Does Medicaid Pay for Assisted Living in Indiana?

What Indiana Medicaid may cover in an assisted-living setting

The Indiana Family and Social Services Administration (FSSA) runs Indiana Medicaid. For adults age 60 and older, Medicaid-funded care in a community setting such as assisted living is delivered through the PathWays Waiver, a Home and Community-Based Services (HCBS) program. According to Indiana Medicaid's provider guidance, Assisted Living is one of the services that may be authorized under that waiver for eligible members.

Covered support must be approved in the person-centered service plan

Medicaid does not pay for assisted living as a single package. It pays for specific services that have been assessed, approved, and written into the member's person-centered service plan. Depending on the individual, approved waiver services in an assisted-living setting may include:

• Help with activities of daily living, such as bathing, dressing, grooming, mobility, and eating
• Home and community assistance, such as housekeeping, laundry, and meal preparation tied to the care plan
• Medication oversight and certain nursing-related needs, within program rules
• Other supports the service coordinator identifies and the health plan approves

Not every person receives every service. Indiana Medicaid's provider guidance states that all waiver services must be furnished under a written service plan that has been approved, and that providers cannot bill for services without an approved authorization. If a family expects a particular service to be covered, it should appear in the plan.

What room and board means

Room and board is the portion of an assisted-living bill that covers the living space, utilities, and meals. It is separate from care services.

Ask each community, in writing, what the resident's remaining monthly responsibility would be. For a general overview of what private-pay assisted living typically includes, see the Two Hearts assisted living cost page.

How Indiana PathWays for Aging relates to assisted living

Who PathWays serves

Indiana PathWays for Aging is the state's Medicaid managed long-term services and supports program for qualifying members age 60 and older. It launched in July 2024. Members are assigned to or choose a managed care health plan, and that plan provides a service coordinator who works with the member on assessments, the service plan, and authorizations.

Not every PathWays member receives waiver services. PathWays is the broader managed-care program. The PathWays Waiver is the specific HCBS benefit within it that can fund care in assisted living for members who qualify.

Families can reach the PathWays Helpline at 87-PATHWAY-4, (877) 284-9294, for enrollment and plan questions.

The PathWays Waiver

According to Indiana Medicaid's provider module, the PathWays Waiver is designed as an alternative to nursing facility admission for Medicaid-eligible people age 60 and older who meet nursing facility level of care. Approved services can be delivered in the person's own home, in assisted living, in adult family care, or through structured family caregiving.

Several things must line up before waiver services begin in an assisted-living setting:

• Indiana Medicaid financial eligibility
• A nursing facility level-of-care determination, based on a functional assessment
• An approved waiver benefit plan and an approved initial service plan
• Program capacity, since the waiver has a federally approved number of slots

On that last point, FSSA has operated a waiting list for the PathWays Waiver since 2024 and invites people from the list each month as capacity allows. Certain groups, such as people transitioning out of a nursing facility or being discharged from a hospital, receive priority invitations. Placement on the waiting list does not guarantee services or a start date.

What about someone younger than 60?

Indiana uses other HCBS programs for some eligible people under 60, including the Health and Wellness Waiver for individuals 59 and younger. Program rules, settings, and capacity differ. Contact FSSA or the local Area Agency on Aging to confirm the right program rather than assuming the PathWays rules apply.

Who may qualify for assistance

Qualifying for Medicaid-funded services in an assisted-living setting is a series of separate determinations, not a single approval. A person generally needs all of the following:

• Indiana Medicaid financial eligibility, determined by the Division of Family Resources through an application
• Functional eligibility, including the required nursing facility level-of-care determination
• Approval for applicable waiver services, subject to program capacity
• A participating assisted-living provider with availability under the member's health plan or program
• An approved person-centered service plan that includes assisted-living services

Indiana Medicaid publishes an online eligibility guide, but the state is clear that it is only a guide. A completed application and an official determination are required before anyone knows whether they qualify. Income and asset rules change and vary by category, so confirm current figures with Indiana Medicaid or the Area Agency on Aging rather than relying on general websites.

Some people with income above the standard Medicaid limit may still be enrolled with what Indiana calls a waiver liability, a monthly share of cost that must be met before waiver services are covered. Whether that applies, and how much it would be, is determined during the eligibility process.

Do all Indiana assisted-living communities accept Medicaid?

No. To bill Medicaid for assisted-living services, a community must be certified by FSSA as a waiver provider, enrolled in Indiana Medicaid, and enrolled with one or more PathWays health plans. Some communities complete all of those steps. Some complete none of them. Some participate with one plan but not another, or limit the number of program-supported residents they accept.

Before assuming coverage will work at a specific community, ask:

• Does the community participate in the applicable Indiana Medicaid waiver program?
• Which PathWays health plans does it contract with?
• Are program-supported openings available now, or is there an internal wait?
• What does the resident pay for room and board?
• Which services require prior authorization or inclusion in the service plan?
• Who coordinates benefits if the person has both Medicare and Medicaid?

Ask each community directly, including any community you tour in Crown Point or Lowell, and ask the member's health plan to confirm the same information.

How to start the Indiana Medicaid and assisted-living process

1. Review Indiana Medicaid's official eligibility guide. It will not give a final answer, but it explains the categories and what documents to gather.
2. Call the PathWays Helpline at (877) 284-9294 if the person is 60 or older and needs help understanding enrollment or plan selection.
3. Contact the local Area Agency on Aging. In Lake County and the rest of Northwest Indiana, that is Northwest Indiana Community Action Corporation, also known as CoAction, in Crown Point. Options counselors there can explain the waiver process and help with next steps.
4. Complete the required Medicaid application and functional assessment. Financial eligibility and the level-of-care assessment are separate processes handled by different parts of the state system.
5. Ask each assisted-living community about waiver participation, contracted health plans, program-supported capacity, room-and-board costs, and required documentation.
6. Get coverage and cost information in writing from the health plan and the community before signing a residency agreement.

Questions to ask when comparing assisted living in Crown Point or Lowell

A short list of direct questions can save weeks of confusion:

• Which services are included in the standard monthly amount, and which are billed separately?
• Which costs are room and board, and which are care services?
• Does the community participate in PathWays or another applicable Indiana program?
• Which managed-care health plans does the community accept?
• Is there a waiting list or limited program-supported capacity?
• Who helps update the resident's service plan if care needs change?
• What happens to the residency agreement if Medicaid approval is delayed or denied?

Local next steps for Northwest Indiana families

It helps to know who does what:

Indiana Medicaid (FSSA)

Determines financial eligibility and sets program rules.

Indiana PathWays for Aging

The managed-care program for members 60 and older. The PathWays Helpline handles enrollment and plan questions.

The health plan (managed care entity)

Assigns the service coordinator, approves the service plan, and authorizes waiver services.

The Area Agency on Aging

Provides options counseling and helps families understand the waiver and waiting-list process.

The assisted-living provider

Delivers the approved care services and bills room and board separately.

The Medicaid decision and the care-setting decision are related, but they are not the same decision. Many families find it easier to evaluate the setting first: the size of the home, the caregiver approach, memory-care availability, meals, and whether it feels right for their parent or spouse.

Frequently asked questions