Disability Medicaid in Indiana: Eligibility, Waivers, and PathWays

If you have a disability in Indiana, you can get Medicaid through the state’s Aged, Blind, and Disabled (ABD) category if you meet the Social Security Administration’s disability definition and fall within the income and asset limits. Disability Medicaid in Indiana also includes home and community-based waivers, a buy-in program called MEDWorks for people who work, and an integrated plan for those who have both Medicare and Medicaid. The rules are tightening: federal work requirements begin January 1, 2027, and Indiana has already shortened eligibility recheck cycles.

Who Qualifies

To qualify under the ABD category, you must meet the SSA’s definition of disability — 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

As of March 2026, the monthly pre-tax income limits are:

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’re institutionalized or receiving Home and Community-Based Waiver services, a higher individual limit of $2,982 per month applies, and only your income counts — a spouse’s or other household member’s income is excluded.¹

Asset limits are $2,000 for a single person and $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 are exempt.¹

If you receive Supplemental Security Income (SSI), you’re automatically enrolled in Indiana Medicaid. Indiana is a “1634 state,” which means it accepts all SSA disability determinations without a separate state medical review. If your SSA application is pending or on appeal, the state’s Medical Review Team can issue a provisional disability determination so coverage can start while the federal decision is pending. Once SSA issues a final decision, it overrides any state provisional finding.²

If Your Income Is Too High: Spend-Down

Indiana lets people over the income limit qualify through a spend-down that works like a monthly medical deductible.³

Your spend-down amount is the difference between your monthly income and the Medicaid income limit. Qualifying expenses include current medical bills, health insurance premiums, prescription costs, and unpaid balances from past medical bills. You don’t have to pay the bills — you only need to owe the amount and give documentation to your caseworker. Old bills can only be counted once. Eligibility is determined month by month: if you don’t meet your spend-down in a given month, you have no Medicaid coverage that month, and failing to meet it for three consecutive months can result in removal from the program.³

Once you meet your spend-down, the county office issues a notice (Form FI 006A) confirming eligibility for the rest of that month, and full Traditional Medicaid benefits kick in.⁴

How to Apply

All applicants complete the Indiana Application for Health Coverage, processed by the FSSA’s Division of Family Resources (DFR). You have three ways to submit it:

Online through the FSSA benefits portal at fssabenefits.in.gov or through the federal Health Insurance Marketplace at healthcare.gov.
In person at a local DFR office, searchable by county on the FSSA website.
By phone at 1-800-403-0864.

Certified navigators can help with the process at no cost. Once you submit a complete application with documentation, it can take up to 90 days for the state to determine eligibility. You can check your status online or by phone using your case number.⁵

What’s Covered and Which Plan You Get

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

Most disabled enrollees receive care through a managed care organization rather than fee-for-service. The specific program depends on your age and situation:

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

You must choose a Primary Medical Provider within your plan to coordinate care, referrals, and prior authorizations. If you don’t select a plan during enrollment, one may be auto-assigned. 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 to necessary services.⁷

Dual-eligible individuals who have Medicare and Medicaid but aren’t on a managed care plan generally receive Medicaid through Traditional fee-for-service, because Hoosier Care Connect excludes people eligible for Medicare.⁸

Working With a Disability: MEDWorks

MEDWorks (Medicaid for Employees with Disabilities) lets you hold a job without losing Medicaid coverage.⁹

To qualify, you must be between 16 and 64, an Indiana resident, have an active SSA disability determination (approved, pending, or on appeal), be 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 the asset limit.¹⁰

The earned income calculation is favorable: $65 is subtracted from gross earnings, any Impairment Related Work Expenses are deducted, and the remainder is divided in half. Unearned income gets a $20 monthly deduction. A spouse’s income doesn’t count for initial eligibility but is factored into premium calculations.¹⁰

Monthly premiums are tiered by income as a percentage of the federal poverty level. People at or below 149% FPL 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 have long-term services and supports Medicaid, the transition to MEDWorks is automatic once employment income pushes you above 100% FPL, provided you earn at least $290 per month. Any change in employment must be reported to FSSA within 10 days.¹⁰

Home and Community-Based Waivers

Indiana operates several Medicaid waivers that fund services allowing people with disabilities to live in the community rather than in a nursing facility or institution. Waivers are not entitlements. Slots are limited, and waiting lists are common.

Health and Wellness Waiver and PathWays for Aging Waiver

On July 1, 2024, Indiana split its longstanding Aged and Disabled waiver into two age-based programs. The Health and Wellness (H&W) Waiver, administered by the Division of Disability and Rehabilitative Services, serves people age 59 and under. The Indiana PathWays for Aging Waiver, administered by the Office of Medicaid Policy and Planning, serves people 60 and older.¹¹

Both waivers require you to be aged, blind, or disabled, have income no greater than 300% of the maximum SSI amount (currently $2,982 per month), and 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 direct hands-on assistance, medical equipment such as a ventilator, or ongoing medical observation.¹¹

Covered services 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. All services go into an individualized Plan of Care developed with a case manager.¹¹

For the PathWays waiver, people ages 60–64 must have a verified disability, while those 65 and older do not.¹² To apply, contact your local AAA to begin the waiver process while separately completing a Medicaid application.¹¹

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. Both are administered by the Bureau of Disabilities Services (BDS). You can apply through the BDS Gateway online portal or with a paper application to a local BDS field office.¹³

Both waivers reached maximum capacity in December 2025. As of early 2026, new applicants go on a waiting list, and no new slots are expected until at least July 1, 2026. Arc of Indiana reported that as of mid-2025, approximately 5,470 people were waiting for HCBS waiver slots and 7,895 for PathWays for Aging waiver slots. Waitlist status can be tracked through an online dashboard maintained by BDS.¹⁴

Significant changes to the CIH and Family Supports waivers take effect in August 2026. The amendments 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 described these changes as preparation for a broader “waiver reset.”¹⁵ Disability service providers and advocates have argued that cutting caregiver hours and pay in a thin labor market risks destabilizing home-based care and pushing families toward more expensive institutional placements.¹⁶

The number of approved Case Management Organizations for CIH and FS waivers has also been reduced to five: AIHS, IPMG, Inspire Case Management, The Columbus Organization, and Unity of Indiana. Individuals assigned to a non-continuing organization had to choose a new provider by July 15, 2026, or face automatic reassignment.¹⁴

PathWays Dual Care for People With Medicare and Medicaid

On January 1, 2026, Indiana launched PathWays Dual Care, which combines Medicare and Medicaid into a single plan for people age 60 and older who qualify for both. The program uses Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs) contracted through Anthem, Humana, and UnitedHealthcare.¹⁷

Members get one ID card, one point of contact for appeals and grievances, and a care coordinator with an interdisciplinary team. The plans eliminate out-of-pocket costs for Medicare Part A and Part B, meaning no copayments, premiums, or deductibles for covered services. Beyond standard medical, behavioral health, and pharmacy benefits, the FIDE SNPs offer enhanced services that vary by plan, including home-delivered meals, fresh food delivery, fitness memberships, home safety kits, up to $5,000 in transition assistance for people moving out of nursing facilities, enhanced dental and vision allowances, and personal emergency response systems.¹⁷

Enrollment is voluntary and open year-round. Free counseling is available through the Indiana State Health Insurance Assistance Program (SHIP) at 1-800-452-4800.¹⁷

Work Requirements and Recheck Changes

Federal Medicaid work requirements take effect on January 1, 2027, following passage of 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, attending school, or volunteering.¹⁸

The federal law exempts people classified as “medically frail,” a category that includes people who are blind or disabled under the Social Security Act’s definition, those with disabling mental disorders, serious or complex medical conditions, and physical, intellectual, or developmental disabilities that significantly impair activities of daily living.¹⁹ A newer rule from the Centers for Medicare and Medicaid Services has narrowed how states apply the exemption. CMS now prohibits states from providing blanket exemptions for people with conditions such as HIV or cancer; affected individuals must demonstrate that their condition is severe enough to prevent them from working 80 hours per month.²⁰

Indiana has added state-level rules on top. 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 that it was hiring 400 new employees to serve as eligibility checkers.¹⁸ Practically, that means keeping your address current with DFR, responding promptly to any notices, and being ready to document your disability status if you receive one.

Appealing a Denial

You have the right to appeal any decision about your eligibility or coverage at no cost. The process depends on the decision. For eligibility denials or changes, follow the instructions on the notice from the Division of Family Resources. For coverage disputes within a managed care plan such as Hoosier Care Connect, contact the health plan directly and follow its internal appeal process.²¹

Appeals must generally 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 continue receiving benefits during the appeal. You can submit appeals 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 either by phone or in person.²²

Where to Get Help

Free legal help on Medicaid denials, spend-down calculations, and appeals is available through Indiana Legal Services (intake 844-243-8570, indianalegalservices.org), and the ABA Free Legal Answers program offers online assistance. Certified navigators located at hospitals, nonprofits, and health centers can also help with both applications and appeals.²²

For disability-specific advocacy, Indiana Disability Rights is the state’s federally mandated Protection and Advocacy system and provides information and referrals across programs covering developmental disabilities, mental illness, assistive technology, and Social Security benefits.²³ Arc of Indiana tracks waiver policy changes and publishes waitlist updates for families navigating CIH and Family Supports waivers.¹⁴

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2
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3
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4
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Indiana FSSA. CIH Fact Sheet – Proposed Changes August 2026
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Indiana Medicaid. PathWays Dual Care
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SHVS. State Considerations When Defining Medical Frailty
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