When Does Medicaid in Indiana Pay for a Nursing Home, Assisted Living, or Home Health Care?

June 26, 2022

The Indiana Medicaid program is a jointly sponsored federal-state health care plan for medically and financially eligible individuals. Like most states, Indiana Medicaid may pay for rehabilitation, acute medical care, and long-term senior care in nursing homes, assisted living, and home health care.

According to a recent Genworth Financial Cost of Care Survey, the average monthly cost of a semi private room in a nursing home in Indiana is $7,133, but if you’re looking for a private room, it could cost more than $8,000 a month. With ever-increasing nursing home care costs, senior citizens likely to require long-term care (LTC) should plan early to ensure they can afford the services.

In most cases, long-term care in Indiana is funded by nursing home insurance, private funds, or Medicaid. Therefore, if you or a senior family member does not have long-term care insurance and cannot afford to pay privately, Indiana Medicaid (sponsored by FSSA – Indiana Family and Social Services Administration) might cover your long-term care needs.

Indiana’s Medicaid program typically pays for patients who meet specific requirements, such as residency and citizenship, age, income, and disability. In addition, patients who stay in intermediate care facilities, skilled nursing homes, or hospitals for more than one month and are thought to need this care may also be eligible for Medicaid benefits. But this is only possible if they meet specific income and asset qualifications.

Subsequently, Indiana also offers a waiver through the Home and Community-Based Services (HCBS) program, allowing qualified applicants who would otherwise need care in nursing facilities to remain in their homes or assisted living facilities.

Medicaid Program for Nursing Homes in Indiana

Indiana Medicaid can pay for your long-term care if you fulfill specified qualifications, including age and disability. For example, if you are 65 years old or older, disabled or blind, and meet certain medical and income specifications, the Indiana Medicaid program may provide your nursing home care coverage.

You must also have the financial qualifications and need the type of care the nursing home offers. For example, most nursing facilities provide 24/7 supervised nursing care, nutrition management, personal care, and organized activities.

When applying for Medicaid coverage, consulting a Medicaid lawyer is recommended if you are concerned about eligibility. An experienced attorney can explain everything you need to know about Medicaid eligibility in Indiana, how to manage finances to maintain eligibility, and prevent you from unnecessarily spending your resources.

Medicaid Income Limitations in Indiana

Under Indiana Medicaid laws, your income, including wages, pensions, IRAs, veteran’s benefits, Social Security benefits, annuities, etc., must not surpass the total cost of care under the private pay rate. As of 2020, a single individual earning a monthly income of up to $2,349 can qualify for Medicaid-funded nursing home care.

On the other hand, the Medicaid income limit for a couple is up to $4,698 per month if both spouses apply. It should be noted that the long-term care income limit may exceed a person’s income limit if they request other health care coverage from Medicaid. When determining Medicaid eligibility, your income from every source is considered.

If you or your spouse applies for Medicaid individually, then the income of one spouse is not counted. As a result, the non-applicant partner may qualify for a monthly needs allowance between $2,113.75 and $3,216.00.

In addition, if you meet the eligibility requirements and live in a nursing facility, you may have to spend much of your countable income on your medical care. The Indiana Medicaid lets patients receive Medicaid in nursing homes to keep $52 as a monthly personal needs allowance.

Asset Limitations in Indiana

In Indiana, Medicaid splits assets into two main groups: Exempt and Available. These assets may include:  

  • Real Estate
  • Life insurance with cash value
  • Bank Accounts
  • Personal Property
  • Vehicles
  • Cash
  • Boats
  • Motorhomes.

Exempt resources are strictly designated under the Medicaid asset rule, and ownership of such assets will not prevent you from receiving benefits. On the other hand, non-exempt assets should be liquidated and used in funding your Medicaid benefits.

As a single individual, you are expected to own assets worth $2,000 with a few exceptions like your home and car. The non-applicant spouse can keep about $128,640 in asset value for married couples.

Indiana Medicaid Waivers, Assisted Living, and Home Care Options

You may also qualify for Medicaid long-term care coverage provided outside nursing homes. In addition, Indiana has exclusive programs with varying qualifications requirements that provide additional benefits to allow senior citizens at home and assisted living facilities to obtain the needed care.

These programs include the Home and Community-Based Services (HCBS) waiver that helps seniors afford LTC services to continue living independently in their homes and communities rather than moving into nursing homes. With the HCBS Medicaid waiver, beneficiaries can access a broader range of services, including adult day care, attendant care, assisted living, transportation services, personal care assistance, and personal emergency response systems.

The All-inclusive Care for the Elderly (PACE) is another Indiana program that delivers community-based care to qualified patients. To be eligible, an applicant must be over 55 years and residing in a location served by a PACE service provider. Indiana also offers a Structured Family Caregiving (SFC) program that offers financial and support services to Indiana families that provide care at home for seniors or disabled family members.

How Medicaid Attorney Can Help

When applying for your Medicaid benefits, it is crucial to have a skilled Medicaid attorney by your side. An experienced attorney will ensure all aspects of a senior’s financial and personal details are considered when determining when and how to apply. The lawyer will also determine if additional steps should be taken to avoid disqualification.

If you live in Indianapolis and need help with your Medicaid application, the Indianapolis Medicaid attorneys at Applegate & Dillman Elder Law can help. Contact us online or call us at (317) 492-9569 to speak with our lead Medicaid attorney’s Carol Applegate and Lisa Dillman.

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