Medicaid for nursing home and home care in Indiana

Who qualifies

You need to meet a care test and money tests:

• Care need: you must meet nursing facility level of care. For home care, your Area Agency on Aging makes the first decision, and your case manager checks it again at least once a year.
• Age or disability: aged (65 or older), blind or disabled. People 60 and over with full Medicaid get their care through Indiana PathWays for Aging.
• Income and assets: see the table.

The income limit is 300% of the SSI payment. It is higher than the regular Medicaid limit of $1,330 a month.

Income over the limit? Indiana's Medicaid manual has rules for a Miller trust (a qualified income trust). This kind of trust is funded only with your income. Ask DFR whether you need one before you apply.

What counts and what does not

Assets that count: bank accounts, cash, stocks, bonds, and property other than your family home.

Assets that do not count:

• The home where you live
• One vehicle used to take you places, whatever its value
• Household goods and personal effects
• Burial spaces
• Up to $1,500 set aside for burial in a separate account (for you, and for your spouse)
• Cash value of life insurance, if the face value of all your and your spouse's policies is $1,500 or less. Term and burial policies are not counted in that total.

Home equity. If your equity in your home is over $752,000, you may not qualify for long-term care.

Gifts and transfers. DFR checks your accounts back five years for new applications. Assets you gave away in that time are reviewed for a transfer penalty, which is a time when Medicaid will not pay for your care.

If your spouse stays at home

• Assets: your spouse can keep the greatest of: the state standard of $32,532; the spousal share of your combined assets, up to $162,660; an amount set by a court; or an amount set by a judge on appeal. Both spouses' retirement accounts are counted in the first calculation.
• Income: part of your income can go to your spouse each month. To figure it, DFR uses a spousal income standard of $2,705 a month and a shelter standard of $812 for housing costs (both from July 1, 2026). The most your spouse can end up with is $4,067 a month.

What Medicaid pays for

Nursing home care

PathWays covers people 60 and over who live in a nursing facility. Your health plan does an assessment. Most of your income goes toward your care each month. This is called your patient liability, and DFR sends you a notice with the amount. You keep the personal needs allowance.

Care at home: the PathWays waiver

The old Aged and Disabled waiver split on July 1, 2024. The PathWays waiver serves people 60 and older. (The Health and Wellness waiver serves people 59 and under.) To qualify you must live in, or be moving to, a home or community setting, meet nursing facility level of care, and meet Medicaid rules. Some people may owe a monthly waiver liability.

Services can include:

• In-home attendant care and adult day care
• Assisted living
• Home-delivered meals and emergency response systems
• Home and vehicle changes
• Respite care for family caregivers
• Transportation and special medical equipment

Your case manager picks services with you and lists them on your Plan of Care.

PACE

PACE (Program of All-Inclusive Care for the Elderly) is for people 55 and older who meet nursing facility level of care and live in a PACE service area. PACE members are not put into PathWays.

How to apply

1. For home care, call your Area Agency on Aging first (statewide line 800-713-9023). Apply as soon as you see a need. The agency decides your level of care.
2. Apply for Medicaid with DFR:
   • Online at the FSSA Benefits Portal, fssabenefits.in.gov
   • By phone at 800-403-0864
   • In person at a local DFR office (weekdays 8 a.m. to 4:30 p.m. local time)
   • Send papers to FSSA Document Center, P.O. Box 1810, Marion, IN 46952
3. Send every paper DFR asks for. DFR starts work only when your application is complete. A decision can take up to 90 days.
4. Check your status at the Benefits Portal or 800-403-0864. Have your case number ready.

If Medicaid was denied before you went to the Area Agency on Aging, you can apply again after your visit. A certified Indiana Navigator can also help you apply.

After you apply

• Yearly checks: your case manager reviews your level of care at least once a year.
• Choosing a plan: PathWays members pick a health plan. You can change plans in your first 90 days, during the yearly selection period (mid-October to mid-December), and once a year for any reason. Call the PathWays Helpline at 877-284-9294.
• Appeals: your appeal must reach DFR by 4:30 p.m. local time on the 33rd day after the notice was sent. You can mail or fax it to the FSSA Document Center, file it at your local DFR office, or call your DFR office (a phone request counts). To keep your benefits the same during the appeal, DFR must get it before the date the change takes effect.

Things people miss

• Only your income counts. Your spouse's income does not count toward the $2,982 limit.
• No copays in PathWays. You may still have copays under a Medicare plan.
• Estate recovery. After death, Indiana may seek repayment for Medicaid paid after age 55, including money left in a nursing home account. It does not recover when there is a surviving spouse, a child under 21, or a blind or disabled child. Heirs can ask for a hardship waiver within 90 days of the claim. Call 877-267-0013.

Free help

• Area Agencies on Aging / Aging and Disability Resource Centers (INconnect Alliance): 800-713-9023
• PathWays Helpline: 877-284-9294
• SHIP (free Medicare counseling): 800-452-4800
• DFR: 800-403-0864

For other programs, see all benefits in Indiana. For a family guide to costs, see paying for a nursing home.

Phone numbers: Free help lines for Indiana agencies

Check what you may qualify for