Indiana Medicaid Definition
Medicaid is a wide-ranging jointly funded state and federal program that provides low-income individuals of all ages with health care coverage. While there are multiple eligibility groups, this page is focused on long-term care Medicaid eligibility for senior Indiana residents (65 years of age and over). In addition to nursing home care and care services in adult foster care homes and assisted living facilities, IN Medicaid pays for non-medical services and supports to help frail seniors remain living at home.
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 varying functional and financial (income and asset limits) eligibility requirements, as well as 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 – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – This is not an entitlement program; The number of participant slots is limited and wait lists may exist. Intended to delay the need for nursing home admissions, services are provided at home, adult day care, adult foster care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – Also called Hoosier Care Connect, this is an entitlement program. Meeting the eligibility requirements ensures services will be received. Various long-term care services, such as personal care assistance or adult day care, may be available.
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 does not mean one is ineligible or cannot become eligible for Medicaid in Indiana. More.
|2022 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||$2,523 / month*||$2,000||Nursing Facility||$2,523 / month per spouse*||$3,000||Nursing Facility||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Facility|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month†||$2,000||Nursing Facility||$2,523 / month per spouse†||$3,000||Nursing Facility||$2,523 / month for applicant†||$2,000 for applicant & $137,400 for non-applicant||Nursing Facility|
|Traditional Medicaid / Hoosier Care Connect||$1,073 / month (eff. 3/21 – 2/22)||$2,000||Help with ADLs||$1,452 / month (eff. 3/21 – 2/22)||$3,000||Help with ADLs||$1,452 / month (eff. 3/21 – 2/22)||$3,000||Help with ADLs|
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. 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. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact Medicaid eligibility.
When only one spouse of a married couple applies for Institutional Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA is $2,178 (effective 7/1/21 – 6/30/22). If a non-applicant’s monthly income is under $2,178, income can be transferred from their applicant spouse, bringing their income up to this level.
In Indiana, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653 / month (effective 7/1/21 – 6/30/22). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled; The income of both spouses counts towards the income eligibility of the applicant spouse. Learn more about how Medicaid counts income for eligibility purposes.
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. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For the home to be exempt, the Medicaid applicant must live in it or have intent to return, and in 2022, their home equity interest must not exceed $636,000. Equity interest is the amount of the home’s value the applicant owns. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant lives or the applicant’s equity interest in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, spousal impoverishment provisions permit the non-applicant spouse of a nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can keep 50% of the couples’ joint assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be keep by the non-applicant.
Indiana has a 5-year Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, Medicaid checks all past asset transfers to ensure no assets were sold or given away under fair market value. This includes asset transfers made by one’s spouse. The look back rule is intended to discourage persons from gifting assets to meet Medicaid’s asset limit. Violating the look-back period results in a penalty period of Medicaid ineligibility.
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) – Also called Miller Trusts, QITs offer a way for individuals over the Medicaid income limit to still qualify for nursing home Medicaid or a Medicaid Waiver. For Medicaid eligibility purposes, monthly income put into an irrevocable QIT no longer counts as income. Irrevocable means the trust cannot be changed or cancelled. In very simple terms, income over the Medicaid income limit is deposited into a trust in which a trustee has legal control. The funds can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee.
2) Asset Spend Down – Persons who have countable assets over IN’s asset limit can spend down” assets to reach the Medicaid asset limit. This can be done by spending excess assets on ones that are non-countable, 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). Remember, assets cannot be gifted or sold under fair market value. Doing so violates the look back rule and can cause a penalty period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Indiana Medicaid Programs
Like all states, Indiana Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. IN Medicaid also offers programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.
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. For some services, beneficiaries are given the choice of care providers and can even hire family members to provide them with personal care assistance.
2) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.
3) Indiana Structured Family Caregiving (SFC) – This is a unique benefit in Indiana via the A&D Waiver or PACE Program that warrants explanation. SFC 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 can also become the paid caregiver, but only through the A&D Waiver can a spouse or legal guardian be paid through SFC.
How to Apply for Indiana Medicaid
Elderly Indiana seniors can apply for Medicaid online by completing the “Indiana Application for Health Coverage” on the FSSA (Family and Social Services Administration) Benefits Portal. They can also 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”. Alternatively, seniors can call DFR at 1-800-403-0864 to apply.
Seniors should be certain they meet all eligibility requirements prior to applying for Medicaid. If persons do not meet the criteria, or are unsure, Medicaid planning is recommended. The application process for long-term care Medicaid can be complicated and confusing. Learn more here.