Does Medicaid Pay for Assisted Living in Indiana?

Medicaid in Indiana provides financial assistance for healthcare services to eligible residents with limited income and resources. This program serves as a significant resource for individuals needing long-term care, including those in assisted living facilities. Understanding how Indiana’s Medicaid system supports care in these settings involves recognizing the specific programs and criteria for accessing benefits. While Medicaid covers various services, direct payment for room and board in assisted living is generally not included.

Indiana Medicaid Programs for Assisted Living

Indiana Medicaid utilizes specific waiver programs to provide financial assistance for services within assisted living facilities. The primary mechanism for covering long-term care services in community settings, including assisted living, has historically been the Aged & Disabled (A&D) Waiver. This waiver supports individuals who require a nursing facility level of care but wish to remain in a community-based environment.

As of July 1, 2024, the Aged & Disabled Waiver was updated and split into two distinct waivers. Individuals aged 60 and older are now served by the Indiana PathWays for Aging Waiver, while those aged 59 and under are covered by the Health and Wellness Waiver. Both of these Home and Community-Based Services (HCBS) waivers allow Medicaid to cover the costs of care services, such as personal assistance and skilled nursing, provided in an approved assisted living facility. These programs provide an alternative to institutional care, enabling eligible individuals to receive necessary support while living in their chosen community setting.

Eligibility Criteria

To qualify for Indiana Medicaid waiver programs that support assisted living, individuals must meet both financial and medical eligibility requirements. Financial criteria include limits on both income and countable assets. For a single applicant in 2025, the countable asset limit is $2,000, encompassing items like bank accounts, retirement funds, stocks, and cash. Married couples have different asset limits, with provisions like the Community Spouse Resource Allowance allowing the non-applicant spouse to retain a certain amount of assets, up to $157,920 in 2025.

Income limits also apply. For a single applicant in 2025, the income limit for the Indiana PathWays for Aging Waiver is $2,901 per month. For those whose income exceeds this threshold but is insufficient to cover care costs, Indiana offers a “spend-down” provision. This allows individuals to become financially eligible by reducing their countable income through incurred medical expenses until they reach the Medicaid income limit. Qualifying medical expenses for spend-down can include Medicare premiums, long-term care facility costs, doctor visits, and prescriptions.

Beyond financial requirements, applicants must also meet a medical or functional need criterion, specifically requiring a Nursing Facility Level of Care (NFLOC). This determination is made through an assessment conducted by a care manager from the local Area Agency on Aging (AAA). The assessment evaluates an individual’s ability to perform Activities of Daily Living (ADLs), such as mobility, bathing, dressing, eating, and toileting, along with cognitive function and behavioral issues. This ensures the individual needs the level of care these waiver programs provide as an alternative to nursing home placement.

Required Information and Documentation

Preparing for a Medicaid application for assisted living benefits in Indiana requires gathering a comprehensive set of documents. Applicants will need to provide:
Proof of identity, such as a government-issued ID like a driver’s license or passport.
Proof of Indiana residency, demonstrated with a recent utility bill or lease agreement.
A Social Security Number for the applicant, and potentially their spouse if married.
Financial documentation, including proof of all income sources (pay stubs, tax returns, pension statements, Social Security benefit statements).
Statements from all bank accounts for a specified period, typically four months, along with details for retirement accounts, stocks, bonds, and certificates of deposit.
Property deeds and related documentation if real estate is owned.
Information regarding any health insurance policies, including Medicare and supplemental insurance cards.
Medical records and any prior functional assessments to support medical necessity for long-term care.
Relevant documents for pre-paid burial arrangements or trusts.

Applying for Indiana Medicaid Assisted Living Benefits

The process of applying for Indiana Medicaid assisted living benefits involves submitting the prepared application through one of several methods. Applicants can submit their application online via the Indiana Family and Social Services Administration (FSSA) Benefits Portal. Individuals can also apply in person at their local Division of Family Resources (DFR) office.

Applications can also be submitted by mail or over the phone by calling the DFR. After submission, the FSSA will review the application to determine eligibility. The processing time can take up to 90 days. During this review period, the state agency may contact the applicant for follow-up interviews or to request additional information. Applicants will receive notification of the decision regarding their eligibility status once the review is complete.

Scope of Covered Services

Indiana Medicaid waiver programs, such as the Indiana PathWays for Aging Waiver and the Health and Wellness Waiver, cover a range of services within approved assisted living facilities. These services support individuals with their daily living needs and medical requirements, allowing them to remain in a community setting. Covered services typically include:
Personal care assistance, such as help with bathing, dressing, eating, and mobility.
Medication management, including reminders and assistance with dispensing.
Skilled nursing services.
Various therapies, such as physical, occupational, and speech therapy.
Care coordination to ensure all aspects of an individual’s care plan are managed.
Attendant care.
Home modifications.
Transportation for medical appointments or other necessary outings.

Personal items, private rooms, or recreational activities not directly tied to a care plan are generally not covered. The assisted living facility must be a state-approved or contracted provider to accept these Medicaid waiver benefits.