In Indiana, the application process for long-term care Medicaid works as follows: the prospective Medicaid recipient must enter the nursing home and begin receiving care from the facility, at which point a Medicaid application can be submitted to the State of Indiana. At that time, the resident must meet the asset limits imposed by the state. Indiana Medicaid will consider the application and determine whether the resident meets eligibility requirements.
When an Indiana nursing home resident achieves Medicaid eligibility, their care will be fully covered by Indiana Medicaid. However, most of their monthly income must be turned over to the nursing facility to assist with paying for their medical care. This includes Social Security (SSI, SSDI, and Social Security Retirement) payments as well as any pensions they might receive. This payment can be thought of as a co-pay that the nursing home resident contributes to the cost of their long-term care. When Social Security payments are raised yearly for the cost-of-living adjustment, the co-pay amount increases accordingly.
Medicaid recipients are permitted to keep a small amount of their monthly income, known as a personal needs allowance (PNA). Indiana’s state PNA was recently raised to $100.00, from the previous $52.00. This monthly personal needs allowance can be used for things like snacks, toiletries, haircuts, and any other small items a nursing home resident might want that are not provided by the facility. Indiana Medicaid recipients are also able to pay healthcare premiums for Medicare and other supplemental health insurance plans out of their income before paying the nursing home. The patient liability for the co-pay is determined after the personal needs allowance and healthcare premiums are subtracted from the nursing home resident’s monthly income.
When a Medicaid recipient is married and the spouse remains in the community, they are permitted to keep their own income. If their income is under a certain amount, they may be able to keep a portion of the Medicaid recipient’s income under the Monthly Maintenance Needs Allowance, also known as the Community Spouse Resource Allowance.
The regulations above only apply to nursing home Medicaid, also known as vendor Medicaid. Other Indiana Medicaid services, such as home and community-based services (HCBS) and skilled caregiving in assisted living facilities are covered under separate Medicaid waivers.
While income cannot be preserved by Medicaid planning, some assets can be preserved. Please contact QMC to learn more about asset protection prior to a Medicaid application.