How to start a private duty nursing agency in Indiana

Indiana requires a Home health agency license (Indiana Department of Health) from Indiana Department of Health (license); FSSA Office of Medicaid Policy and Planning (IHCP enrollment) to operate a private duty nursing agency.

License required

Yes

License

Home health agency license (Indiana Department of Health)

Issuing agency

Indiana Department of Health (license); FSSA Office of Medicaid Policy and Planning (IHCP enrollment)

Regulation

405 IAC 5-16 (home health agency services); IHCP Home Health Services provider reference module

1. Obtain an IDOH home health agency license
2. Enroll in the Indiana Health Coverage Programs as a home health agency
3. Obtain prior authorization for skilled nursing with a plan of care and face-to-face attestation

Staffing

• RNs and LPNs employed by the home health agency deliver nursing services

Program

Indiana Health Coverage Programs (IHCP) — Indiana Medicaid

Enrollment portal

IHCP Provider Healthcare Portal (IHCP Portal)

Fiscal agent

Gainwell Technologies (IHCP fiscal agent for provider enrollment and revalidation)

Application fee

IHCP's Risk Category and Application Fee Matrix shows which specialties owe the fee. Proof of electronic payment (or of payment to Medicare or another state) must come with the application, and a separate fee is due for each service location at initial enrollment, revalidation and change of ownership. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

In Indiana, every individual with 5%+ ownership or control of a high-risk enrolling entity must finish Medicaid fingerprinting before the application is submitted, and the fingerprint confirmation number goes on the application. IHCP may assign a higher risk level than its matrix shows. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

IHCP has said DME and home medical equipment providers (including pharmacies with DME/HME specialties) revalidate every three years and other specialties every five years. Due-date lists are published through December 2026, and revalidation is done in the IHCP Portal or by mail packet. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Indiana Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need for Comprehensive Care Health Facilities

Agency

Indiana Department of Health (Long-Term Care)

Services covered

• comprehensive care health facilities (nursing homes): new facilities, added beds, bed transfers and Medicaid certification of beds

Moratoria

Except as the CON chapter allows, comprehensive care beds may not be added or transferred, new comprehensive care facilities may not be built, and Medicaid certification of comprehensive care beds may not be added or transferred (IC 16-29-7-10). A CON may not be granted where the receiving county's comprehensive care occupancy is below 85% or would drop below 85%.

Indiana certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.in.gov/medicaid/providers/business-transactions/electronic-visit-verification/

Indiana EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

Rate pass-through

From 2025-07-01, for the Health and Wellness, TBI and PathWays for Aging 1915(c) waivers and Money Follows the Person, attendant care providers must spend at least 70% of the hourly rate on direct-service compensation, and structured family caregiving providers at least 60% of the daily rate on caregiver stipends and direct-service pay. Providers sign a compliance attestation and keep records for audit.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

110 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,358,600 (as of Jun 1, 2026)

• Adult 1915(i) programs — Adult Mental Health Habilitation (AMHH) and Behavioral and Primary Healthcare Coordination (BPHC) (1915(i))
• Community Integration and Habilitation Waiver (1915(c))
• Child Mental Health Wraparound (CMHW) (1915(i))
• Family Supports Waiver (1915(c))
• Health & Wellness Waiver (1915(c))
• PathWays for Aging Waiver (1915(c))
• Traumatic Brain Injury Waiver (1915(c))

Indiana waivers and waiting lists →