With the average monthly cost of a private room in a nursing home in Indiana surpassing $8,000 in 2020, seniors who are likely to need long-term care (LTC) need to plan ahead to ensure they have a way to pay for that care. Long-term care is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have long-term care (LTC) insurance, Indiana's Medicaid program (Indiana Medicaid), administered by the Indiana Family & Social Services Administration (FSSA), might cover his or her care.
Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet specified income and resource qualifications. Indiana also operates a Medicaid waiver plan, known as a Home and Community-Based Services (HCBS) waiver, that allows elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Indiana Medicaid provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
For more information and to apply for Indiana Medicaid, visit the Indiana FSSA benefits portal or request an application by mail. You can also visit your local FSSA Division of Family Resources (DFR) office and apply in person, or call DFR for assistance at (800) 403-0864.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about Indiana Medicaid and nursing home coverage, call the Indiana FSSA at (800) 457-8283.
In Indiana, a single person can have a monthly income up to only $2,349 in 2020 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,698 per month in 2020. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Indiana Medicaid allows nursing home residents receiving Medicaid to keep only $52 per month as a personal needs allowance.
Indiana Medicaid for LTC has resource rules, which you must satisfy to be eligible for coverage, that can be different from those for other Indiana Medicaid programs. Resources are assets like real estate, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Indiana residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, Indiana offers a Home and Community-Based Services (HCBS) Medicaid waiver program that affords individuals LTC services assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. The Indiana Aged and Disabled (A&D) Medicaid waiver program offers nursing home services to recipients living (or wising to return to living) at home, in foster homes, or in assisted living facilities. This program allows individuals access to a range of benefits and services, such as adult day care, personal care assistance, assisted living, attendant care, transportation services, home-delivered meals, and personal emergency response systems, among others.
Structured Family Caregiving (SFC) is a related state benefit that can provide a caregiver to a waiver participant in the home of either the participant or the caregiver. Under this program, relatives of the individual in need—such as adult children, for example—can serve as caregivers, and be compensated for the services they provide, to a person who would otherwise need care in an LTC facility.
Indiana has also designed and implemented a Program of All-Inclusive Care for the Elderly (PACE) to provide community-based care to eligible individuals. To qualify for PACE, you must be 55 or older and live in an area served by a PACE provider. You must also require a nursing home level of care, and you must be able to live safely in the community with PACE services. You can review a list of Indiana’s PACE program providers, with whom the Indiana FSSA has partnered, and access additional Indiana PACE information here.
PACE participants receive their services from an interdisciplinary team of professionals including physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. Under this model, Indiana Medicaid pays for services offered in the PACE program under a managed care arrangement with its partner entities. If you are interested in a PACE program, apply directly to the one you are interested in, and the program will help determine your eligibility.