Indiana Assisted Living and In-Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Indiana provides long-term resources to seniors through its Family & Social Services Administration(FSSA), Office of Medicaid Policy & Planning. The office provides resources for seniors including long-term care services through the State local Area Agencies on Aging. It also administers the Program of All-Inclusive Care for the Elderly (PACE). This model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. PACE serves individuals who: 1) are ages 55 or older; certified by their state to need nursing home care; 2) able to live safely in the community at the time of enrollment; and 3) live in a PACE service area.

Indiana also has a program for Medicaid-eligible seniors over 65 years of age, the Residential Care Assistance Program (RCAP). RCAP provides residential financial assistance to eligible individuals residing in Indiana State Department of Health (ISDH) licensed Residential Care Facilities and County Homes that have an approved RCAP contract with the Division of Aging. RCAP services include room, board, and laundry with minimal administrative direction as well as care coordination provided on behalf of eligible individuals at an approved per diem rate established by the Division of Aging.

Medicaid Waiver Programs for Assisted Living and In-Home Care

Indiana Aged and Disabled Medicaid Waiver (HCBS A&D Waiver)

The Aged & Disabled (A&D) Waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. The waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other supports were not available. Waiver services can be used to help people remain in their own homes, as well as assist people living in nursing facilities to return to community settings such as their own homes, apartments, assisted living or Adult Family Care.

In Indiana the A&D Waiver is implemented by the  Family & Social Services Administration(FSSA), Office of Medicaid Policy & Planning. The IndianaDivision of Aging performs the daily operational tasks of the Waiver, and the Office of Policy and Medicaid Planning oversees all executive decisions related to the A&D Waiver.

Services

Services included in the Indiana A&D Waiver program: Adult day services, Assisted living, Attendant care, Case management, Community transition, Congregate care, Environmental modifications, Home delivered meals, Homemaker, Nutritional supplements, Personal emergency response systems (PERS), Pest control, and Respite care.

Eligibility

  1. Health: Applicants must meet a Nursing Home Level of Care
  2. Financial: Indiana is a Special Income Limit state, and the applicant for long-term services through the A&D waiver must meet specific income and asset limits. For 2017, an individual must make less than $2,205 in order to meet the income limits, and assets of $2,000 or $3,000 if the applicant is married and both spouses are applying. A Miller Trustis allowed to help divert income into a trust vehicle that will pay out monthly installments for care and disregard the rest for purposes of determining financial eligibility. For a married applicant, thenon-applicant spouse (or, “community spouse”) may keep certain assets and other allowances without if affecting the financial limits of the applicant. For 2017, the community spouse may keep up to $120,900 in assets, known as the community spouse resource allowance (CSRA). In addition, the community spouse is allowed a monthly income while the applicant is in the waiver program. This is known as the maximum monthly maintenance needs allowance (MMMNA), which for 2017 is $3,022.50 per month.

Practical Considerations

Indiana’s special income limit (SIL) status means that through the use of a Miller trust an applicant can qualify for Medicaid benefits for long-term care if they meet the other healthcare criteria. As a SIL state, it may be easier than other states, such as 209(b) states, that have a more strict income test for financial eligibility. Further, the ability to use a Miller Trust to help an applicant meet the income limit is a good feature of the A&D Waiver program.

Conclusion

Indiana has robust senior long-term care resources, administered either through the A&D waiver or additional state programs. The high enrollment cap provides a good chance that the waitlist for the A&D Waiver program might not be as long as in some other states. In addition, the Special Income Limit (SIL) status, combined with the ability to use a Miller Trust, makes Indiana a great state to use a Medicaid Planning specialist, who may be able to use techniques to help meet the requirements for the program sooner than otherwise and save you money.