Indiana Medicaid may pay for certain authorized non-medical services for an assisted living resident, but coverage is not automatic. The resident must meet Medicaid and waiver requirements, use an eligible setting and participating provider, and have the service and hours included in an approved person-centered care plan.
Medicaid may cover authorized support in assisted living, but it does not simply reimburse any privately arranged caregiver. Coverage depends on the resident’s waiver enrollment, assessed level of care, approved services, provider participation, authorization, and the rules for the assisted living setting.
Indiana’s current waiver framework requires applicants to meet Medicaid eligibility and home and community-based services requirements. For the PathWays for Aging and Health and Wellness Waivers, this generally includes living in an HCBS-compliant setting and meeting nursing facility level-of-care criteria. Level of care is evaluated during application and reviewed periodically.
Assisted living can qualify as a community setting for waiver services, but living there does not automatically establish eligibility or create approval for outside private duty hours.
Families comparing payment sources can review paying for private duty care in assisted living.
Indiana Medicaid waiver assisted living services may be available through PathWays for Aging, the Health and Wellness Waiver, or another applicable HCBS program when the resident meets that program’s requirements.
The former Aged and Disabled Waiver was divided on July 1, 2024:
The resident’s case manager, service coordinator, or PathWays health plan determines which services may be included in the person-centered plan. A home care agency cannot approve eligibility or add hours independently.
Medicaid assisted living coverage limitations can include room and board, unauthorized services, hours beyond the approved plan, services from an ineligible provider, and tasks that are already included within another waiver payment.
Indiana’s current PathWays provider module states that the Assisted Living service payment does not include room and board. It also says separate payment is not made for attendant care, respite, transportation, home-delivered meals, and several other services when a participant selects the PathWays Assisted Living service because those activities are considered part of that service.
This means Medicaid may not pay a second agency separately for services already bundled into the resident’s authorized assisted living benefit. Additional outside care may require a different approved service arrangement or private payment.
Medicaid also does not guarantee:
Residents should compare these limits with long-term care insurance for private duty care and VA benefits for private duty care when relevant.
To verify Medicaid home care authorization, the resident or authorized representative should contact the assigned care manager, service coordinator, PathWays health plan, or local Area Agency on Aging before scheduling services.
Ask for written confirmation of:
Indiana directs people applying for the Health and Wellness or TBI Waiver to their local Area Agency on Aging. PathWays members receive long-term service coordination through the program’s managed care structure.
Residents, authorized representatives, case managers, and assisted living teams can contact Nana Cares after eligibility and care-plan requirements are confirmed.
Nana Cares is a certified provider for applicable PathWays for Aging, Health and Wellness, and TBI Waiver services, with care delivered according to authorization and care-plan requirements. Medicaid approval, zero out-of-pocket cost, resident acceptance, staffing, facility permission, and a particular start date are not guaranteed.
Compassionate, non-medical in-home care for seniors and adults with disabilities across Central Indiana.
Nana Cares provides personal care, homemaker services, companion care, respite care, and overnight support with a warm, professional approach.