Indiana Medicaid Guide 2026: PathWays & LTC Programs

Indiana Medicaid covers long-term nursing and home care through an income-cap system, with a 2026 limit of $2,982 per month and a required Miller Trust for applicants over that cap.

Indiana Medicaid is administered by the Indiana Family and Social Services Administration (FSSA), with eligibility processed by its Division of Family Resources (DFR). Since July 1, 2024, seniors who need ongoing care receive their long-term services through PathWays for Aging, Indiana's managed-care program for adults 60 and older. This guide maps every key question about Indiana Medicaid to the dedicated article that answers it.1

What Indiana Medicaid Covers

Indiana Medicaid covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: Inpatient and outpatient services
• Physician, clinic, and specialist visits
• Prescription drugs through managed care formularies
• Behavioral health: Mental health and substance use disorder services
• Home health and private duty nursing
• Long-term care: Nursing facility coverage and home- and community-based services (HCBS) waiver services for members who meet the level-of-care standard
• PathWays for Aging: Managed long-term services and supports for adults 60 and older
• Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries

For older adults, long-term care is the most financially significant benefit. Indiana sits mid-pack nationally on care costs: the CareScout 2025 Cost of Care Survey reports in-home care at about $35 per hour for a non-medical caregiver, exactly the national median and 26th among the states, and about $70 per hour for a private-duty nurse. A semi-private nursing facility room runs about $107,310 a year and assisted living about $67,665 a year, ranking Indiana 38th and 35th, below national medians of about $114,975 and $74,400. One category runs the other way: adult day health care costs about $33,020 a year in Indiana, roughly a third above the national median of $24,700 and the 13th highest of any state, so the option families often reach for as the cheap one is comparatively expensive here.3 Once a resident meets the financial and clinical tests, Medicaid pays the nursing facility bill above the resident's own required contribution, which is nearly all of their monthly income.1

Who Qualifies for Indiana Medicaid

Indiana Medicaid long-term care eligibility uses both financial and clinical criteria. The rules below apply to the nursing facility and HCBS-waiver track for seniors and people with disabilities. The key financial parameters in 2026:1

• Asset limit: $2,000 for a single applicant; $3,000 for a couple with both spouses applying. Exempt resources include the home if a spouse, a child under 18, or a disabled or blind child lives there, or the applicant is expected to return home; one vehicle of any value if it is used for the applicant's employment or medical treatment, has been modified for a disability, or is the community spouse's, and otherwise $5,000 of that vehicle's market value; household furnishings and personal effects other than collections; burial spaces and irrevocable burial or funeral trusts tied to specific services; and real property held in the community spouse's sole name.1
• Income cap: $2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate. Indiana is an income-cap state with no medically needy spend-down pathway for long-term care.1
• Home equity limit: Indiana sets its substantial-home-equity bar at the federal floor, which is $752,000 for 2026. That bar does not apply at all where the applicant's spouse, or a child under 21 or a blind or disabled child, lawfully lives in the home, and an applicant can use a reverse mortgage or home equity loan to bring equity under the limit. Indiana Partnership long-term-care policyholders are exempt from it, and a hardship waiver process exists.1
• Miller Trust required: An applicant with gross monthly income above $2,982 must establish a Qualified Income Trust (Miller Trust) and deposit the excess each month before Medicaid will pay for care.1

Because an applicant over the cap is ineligible unless a valid Miller Trust is in place, the Miller Trust is the only path forward for an over-income applicant. The figures above are the long-term-care ones. Non-long-term-care aged, blind, and disabled Medicaid uses a different and much lower income limit, $1,330.00 a month for a household of one and $1,803.33 for a household of two, and Indiana made those standards effective March 1, 2026 rather than January 1.1

For adults aged 19 to 64 who are not eligible for Medicare or another Medicaid category, Indiana runs a separate expansion pathway, the Healthy Indiana Plan (HIP), open to family income below roughly 138 percent of the federal poverty level and determined under Modified Adjusted Gross Income (MAGI) rules with no asset test. For full income and asset rules, see Indiana Medicaid Eligibility and Income Limits.4

Indiana Medicaid Long-Term Care: PathWays for Aging

Indiana launched PathWays for Aging on July 1, 2024, as its managed long-term services and supports program for Medicaid members aged 60 and older.2 PathWays is administered by FSSA's Office of Medicaid Policy and Planning (OMPP) and delivered through managed care organizations (MCOs). Under PathWays, an eligible senior receives their Medicaid long-term services coordinated through a single managed care plan that covers both home-based care and nursing facility care.1

Nursing Facility Coverage

Indiana Medicaid pays for nursing facility care for members who meet both clinical eligibility (nursing facility level of care) and financial eligibility (the $2,000 asset limit and $2,982/month income cap, with a Miller Trust if over the cap). Once enrolled, the resident contributes nearly all monthly income toward the cost of care, keeping only the $52 Personal Needs Allowance plus deductions for health-insurance premiums, taxes, and medical expenses Medicaid does not cover, and an allowance for a community spouse. Indiana calls that contribution the resident's "liability."1

HCBS Waivers: Home and Community-Based Services

On July 1, 2024, Indiana's former Aged and Disabled (A&D) Waiver split in two, so a senior applying today does not apply for the A&D waiver. People 60 and older use the PathWays Waiver; people 59 and under use the Health and Wellness Waiver. Covered HCBS waiver services include attendant care, adult day service, assisted living, home-delivered meals, home modifications, respite care, structured family caregiving, personal emergency response systems, specialized medical equipment and supplies, and transportation, with a case manager setting which of them go on the member's plan of care. To qualify, a person must meet a nursing facility level of care and have income no greater than 300% of the maximum SSI amount, the same cap that applies to nursing facility Medicaid. Applications start with one of Indiana's 16 Area Agencies on Aging, which makes the initial level-of-care determination, and the applicant must apply for Medicaid as well.2

The 5-Year Lookback and Transfer Penalties

Indiana applies a 60-month (five-year) lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window generate a penalty period of Medicaid ineligibility. An undue-hardship waiver is available where the penalty would deprive the applicant of necessary care.1

Estate Recovery

Indiana operates an expanded-estate recovery program: after the death of a recipient age 55 or older who received long-term care services, FSSA recovers not only from the probate estate but also from non-probate assets, such as real property conveyed to a survivor through joint tenancy with right of survivorship (where the joint tenancy was created after June 30, 2002), funds remaining in a Miller Trust at death, annuities purchased after May 1, 2005, and assets moved into a revocable trust after May 1, 2002. The State's claim has preferred status, meaning it is paid in full before other debts or distributions to heirs, and for deaths on or after July 1, 2025 the State has nine months from the date of death to file its claim, a limit that does not apply to assets never reported to the county DFR office.5 Recovery is deferred while a surviving spouse is alive, a surviving child is under 21, or a surviving child of any age is blind or permanently disabled, and an undue-hardship waiver is available.6

See Indiana Medicaid Estate Recovery for the full scope of recoverable assets and exemptions.

Indiana Medicare Savings Programs

Indiana Medicaid administers the federal Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries:7

These are the federal standards, not absolute cutoffs: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so someone somewhat over should apply rather than rule themselves out. Enrolling in QMB, SLMB, or QI automatically qualifies you for Part D Extra Help (the Low-Income Subsidy), which reduces prescription drug cost-sharing, and federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing. Three limits apply to QI specifically: it is paid from a limited annual pot and granted first come, first served, you cannot hold QI and full Medicaid at the same time, and you have to apply again every year, since being selected one year does not entitle you to help the next. A fourth MSP, QDWI, pays the Part A premium for certain working people with disabilities who lost premium-free Part A; it does not confer Extra Help.7 See Indiana Medicare Savings Programs for full details on income disregards, the QMB billing prohibition, and how to apply.7

Spousal Impoverishment Protections

When one spouse enters a nursing facility or HCBS waiver program, federal spousal impoverishment rules keep the community spouse from losing all of the couple's shared resources.8

Key 2026 figures for Indiana:

• Community Spouse Resource Allowance (CSRA): Half the couple's non-exempt assets, capped at $162,660 and never less than $32,532. The nursing-home spouse is left with $2,000.1,8
• Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,705.00 a month effective July 1, 2026. If the community spouse's own income falls below that floor, income from the institutionalized spouse is redirected to make up the gap. A community spouse with high living expenses can appeal to keep more, but not above the 2026 maximum of $4,066.50 a month, which Indiana publishes rounded as $4,067.8
• Home: Exempt from the eligibility calculation while the community spouse lives there.

See Indiana Medicaid Spousal Impoverishment Protections for the snapshot process and CSRA calculation.

How to Apply for Indiana Medicaid

Applying for Indiana long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the FSSA pathways.

See How to Apply for Indiana Medicaid for a full walkthrough and document checklist.

If Indiana denies your application

A denial can be appealed, but the clock is short and it starts without you. Indiana's deadline is 33 days, not 90: the appeal must be filed in writing, by close of business, within 33 days of the date of the notice or the adverse action, whichever is later.9 The 90 days you may see quoted elsewhere is the federal ceiling at 42 CFR 431.221(d) on the longest window a state may allow, measured from the date the notice is mailed, and Indiana has set a shorter window inside it.9 Read both dates off your own notice and count from the later one.

Keeping coverage while the appeal is pending runs on a separate and earlier clock, and it is the deadline families miss most often: benefits continue at the same level only if you submit the appeal before the effective date of the coverage change stated in your notice.9 HIP Plus and HIP State Plan Plus members must also keep paying the monthly POWER account contribution during the appeal to hold those benefits, though the 33-day filing deadline itself is the same one that applies to any other Indiana Medicaid decision.9 A denial of covered services by a Healthy Indiana Plan, Hoosier Healthwise, or Hoosier Care Connect health plan follows a different track, and its numbers are not the eligibility-denial deadline: you work through the plan's own appeal process first, on the plan's separate 60-calendar-day clock.9,10 See Indiana Medicaid Appeals and Fair Hearings for both routes in full.

Keeping Indiana Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, Indiana Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.11 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it.11 That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Indiana may offer the same windows but is not required to, so ask FSSA what applies to you.11

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).11 So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Return a renewal form the week it arrives. See Indiana Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Indiana Medicaid FAQ

Learn More

Find personalized help with Indiana Medicaid and PathWays for Aging at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.