Indiana Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal program that provides low-income individuals of all ages health care coverage. However, the focus here will be specifically on long-term care Medicaid eligibility for senior Indiana residents (65 years of age and over). With long-term care, services may be provided in a variety of settings, including one’s home, the home of a relative, an adult foster care home, a nursing home, or in an assisted living facility. Please note, Medicaid for the aged, blind, and disabled in Indiana is also called Hoosier Care Connect or Traditional Medicaid.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Indiana seniors may be eligible. These programs have slightly different eligibility requirements, such as functional ability and income and asset limits, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Indiana offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Wait lists may exist. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement and is provided at home or adult day care.
As stated previously, eligibility for these programs is complicated by the facts that the criteria vary based on whether one is single or married and that Indiana offers more than one pathway towards eligibility. The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Indiana Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Indiana Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Help w/3 ADLs||$3,375 / month||$3,000||Help w/3 ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w/3 ADLs|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Help w/3 ADLs||$3,375 / month||$3,000||Help w/3 ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w/3 ADLs|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$2,000||None||$1,372/ month||$3,000||None||$1,012 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
It’s important to be aware that Indiana has a 5-year Medicaid Look-Back Period. This is a period of time in which Medicaid checks to see if any assets were sold, gifted, or transferred. If any assets were sold, transferred, or given away under fair market value during this time frame, violating the look-back period, a period of Medicaid ineligibility for long-term care will ensue.
Qualifying When Over the Limits
For Indiana residents, 65 years of age and over, who do not meet the Medicaid eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, which are also called Miller Trusts, offer a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid. This is because money deposited into a QIT is not considered income when it comes to Medicaid eligibility. In very simple terms, income over the Medicaid income limit is deposited into a trust, and a trustee is named, giving that individual legal control of the money. The QIT must be irreversible, meaning once it has been created, it cannot be changed or canceled. The money in the account can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee.
Unfortunately, Qualified Income Trusts do not assist one who has assets over the asset limit in qualifying for Medicaid. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their extra assets. However, one can “spend down” assets in order to reach the Medicaid asset limit. This can be done by spending excess assets on non-countable assets, such as home repairs and additions (updating plumbing system, adding a ground floor bedroom, and reroofing), home modifications (addition of wheelchair ramps, chair lifts, and walk-in tubs), prepaying funeral and burial expenses, and paying off existing debt (car, mortgage, and credit cards).
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Indiana Medicaid Programs
Nursing home care paid for by Indiana’s Medicaid program is an entitlement. Phrased differently, if an Indiana resident is medically and financially eligible for nursing home care, then the Indiana Medicaid program is required by law to pay for it. Waiting lists cannot exist. However, Indiana Medicaid also pays for care outside of nursing homes, in assisted living, adult foster care homes or in the home of the beneficiary. These benefits are paid for through a program called a Medicaid waiver. Medicaid waivers are not entitlements and waiting lists can exist.
1) Aged and Disabled (A&D) Waiver – this waiver provides home care, adult day care, home modifications and assisted living among many other supports that help seniors to live and function independently. Furthermore, for some services, beneficiaries are given the choice of care providers and can even choose to hire family members to provide them with personal care assistance.
2) Indiana Structured Family Caregiving – this is a unique benefit in Indiana that warrants explanation. Structured Family Caregiving (SFG) allows an aging parent to move into the home of their adult child and the state will compensate the adult child to serve as their parent’s caregiver. Other relatives, but not spouses, can also participate in this program.