Patient-Driven Groupings Model (PDGM).

Plan of care requirements. Medicare requires a plan of care signed by a physician specifying services needed, frequency, and duration, reviewed at least every 60 days.

Certification process. Agencies seeking Medicare certification must meet federal Conditions of Participation and undergo state survey. Given the favorable Medicaid rates in Indiana, both Medicare and Medicaid certification provide financial stability.

Labor Laws and Wage Requirements

Indiana follows federal minimum wage standards with limited state-specific enhancements. Understanding these requirements is essential for compliance and competitive compensation.

Minimum wage. Indiana's minimum wage is $7.25 per hour, matching the federal minimum. This rate has not increased in over a decade and is significantly lower than neighboring states like Illinois ($15.00) and Michigan.

Training wage. Indiana allows employers to pay trainees under age 20 a subminimum wage of not less than $4.25 per hour for the first 90 consecutive calendar days of employment.

Overtime requirements. Indiana state law requires employers to pay employees one and a half times their regular rate for hours worked over 40 in a workweek. Many home health aides are eligible for overtime under the Fair Labor Standards Act (FLSA).

Live-in exemption. Overtime pay is not required for live-in employees under federal regulations.

Pay statements. Indiana law requires employers to furnish each employee a statement of hours worked, wages paid, and a listing of deductions made.

Workers' compensation. Indiana does not require household employers to have workers' compensation coverage, though voluntary policies are available.

FICA thresholds. If you pay cash wages of $3,000 or more to any household employee in 2026, you must withhold and pay FICA taxes at 15.3% of cash wages.

Indiana Workforce Challenges

Indiana faces significant workforce challenges driven by demographic trends, low state minimum wage, and competition from other industries and neighboring states.

Current wages. According to available data, the average salary for a Home Health Aide in Indiana is approximately $15.66 per hour or $37,475 per year. Top earners can make up to $48,764 annually, with the typical range between $32,879 (25th percentile) and $43,059 (75th percentile).

National comparison. The Bureau of Labor Statistics reports the national average annual personal care and home health aide salary at $34,990, with an hourly rate of $16.82. Indiana wages are competitive with national averages despite the low state minimum wage.

Low minimum wage impact. Indiana's $7.25 minimum wage creates a wide gap between minimum and actual home health wages. While this means HHA jobs pay well above minimum wage, the low floor limits overall wage growth in the care economy.

Neighboring state competition. Illinois's $15.00 minimum wage and higher average HHA wages create recruitment competition, particularly in border regions. Chicago-area agencies can draw workers from Indiana with higher pay.

Aging population. With approximately 1.1 million residents aged 65 and older, Indiana faces sustained demand for home health services. The restructured PathWays for Aging program serves this growing population.

Rural challenges. Indiana's rural communities face particular challenges with worker availability, travel distances, and limited training program access.

Strategies for Indiana Agencies

Given Indiana's specific market dynamics, agencies must adopt targeted strategies to build sustainable operations and competitive workforces.

Leverage competitive Medicaid rates. Indiana's Medicaid rates are among the highest nationally, with Attendant Care at $34.36/hour. Maximize participation in PathWays, Health and Wellness, and other waiver programs to capture this favorable reimbursement.

Maximize Medicare revenue. Combine Medicaid waiver services with Medicare-certified skilled care to diversify revenue and provide margin for competitive wages and benefits.

Offer above-market wages. With the low state minimum wage, there is significant room to differentiate through compensation. Paying $16-18 per hour or more attracts quality candidates in a market where minimum wage is only $7.25.

Provide training programs. Offering free or subsidized HHA or CNA training removes barriers to entry. The 75-hour HHA or 105-hour CNA programs are manageable investments that build committed workers.

Navigate waiver restructuring. Understand the July 2024 waiver changes. Build relationships with PathWays for Aging managed care plans for seniors 60+ and ensure proper credentialing with DDRS for Health and Wellness Waiver services for those 59 and under.

Ensure EVV compliance. Choose an EVV system that integrates with the Sandata aggregator. Train staff thoroughly on clock-in/clock-out procedures to avoid claim denials that began in 2023.

Invest in retention. Given training requirements and workforce shortages, retaining workers is critical. Provide thorough onboarding, consistent scheduling, supervisor support, and recognition programs.

Address rural markets. Consider mileage reimbursement, company vehicles, or geographic clustering of assignments to reduce travel burden in rural areas.

Build community partnerships. Partner with community colleges, workforce development boards, and organizations to identify and train potential caregivers.

Key Resources and Contacts

Agencies operating in Indiana should maintain relationships with these key regulatory and support organizations:

Indiana Department of Health (IDOH)
Home health agency licensing and certification
2 North Meridian Street, 4A, Indianapolis, IN 46204
Phone: (317) 233-7474
Website: in.gov/health/cshcr/acute-and-continuing-care/home-health-agency-hha-licensing-and-certification-program/

Indiana Aides Registry
HHA, CNA, and QMA certification and verification
Website: in.gov/health/ltc/aide-training-and-certification/

Indiana Health Coverage Programs (IHCP)
Medicaid reimbursement and provider enrollment
Website: in.gov/medicaid/providers/
Fee Schedules: in.gov/medicaid/providers/business-transactions/billing-and-remittance/ihcp-fee-schedules/

Electronic Visit Verification (EVV)
Website: in.gov/medicaid/providers/business-transactions/electronic-visit-verification/

Division of Disability and Rehabilitative Services (DDRS)
Health and Wellness Waiver, TBI Waiver
Website: in.gov/fssa/ddrs/

Division of Aging
PathWays for Aging, Medicaid HCBS
Website: in.gov/fssa/da/medicaid-hcbs/

Indiana Department of Labor
Wage and hour enforcement
Website: in.gov/dol/wage-and-hour/

The Bottom Line

Indiana presents significant opportunities for home health agencies, particularly given the state's competitive Medicaid reimbursement rates among the highest nationally. With Attendant Care reimbursed at $34.36 per hour, agencies have margin to offer competitive wages and invest in workforce development.

The July 2024 restructuring of HCBS waivers requires agencies to understand the new PathWays Waiver for seniors 60+ and Health and Wellness Waiver for those 59 and under. Building relationships with PathWays for Aging managed care plans and maintaining proper DDRS credentialing is essential for serving both populations.

Indiana's low $7.25 minimum wage creates both challenge and opportunity. While it reflects a lower overall wage floor, home health positions paying $15-16 per hour are well above minimum and can attract workers. Competition from higher-wage neighboring states like Illinois requires agencies to emphasize total compensation, career advancement, and workplace culture.

EVV compliance is mandatory, with claims denials for non-compliant personal care services beginning in 2023 and home health services in 2024. Selecting a system that integrates with the Sandata aggregator and training staff thoroughly prevents revenue loss.

Agencies that understand Indiana's regulatory environment, leverage the favorable Medicaid rates, navigate the restructured waiver programs, maintain EVV compliance, and invest in workforce development will be best positioned to serve the Hoosier State's growing home health care needs and build sustainable operations.