Disability Medicaid in Indiana: Eligibility, Waivers, and Appeals

Disability Medicaid in Indiana runs through the Family and Social Services Administration (FSSA) under the Aged, Blind, and Disabled (ABD) category. To qualify, you must meet the Social Security Administration’s definition of disability, live in Indiana, and fall within the state’s income and asset limits. Once enrolled, most members receive care through a managed care plan, and people who work, need in-home services, or have both Medicare and Medicaid have separate programs built around their situation.

Who Qualifies

Indiana uses the SSA’s disability definition: a medically determinable physical or mental impairment that prevents substantial gainful activity and is expected to last at least 12 months or result in death.¹ Indiana is a “1634 state,” which means it accepts SSA disability determinations without a separate state medical review. If your SSA application or appeal is still pending, the state’s Medical Review Team can issue a provisional disability determination so coverage can begin, and the SSA’s final decision later overrides it.² If you already receive Supplemental Security Income (SSI), you are automatically enrolled in Indiana Medicaid.

Monthly income limits for ABD Medicaid as of March 2026, calculated on pre-tax income:

1 person: $1,330
2 people: $1,803.33
3 people: $2,276.67
4 people: $2,750
5 people: $3,233.33

If you are institutionalized or receive Home and Community-Based Waiver services, a higher individual limit of $2,982 per month applies, and only your own income counts.¹

Asset limits are strict: $2,000 for a single person, $3,000 for a married couple. Countable assets include bank balances, cash, stocks, bonds, and non-primary-residence property. Your primary home, one vehicle, and burial spaces do not count.¹

If Your Income Is Over the Limit: Spend-Down

Indiana doesn’t label a separate “medically needy” program, but it does run a spend-down that works like a monthly medical deductible. If your income exceeds the ABD limit, you can still qualify in any month where your medical expenses close the gap between your income and the Medicaid threshold.³

Qualifying expenses include current medical bills, health insurance premiums, prescription costs, and unpaid balances on past medical bills. You don’t have to pay those bills to count them — you only need to owe the amount and give your caseworker documentation. Old bills count only once. Eligibility is month by month: miss your spend-down in a given month and you have no coverage that month, and missing it three months in a row can get you removed from the program entirely.³ Once you meet your spend-down, the county office issues Form FI 006A confirming eligibility for the rest of that month, and full Traditional Medicaid benefits kick in.⁴

How to Apply

Every applicant files the Indiana Application for Health Coverage through FSSA’s Division of Family Resources (DFR). Three ways to submit:

Online at fssabenefits.in.gov, or through the federal Marketplace at healthcare.gov.
In person at a local DFR office (county locator is on the FSSA site).
By phone at 1-800-403-0864.

Certified navigators can help you through the process. After you submit a complete application with supporting documentation, the state has up to 90 days to decide. You can check status online or by phone using your case number.⁵

What Medicaid Covers and Which Plan You Get

Indiana’s full-benefit Medicaid package (Package A) covers doctor visits, hospital care, mental health and substance use treatment, dental and vision care, prescription and over-the-counter drugs, medical supplies and equipment, physical, occupational, and speech therapy, home health, nursing facility services, hospice, chiropractic, lab and X-ray, family planning, and both emergency and non-emergency transportation. Some services need prior authorization from your primary medical provider or health plan.⁶

Most disabled enrollees receive those benefits through a managed care organization, and which program you join depends on your age and situation:

Hoosier Care Connect covers people age 59 and under who are blind or disabled, not institutionalized, not on a waiver, and not eligible for Medicare. Contracted plans: Anthem, Managed Health Services (MHS), and UnitedHealthcare.
Indiana PathWays for Aging covers people age 60 and older. Contracted plans: Anthem, Humana, and UnitedHealthcare.

You choose a Primary Medical Provider within your plan to coordinate care, referrals, and prior authorizations. If you don’t pick a plan at enrollment, you may be auto-assigned one. You can switch plans during the first 90 days of enrollment, during annual open enrollment, or at any time for “just cause” reasons such as poor quality of care or lack of access.⁷

If you have both Medicare and Medicaid and aren’t on a managed care plan, you generally receive Medicaid through Traditional Medicaid on a fee-for-service basis, because Hoosier Care Connect excludes people eligible for Medicare.⁸ Dual-eligible Hoosiers age 60 and older have another option: PathWays Dual Care, launched January 1, 2026, combines Medicare and Medicaid into a single Fully Integrated Dual Eligible Special Needs Plan through Anthem, Humana, or UnitedHealthcare. Members get one ID card, a single point of contact for appeals, and no out-of-pocket costs for Medicare Part A and Part B services. Enrollment is voluntary and open year-round, and free counseling is available through the Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800.⁹

Working With a Disability: MEDWorks

If you want to work without losing Medicaid, MEDWorks (Medicaid for Employees with Disabilities) lets you keep coverage at higher income levels than standard ABD rules allow.¹⁰ You qualify if you are between 16 and 64, an Indiana resident, have an active SSA disability determination (approved, pending, or on appeal), are employed and earning at least $290 per month, have countable income below 350% of the federal poverty level, and meet the standard asset limits of $2,000 single or $3,000 married. Retirement accounts, a primary home valued under $713,000, one vehicle of any value, and ABLE accounts don’t count toward assets.¹¹

MEDWorks calculates earned income favorably: $65 is subtracted from gross earnings, any Impairment Related Work Expenses come off, and the remainder is divided in half. Unearned income gets a $20 monthly deduction. A spouse’s income is excluded for initial eligibility but factored into premium calculations.

Monthly premiums are tiered. At or below 149% FPL, you pay nothing. At the top tier (301%–350% FPL), premiums reach $161 for a single person or $218 for a married person. If you already receive long-term services and supports Medicaid, the transition to MEDWorks is automatic once your employment income pushes you above 100% FPL, as long as you earn at least $290 per month. Any change in employment must be reported to FSSA within 10 days.¹¹

Waivers for Home and Community Services

Indiana runs several Medicaid waivers that pay for services letting people with disabilities live at home instead of in a nursing facility. Waivers are not entitlements. Slots are capped and waiting lists are common.

Health and Wellness Waiver and PathWays for Aging Waiver

On July 1, 2024, Indiana split the old Aged and Disabled (A&D) waiver into two age-based programs. The Health and Wellness (H&W) Waiver, run by the Division of Disability and Rehabilitative Services, serves people age 59 and under. The Indiana PathWays for Aging Waiver, run by the Office of Medicaid Policy and Planning, serves people 60 and older.¹²

Both require you to be aged, blind, or disabled, to have income no greater than 300% of the maximum SSI amount (currently $2,982 per month), and to meet a nursing facility level of care. The level-of-care determination is made initially by a local Area Agency on Aging (AAA), with annual reviews by a waiver case manager. Nursing facility level of care generally means an unstable or complex medical condition requiring hands-on assistance, medical equipment like a ventilator, or ongoing medical observation.

Services under both waivers include attendant care, adult day services, assisted living, adult family care, structured family caregiving, home and vehicle modifications, home-delivered meals, respite care, personal emergency response systems, pest control, specialized medical equipment and supplies, transportation, nutritional supplements, and community transition support. Everything is documented in an individualized Plan of Care developed with a case manager. For PathWays, people ages 60–64 must have a verified disability; those 65 and older do not.¹³ To apply, contact your local AAA to start the waiver process and submit a separate Medicaid application at the same time.¹²

CIH and Family Supports Waivers

The Community Integration and Habilitation (CIH) waiver and Family Supports (FS) waiver serve children and adults with intellectual and developmental disabilities, administered by the Bureau of Disabilities Services (BDS). You apply through the BDS Gateway online portal or by paper application to a local BDS field office.¹⁴

Both waivers reached maximum capacity in December 2025. As of early 2026, new applicants are placed on a waiting list, with no new slots expected until at least July 1, 2026. One source reported that as of mid-2025, roughly 5,470 people were waiting for HCBS waiver slots and 7,895 were waiting for PathWays for Aging waiver slots. You can track waitlist status through an online dashboard maintained by BDS.¹⁵

Major changes take effect in August 2026. Amendments to CIH and FS cap paid caregiving by legally responsible individuals, parents of minor children, and spouses at 40 hours per week combined, and cap services provided by other relatives and legal guardians at 40 hours per week per waiver participant. The amendments also include a “live-in caregiver rate reduction” for residential habilitation and support services, though specific dollar amounts have not been published. The state has described these as preparation for a broader “waiver reset.” Disability service providers and advocates have argued the changes risk destabilizing home-based care and pushing families toward institutional placements.¹⁶¹⁷

The number of approved Case Management Organizations for CIH and FS has been cut to five: AIHS, IPMG, Inspire Case Management, The Columbus Organization, and Unity of Indiana. Anyone assigned to a non-continuing organization had to choose a new provider by July 15, 2026, or be reassigned automatically.¹⁵

Work Requirements and Redeterminations in 2026 and 2027

Federal Medicaid work requirements take effect January 1, 2027, under the One Big Beautiful Bill Act. Medicaid expansion enrollees ages 19 to 64 will be required to spend at least 80 hours per month working, in a work program, in school, or volunteering.¹⁸ The law exempts people classified as “medically frail,” which includes those who are blind or disabled under the Social Security Act’s definition, people with disabling mental disorders, serious or complex medical conditions, and physical, intellectual, or developmental disabilities that significantly impair activities of daily living.¹⁹

A new CMS rule has narrowed how that exemption works. States can no longer grant blanket exemptions for conditions like HIV or cancer; affected individuals must demonstrate that their condition is severe enough to prevent 80 hours of monthly work. Health advocates have warned that case-by-case verification could cause significant coverage losses among people who struggle to navigate documentation.²⁰

State legislation (Senate Enrolled Act 1) requires FSSA to check enrollee compliance at least quarterly, and federal rules have shortened redetermination cycles for Healthy Indiana Plan members to every six months, up from annually. FSSA announced in April 2026 it was hiring 400 new eligibility checkers to handle the workload.¹⁸ More frequent income checks have already produced steep enrollment declines: approximately 400,000 Hoosiers lost Medicaid coverage since early 2025, which state officials described as nearly $400 million in savings. The Indiana Hospital Association reported a 17% increase in emergency department visits between January and August 2025, with a rise in patients lacking health coverage.²⁰

Practical takeaway: keep your contact information current with DFR, respond to every redetermination notice promptly, and if you believe you qualify as medically frail, be prepared to document it.

If You’re Denied: Appeals

You have the right to appeal any decision about your eligibility or coverage at no cost. The process depends on what you’re challenging. For eligibility denials or changes, follow the instructions on the notice you received from the Division of Family Resources. For coverage disputes inside a managed care plan like Hoosier Care Connect, contact the health plan directly and use its internal appeal process first.²¹

Appeals generally must be filed within 33 days of the date on the denial notice. Filing within 10 days, or before the effective date of a coverage change, may let you keep benefits during the appeal. You can submit by mail, fax, or in person at a DFR office using State Form 53932 or a written letter. The state will contact you for a pre-hearing conference, and a formal hearing is conducted by an Administrative Law Judge by phone or in person.²²

Free legal help is available through Indiana Legal Services (intake at 844-243-8570 or indianalegalservices.org), and the ABA Free Legal Answers program offers online help. Certified navigators at hospitals, nonprofits, and health centers can assist with both applications and appeals. For broader disability advocacy, Indiana Disability Rights is the state’s federally mandated Protection and Advocacy system and handles information and referrals across programs covering developmental disabilities, mental illness, assistive technology, and Social Security benefits.²³ Families navigating CIH and Family Supports waiver issues can also turn to Arc of Indiana for current policy and waitlist guidance.¹⁵

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2
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Indiana Capital Chronicle. FSSA Hiring 400 Medicaid Eligibility Checkers Ahead of Work Requirements
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