Indiana Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Indiana, Medicaid is run by the Family and Social Services Administration. This article focuses on Indiana Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jul 15, 2024

Indiana Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Indiana Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Indiana Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Indiana seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Indiana Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $52/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Indiana Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – Indiana Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Indiana’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers can cover long-term care services and supports that help financially limited Indiana seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for qualified Indiana seniors who live in their own home, the home of a loved one, an adult care home (adult foster care) or an assisted living residence. While Indiana HCBS Waivers may cover some long-term care benefits in those settings, it will not cover room and board costs.

The HCBS Waiver relevant to Indiana seniors is the Pathways for Aging Waiver.

Pathways for Aging Waiver
Indiana’s Pathways for Aging Waiver, often just called the Pathways Waiver, provides long-term care services and supports to eligible Indiana seniors age 60 and over who require a Nursing Facility Level of Care but instead live in their own home, the home of a loved one, an adult family care home or an assisted living residence. While the Pathways Waiver will pay for benefits in those settings, it will not cover room and board costs. This Waiver replaces the Aged and Disabled Waiver and is part of Indiana’s new Pathways to Aging managed long-term care services and supports program for all state residents age 60 and over who are Medicaid eligible due to age, disability or blindness.

Pathways Waiver benefits include adult day care, home/vehicle modifications, housekeeping services, Personal Emergency Response Systems, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Some long term care can be self-directed, which allows the Pathways Waiver beneficiary to select a caregiver of their choice for certain services, such as housekeeping and personal care assistance. Relatives can be hired and paid as caregivers, including spouses, legal guardians, adult children and grandchildren.

The Pathways Waiver will also help Indiana Nursing Home Medicaid beneficiaries who want to move out of their nursing home and return to the community. In these cases, the Waiver will cover transitional expenses like movers, security deposits, utility start-up fees, essential furnishings, etc.

Unlike Nursing Home Medicaid, the Pathways Waiver is not an entitlement. Instead, it has a limited number of enrollment spots (39,842 as of 2024). Once those spots are full additional applicants will be placed on a waitlist.

Aged, Blind, and Disabled (ABD) Medicaid

Indiana’s Aged, Blind, and Disabled (ABD) Medicaid, which is also known as Hoosier Care Connect, provides healthcare coverage and long-term care services and supports to financially limited Indiana residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the beneficiary’s region.

1. ABD Long Term Care Benefits
Financially eligible Indiana seniors who show a medical need for long-term care benefits can receive them through ABD Medicaid via the Pathways for Aging managed long-term care services and supports program. These long-term care benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Indiana seniors will be evaluated by the state to determine what kind of long-term care benefits they need and Medicaid will cover.

2. Program of All-Inclusive Care for the Elderly (PACE)
Indiana residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Indiana’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Indiana’s PACE programs are located in Indianapolis (Ascension Living St. Vincent PACE and Franciscan Senior Health & Wellness), Fort Wayne (PACE of Northeast Indiana), Richmond (Reid Health PACE Center) and Mishawaka (Saint Joseph PACE Trinity). To learn more about PACE, click here.

Eligibility Criteria For Indiana Medicaid Long Term Care Programs

To be eligible for Indiana Medicaid a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid, which is also called Hoosier Care Connect in Indiana.

Just For You: The easiest way to find the most current Indiana Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Indiana Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Indiana residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Indiana Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Indiana Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Indiana Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $52/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Indiana Medicaid is a combined $3,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Indiana Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Indiana has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Indiana Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine level of care need requirement for Indiana Medicaid, a care manager from the applicant’s local Area Agency on Aging will conduct a screening that takes into consideration the applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive function and any behavioral issues.

Indiana Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Indiana residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. In Indiana, the HCBS Waiver is called the Aged and Disabled (A&D) Waiver. For a single applicant in 2024, the asset limit for the HCBS Waiver in Indiana is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Indiana for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Indiana is a combined $3,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Indiana HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Indiana has a Look-Back Period of five years. This means the state will look back into the previous five years of the HCBS Waiver applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for HCBS Waivers through Indiana Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if this level of care need is met for HCBS Waivers in Indiana, a care manager from the applicant’s local Area Agency on Aging will conduct a screening that takes into consideration the applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), as well as their cognitive function and any behavioral issues.

Indiana Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Indiana residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid, which is also called Hoosier Care Connect in Indiana. The asset limit for a single applicant from March 2024 to Feb. 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for Indiana ABD Medicaid for a single applicant from March 2024 to Feb. 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants from March 2024 to Feb. 2025, the asset limit for Hoosier Care Connect is a combined $3,000, and the income limit is a combined $1,703/month. These limits are used for both married couples with both spouses applying for Hoosier Care Connect and married couples with only one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Indiana ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Indiana has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Indiana ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Indiana Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Indiana Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Indiana and how you can protect your home from it, click here.

Applying For Indiana Medicaid Long Term Care Programs

The first step in applying for Indiana Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid, which is also called Hoosier Care Connect in Indiana.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Indiana Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Indiana Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Indiana residents can apply for Medicaid online through the Indiana Family and Social Services Administration Benefits Portal. They can also apply in person at their Division of Family Resources office, or by calling 1-800-403-0864.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing an Indiana Medicaid Nursing Home

After being approved for nursing home coverage through Indiana Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home that best meets your needs. Even though Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do might not have available beds.

Indiana has roughly 520 nursing homes that accept Medicaid, which is a large number for a state this size. The facilities are spread evenly throughout the state, much like the population, but there are more facilities around the bigger cities. There are about 90 nursing homes in the Indianapolis Metro Area, which includes the cities of Carmel, Noblesville and Fishers, and roughly a dozen more within 10 miles of Muncie. There are almost 50 nursing homes within 25 miles of Fort Wayne, and about 15 within 10 miles of South Bend. There are almost 40 facilities in the northwest corner of the state, ranging from Michigan City to Crown Point to Gary.

Residents in some Indiana communities travel over state lines regularly for personal and business reasons, including healthcare. Medicaid coverage, however, does not travel across state lines. So, someone with Indiana Medicaid would not be covered in a nursing home in Chicago, Louisville or Cincinnati, even though there may be more convenient options in those cities for some Indiana residents.

TOOLS: Indiana residents can find and compare nursing homes using Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use the state’s official Long Term Care Facility Directory. And this Indiana Care Planning Council webpage also has a list of nursing homes.

Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? What is the food like? Does it provide transportation? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS reveals that Indiana nursing homes averaged 20.7 fire safety deficiencies that resulted in citations from 2019-2022, which is notably more than the national average of 13.5. The data also showed that 15.5% of Indiana nursing home residents had depressive symptoms, which was almost twice the national average of 8.1%.