Indiana Medicaid (Hoosier Care) Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Indiana Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In Indiana, Medicaid is administered by the Family and Social Services Administration. Indiana residents can receive long term care benefits through Medicaid in a nursing home, in their home, the home of a loved home, an adult care home (adult foster care) or an assisted living residence through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
Indiana Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Indiana Medicaid will cover the cost of long term care in a nursing home for eligible Indiana residents who require a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that can only be provided in a nursing home. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things that Indiana Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Nursing Home Medicaid is an entitlement. This means that eligible Indiana residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.
Any Indiana Medicaid beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $52 / month, as of 2023. This can be spent on personal items such as clothes, snacks, books, etc.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Indiana Medicaid recipients who require a Nursing Facility Level of Care, but choose to 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 Rhode Island residents who live in their own home, the home of a loved one, an adult care home (adult foster care) or an assisted living residence.
Unlike Nursing Home Medicaid, Indiana HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for an HCBS Waiver program in Indiana, they are not guaranteed by law to receive the benefits. Instead, there are a limited number of enrollment spots. Once those spots are full, additional eligible applicants will be placed on a waiting list.
Indiana residents can receive HCBS Waiver benefits through the Aged and Disabled Waiver.
Aged and Disabled (A&D) Waiver
Indiana’s Aged and Disabled (A&D) Waiver provided long term care services and supports to Indiana residents who require a Nursing Facility Level of Care but instead live in their own home, the home of a loved one, an adult care home (adult foster care) or an assisted living residence. While the A&D Waiver will pay for benefits in those settings, it will not cover room and board costs.
A&D 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 A&D Waiver beneficiary to select a caregiver of their choice for certain services, such as housekeeping and personal care assistance. Relatives can be hired as caregivers, including spouses, legal guardians, adult children and grandchildren.
The A&D 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 A&D Waiver will cover transitional expenses like movers, security deposits, utility start-up fees, essential furnishings, etc.
There are a limited number of enrollment spots for the A&D Waiver (31,855 as of 2022). Once those spots are full, additional eligible applicants will be placed on a waiting list. Some of the enrollment places for the A&D Waiver are reserved for individuals residing in nursing homes who wish to move back into the community.
Aged Blind and Disabled / Regular Medicaid
Indiana’s Aged Blind and Disabled (ABD) Medicaid, which is also known as Hoosier Care Connect, provides healthcare and long term care services and supports to low-income Indiana residents who are aged (age 65+) 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 low-income people of all ages.
ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
1) Standard ABD Benefits
In addition to medical care, ABD Medicaid benefits can include non-medical services and supports such as in-home personal care, adult day care, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long term care benefits they need and will receive.
2) Program of All-Inclusive Care for the Elderly (PACE)
Indiana residents who are age 55 or older and have ABD Medicaid can coordinate their medical, social service and non-medical personal needs into 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 (Franciscan Senior Health & Wellness), Fort Wayne (PACE of Northeast Indiana), Richmond (Reid Health PACE Center) and Mishawaka (Saint Joseph PACE Trinity). More.
Eligibility Criteria For Indiana Medicaid’s 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 / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid, which is called Hoosier Care Connect in Indiana.
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 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / 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 are only allowed to keep $52 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.
For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through Indiana Medicaid is $3,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
Indiana Medicaid applicants are not allowed to 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 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 can only be provided in 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 Service (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 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / 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 2023 asset limit for HCBS Waivers in Indiana is $3,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
Indiana Medicaid applicants are not allowed to 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 applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (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 can only be provided in 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 called Hoosier Care Connect in Indiana. For a single applicant in 2023, 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 red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $1,215 / 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, the 2023 asset limit for Hoosier Care Connect is $3,000 combined between the two applicants/spouses, and the income limit is a combined $1,643 / month combined. These limits are used for both married couples with both spouses applying for Hoosier Care Connect and married couples with only one spouse applying.
While Indiana has a “look-back” period of five years for Nursing Home Medicaid and Home and Community Based Service 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 functional requirements for Indiana’s Aged Blind and Disabled (ABD) Medicaid, which is called Hoosier Care Connect, are being disabled, blind or aged (65 or over). Indiana Medicaid will conduct an assessment of ABD Medicaid applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) to determine the kind of long term care services the beneficiary needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit, it would likely cause them to be over the limit for eligibility. However, in some 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 $688,000 (as of 2023) 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 $688,000. 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. More on Medicaid & Homeownership.
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 Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid / 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 include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
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.
Choosing an Indiana Medicaid Nursing Home
After an applicant has been approved for nursing home coverage through Indiana Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Medicaid nursing home coverage is an entitlement, Indiana Medicaid will only cover stays and care in approved nursing homes. Indiana residents can find and compare nursing homes in there area using the state’s Long Term Care Facility Directory. They can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country. All of the nursing homes on this site are either Medicaid- or Medicare-approved.