Indiana Medicaid Long Term Care Eligibility
Indiana Long Term Care
1. Residency and Citizenship – the applicant must be an Indiana resident and be a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, IRAs, etc.) must be less than the cost of care at the private pay rate. There is a personal needs allowance of $52/month that is not factored into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits.
Exempt Assets for an applicant in Indiana include:
i. $1,500 or less in cash/non-exempt assets if single; for a married couple the total is $2,000.
ii. Personal effects and household goods.
iii. One home ($552,000 equity value) if planning to return, under the name of a spouse, or a child under 21, or a disabled person resides in it.
iv. One motor vehicle if worth less than $5,000 of the current market value. If the vehicle is used for the long term care recipient’s medical treatment, employment, modified to accommodate a disability, or the primary vehicle of the community spouse then it is exempt no matter the value.
v. Life insurance is considered income in the month it is received, but dividends from life insurance fall into the asset category, to be no higher than $1,500. Note that interest on dividends from a life insurance policy is not exempt. If life insurance has a face value of $10,000 or less and the beneficiary is the policy holder’s estate or the funeral home, it is exempt.
vi. Burial spaces and irrevocable pre-paid burial trusts if tied to specific funeral or burial services.
vii. Series E/EE Saving Bonds interest, I Bonds interest.
Amount of assets community spouse may retain: The maximum value of assets a community spouse can retain for self-support without disqualifying the nursing home spouse from eligibility is $119,220. If the community spouse does not have assets worth at least a minimum of $23,844, he/she may keep some of the institutionalized spouse’s income until the minimum is reached.
Community spouse impoverishment protection: all income that is solely in the name of the community spouse is exempt, plus half of all jointly owned income. If the community spouse’s income does not equal at least $1,966 per month, he/she may keep some of the institutionalized spouse’s income in order to meet the minimum of $1,966. If the community spouse’s living expenses are exceptionally high, he/she can appeal to keep more of the institutionalized spouse’s income, up to $2,980.
- The nursing home spouse must contribute all income except for $52 per month towards their long term care costs.
Indiana long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used you may apply for Medicaid with $155,000 worth of assets exempted.
- Although Indiana recommends this option, the Indiana Long Term Care Insurance Program does not receive money from policies sold. Insurance companies sell the policies through traditional insurance agencies. Cost varies by age, health, and company. The older the policy holder, the higher the premium.
A complete list of insurance companies is available from the Indiana Long Term Care Insurance Program by calling 1-866-234-4582, 317- 232-2187, or visiting www.longtermcareinsurance.IN.gov.