The Indiana Medicaid program covers a wide variety of healthcare related services for low-income and low asset Hoosiers. Eligibility requirements for each program vary, but all Medicaid programs are predicated on lack of financial ability to private pay for healthcare services and being under the applicable asset limits for countable assets. In the state of Indiana, the federal government provides funding for the Medicaid programs, which are overseen by the Family and Social Services Administration (FSSA). The FSSA administers the many health insurance programs for low-income Indiana families, children, pregnant women, and seniors, including processing Medicaid applications and managing the application process.
The most relevant programs for Indiana seniors are Medicaid’s home and community based services (HCBS) and nursing home care (in long-term care facilities) and health coverage related to those services. Medicare does not cover these needs such as long-term care, in-home services, and personal care services, so the Indiana Medicaid provides these programs for those who cannot afford them. Under these programs, Medicaid will pay providers and nursing facilities directly for those who meet eligibility criteria and achieve enrollment. For those who exceed the applicable income limit, the Indiana Medicaid member is often required to “spend down” a portion of their Social Security and other income as a co-pay to the nursing facility before services begin. For home and community based services, Medicaid will pay the caregiver (or caregiver agency). This process involves an HCBS waiver from other services in order to allow the Indiana Medicaid member to remain in-home.
Indiana Medicaid recipients can also receive Medicaid coverage for ancillary care needs, medical expenses, personal care, attendant care, and some other costs. For individuals who meet Medicaid eligibility requirements but reside in assisted living rather than a nursing facility or long-term care facility, Indiana Medicaid provides a waiver program. The Medicaid waiver covers personal care and other services, but usually does not cover room and board.
In the case of married couples, when one spouse enters long-term care and requires Medicaid coverage, Indiana Medicaid will divide their assets, which protects the non-applicant spouse (also known as the community spouse) from becoming impoverished. In addition to this community spouse resource allowance, key exempt assets for both married couples and individuals are one parcel of real estate (usually their primary residence), one vehicle, and personal belongings. However, while the primary residence is exempt from the asset limit, it is not exempt from the Indiana Medicaid’s estate recovery program. Following an Indiana Medicaid beneficiary’s death, Indiana FSSA will attempt recovery of care costs through whatever assets of the deceased remain, including the real estate. With proper Medicaid planning strategies and by working with a Medicaid planning professional, strategies can be employed to prevent estate recovery while preserving eligibility for Medicaid long-term care services. Please contact QMC to learn more about ways to receive assistance for care at home, in assisted living, or in a nursing facility today.