Indiana Medicaid for seniors and long-term care

Last verified: June 2026

Indiana PathWays for Aging: the primary HCBS waiver for seniors

Indiana's primary long-term services and supports (LTSS) program for seniors is Indiana PathWays for Aging, a Section 1115 demonstration waiver launched in 2022. PathWays for Aging replaced multiple older HCBS waivers and consolidated home and community-based services for Medicaid-eligible adults age 60 and older under a single managed care structure.

Under PathWays for Aging, eligible seniors receive coordinated care from specialized managed care plans designed for older adults. The program emphasizes keeping people in their homes and communities rather than institutional settings — a consistent policy direction in HCBS waiver design since the Olmstead decision.

PathWays for Aging covers services including personal care assistance, adult day services, home-delivered meals, respite care, caregiver support, environmental modifications, and transportation. Contact FSSA at in.gov/fssa or 800-457-4584 for current PathWays service details and eligibility requirements.

Nursing facility coverage

Indiana Medicaid covers nursing facility care for individuals who meet both financial and clinical eligibility requirements. Clinical eligibility requires a Level of Care (LOC) assessment showing a nursing facility level of need. Financial eligibility requires meeting Medicaid income and asset limits.

For individuals in a nursing facility, Indiana Medicaid generally requires the resident to contribute most of their income toward the cost of care — retaining only a Personal Needs Allowance (PNA) of $52 per month (subject to change). The Medicaid program pays the difference between what the resident contributes and the facility's Medicaid rate.

Asset limits for long-term care Medicaid in Indiana

Source: Indiana FSSA long-term care Medicaid eligibility policy; federal CSRA limits under 42 U.S.C. § 1396r-5. CSRA amounts are adjusted annually for inflation. Verify current figures with FSSA.

Spousal protections: keeping the community spouse financially secure

When one spouse enters a nursing facility and the other remains at home (the "community spouse"), Indiana follows federal spousal impoverishment protections under 42 U.S.C. § 1396r-5. These protections exist to prevent institutionalization from impoverishing the spouse who remains in the community.

• Community Spouse Resource Allowance (CSRA): the at-home spouse keeps up to the federal maximum (~$154,140 in 2025) of the couple's combined countable assets
• Minimum Monthly Maintenance Needs Allowance (MMMNA): the at-home spouse is entitled to a minimum monthly income — if their own income falls short, they may receive an allowance from the institutionalized spouse's income
• The home is exempt while the community spouse lives in it
• A fair hearing process is available if the CSRA calculation seems incorrect

PACE: program of all-inclusive care for the elderly

PACE (Program of All-Inclusive Care for the Elderly) operates at select sites in Indiana, providing comprehensive medical and social services to eligible seniors age 55+ who require nursing facility level of care but can be safely served in the community. PACE participants receive all covered Medicaid and Medicare services through the PACE organization at no additional premium cost. Check with FSSA or the National PACE Association (npaonline.org) for current PACE site availability in Indiana.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Indiana's share of that population is administered through Indiana Medicaid (Healthy Indiana Plan). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Indiana Medicaid (Healthy Indiana Plan) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Indiana may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Indiana uses this approach with Indiana Medicaid (Healthy Indiana Plan).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Indiana Medicaid (Healthy Indiana Plan) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Indiana Medicaid (Healthy Indiana Plan) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Indiana Medicaid (Healthy Indiana Plan) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Indiana's current CSRA is set by Indiana Medicaid (Healthy Indiana Plan) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments