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 (meeting the eligibility requirements ensures services will be received) 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 might be immediately eligible for long term care from an Indiana Medicaid program. Alternatively, taking the Medicaid Eligibility Test may be helpful. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Indiana. More.
|2019 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||$2,313 / month||$2,000||Help w/3 Activities of Daily Living||Each spouse is allowed $2,313 / month||$3,000||Help w/3 Activities of Daily Living||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help w/3 ADLs|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Help w/3 Activities of Daily Living||Each spouse is allowed $2,313 / month||$3,000||Help w/3 Activities of Daily Living||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help w/3 ADLs|
|Regular Medicaid / Aged Blind and Disabled||$1,041 / month||$2,000||None||$1,409 / month||$3,000||None||$1,409 / 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. (Learn more about how Medicaid counts income for eligibility purposes).
There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse of a spouse applying for nursing home Medicaid or a HCBS Medicaid waiver is entitled. As of July 2019, this figure is $2,113.75 / month and is set to increase again in July 2020. Simply stated, if the non-applicant spouse has income under $2,113.75 / month, the applicant spouse can transfer a portion (or all) his or her income to the non-applicant spouse to bring his or her monthly income up to this amount. However, if the non-applicant has high shelter costs, he or she may be entitled to an even greater amount of monthly income. As of January 2019, this figure is $3,161 / month and will increase again in January 2020. This spousal impoverishment 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 $585,000 (in 2019).
For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain half of the couples’ joint assets, up to a maximum of $126,420, as the chart indicates above. However, if the couple has assets valued at $25,284 or less, the non-applicant spouse is entitled to all of it. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). As with the spousal income allowance, this asset allowance is strictly for non-applicant spouses of husbands and wives that are applying for institutional Medicaid or long-term home and community based services and supports via a Medicaid waiver.
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). More on trusts.
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 services in assisted living and adult foster care homes, 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 his or her parent’s caregiver. Other relatives, but not spouses, can also participate in this program.
How to Apply for Indiana Medicaid
There are several ways in which elderly Indiana residents can apply for Medicaid. Persons can complete the application, called the Indiana Application for Health Coverage, online on the FSSA (Family and Social Services Administration) Benefits Portal. Alternatively, seniors can apply in person at their local FSSA DFR (Division of Family Resources) office. To find your county DRF office, click here and then enter your zip code where it reads “Find Your Local DFR Office”. Persons can also apply by telephone by calling DFR at 1-800-403-0864.
Prior to application, seniors should make sure they meet all of the eligibility requirements discussed above. If persons do not meet the criteria, or are unsure, they might want to consider Medicaid planning. Applying for long-term care Medicaid can be complicated and confusing, to learn more about the process, click here.