Elder Care Index

What Medicaid Actually Covers for Senior Care

Navigating senior care options in Indiana can feel like a maze, but let's break down what Medicaid truly covers. As of July 1, 2024, Indiana's Aged and Disabled (A&D) Waiver was updated and replaced by two main programs for long-term care in your community: Pathways for Aging for those aged 60 and older, and the Health & Wellness (H&W) Waiver for individuals aged 59 and younger with disabilities. These programs are designed to help your loved one receive care at home or in an assisted living setting, rather than a nursing home. They cover essential services like personal care assistance, help with daily activities, homemaker services (meal prep, housekeeping), medication reminders, transportation, respite care to give you a break, adult day services, and necessary home modifications. A significant benefit is the option for Structured Family Caregiving, which can even pay family members who provide care. Beyond these, Indiana also has the Traumatic Brain Injury (TBI) Waiver for those with a documented TBI and the Community Integration and Habilitation (CIH) Waiver for individuals with intellectual or developmental disabilities, offering specialized support and services. While these waivers cover a broad range of support, it's important to know that Medicaid generally doesn't cover the cost of room and board in assisted living facilities. Your loved one's income, after a small personal needs allowance, will typically contribute to their care costs.

Do You Qualify?

The financial picture for 2026 can be a bit tricky, but here’s the rundown. For a single senior needing long-term care through Indiana Medicaid, the income limit is $2,982 per month, and the asset limit is $2,000. If your parent is married and both are applying, their combined asset limit is $3,000. If only one spouse is applying, the applicant still has an asset limit of $2,000, but the non-applicant (community) spouse can keep significantly more, up to $162,660 in joint assets. If your parent's income or assets are above these limits, don't despair; Indiana has "spend-down" rules. This means you can use excess income or assets to pay for medical expenses, and once that "spend-down" amount is met, Medicaid can kick in for the rest of the eligibility period.

What if your parent owns a home? Usually, their primary residence is exempt from asset limits as long as they, their spouse, a child under 21, or a blind or disabled child lives there. If not, there's a home equity limit of $752,000 in 2026, and an "intent to return home" may be required if they're in a facility. However, remember that the home isn't protected from Medicaid's Estate Recovery Program after their passing. If your parent has a pension, that income counts, but for married couples, the non-applicant spouse may be able to keep some of the applicant's income if their own is low, up to $4,067 per month. Be aware of Indiana's 60-month (five-year) look-back period for asset transfers; gifting assets can result in a penalty period. Finally, to qualify for most long-term care programs, your parent will need to meet a Nursing Facility Level of Care, meaning they require a significant level of care typically provided in a nursing home.

Waitlists & How to Apply

The reality is that Indiana's waiver programs, including Pathways for Aging and Health & Wellness, currently have waitlists. As of March 2026, over 6,500 individuals were on the Health & Wellness Waiver waiting list alone, as the state has reached its federally approved capacity. Even with a wait, it's crucial to apply as soon as possible.

You can apply for Indiana Medicaid online through the FSSA Benefits Portal, in person at your local Division of Family Resources (DFR) office, or by calling 1-800-403-0864. For the Pathways for Aging Waiver, you'll also need to contact your local Area Agency on Aging (AAA) for an initial level of care screening. Be prepared to gather extensive paperwork, including identification, Social Security and health insurance cards, property deeds, burial arrangements, income records like pensions, and four months of bank statements. While federal guidelines suggest a 45-day processing time (or 90 days if a disability determination is needed), in practice, it often takes longer, with an average of 83 days for a decision after submission. The entire process, including gathering documents, could take around five and a half months. The most important thing while you wait is to respond immediately to any requests for more information from FSSA or DFR.

Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.