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Elder care in Indiana
Do I (or a relative) qualify for Medicaid? Quick check
Answer yes or no to each question for a rough first answer. The figures are Indiana's.
Under each question: what a yes and a no mean.
Not legal advice. Figures are for 2026. The final decision is the state's: Indiana Family and Social Services Administration (FSSA), Division of Family Resources (eligibility) / Office of Medicaid Policy and Planning. The requirements in full: Qualifying for Medicaid in Indiana.
Check these first
Estate recovery reaches joint accounts, POD accounts, post-2002 joint real estate and revocable trusts
Indiana's estate recovery is expanded: FSSA can recover from bank accounts with a payable-on-death beneficiary or a joint owner, real estate passing by joint tenancy with survivorship created after June 30, 2002, revocable-trust assets added after May 1, 2002, and leftover Miller-trust and funeral-trust money. Adding a child to the deed or the account does not shield it. A life estate is listed as not recoverable, but giving away the remainder is still a transfer under the 60-month lookback.
Source and quote
regardless if the account has a payable on death provision or has a joint owner
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Income over $2,982/month means a Miller trust, funded every month
Indiana is an income-cap state. Anyone whose gross income exceeds the $2,982 (2026) Special Income Level must set up a Qualified Income Trust and deposit at least the excess every month into a separate, non-commingled account. Missed or short deposits can cost eligibility for that month. Whatever remains at death goes to the State up to Medicaid paid.
Source and quote
IHCPPM 2615.75.15
A Miller trust must be funded at least each month in the amount of the beneficiary's monthly income exceeding the SIL.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Caregiver agreements: must be written, notarized up front, logged, at fair market value; lump sums are penalized
For applications on/after July 26, 2024, paying a family caregiver is only an allowable transfer if the agreement is written, lists services, rate and providers, is signed and notarized when made, and detailed logs are kept, unless payments were made contemporaneously (checks/bank records). Lump-sum payments for past or future care, retroactive agreements, 'on call' time, and more than 16 hours/day per caregiver are not valid and can trigger a transfer penalty. Agreements must be produced at application even if unpaid.
Source and quote
IHCPPM 2640.10.20.20
Lump sum payments for past or future services are not valid and may result in a transfer of property penalty.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Penalty divisor jumps every July 1 and is locked by the application date
Indiana divides uncompensated transfers by the average private-pay nursing facility rate in effect on the APPLICATION date: $7,651 for applications filed 7/1/2025-6/30/2026 and $8,027 from 7/1/2026. A $100,000 gift therefore costs about 12.5 months of ineligibility if you apply now. The penalty only starts once the person is otherwise eligible (assets spent down and in care), so gifting then applying leaves the family paying privately during the penalty. Indiana does allow a $1,200/year de minimis gift allowance to relatives or charities.
Source and quote
IHCPPM 3006.00.00
This amount is in effect for applications filed on and after July 1, 2026.
Source page · Agency guidance · as of 2026-07-01 · retrieved 2026-11-04
Waiver waitlists: over 12,000 waiting for the PathWays waiver
Being eligible for Medicaid and PathWays for Aging does not mean in-home waiver services start: as of October 2026, 12,680 people were on the PathWays waiver waitlist and 7,141 on the Health and Wellness waiver waitlist. People leaving a nursing facility or hospital, or on CHOICE, get priority invitations. Families planning for in-home care should get on the list (level-of-care assessment) early since others are invited by assessment date.
Source and quote
As of October 2026 there are 12,680 individuals on the PathWays Medicaid Waiver Waiting List.
Source page · Agency guidance · as of 2026-10 · retrieved 2026-11-04
Adult children can be sued, or prosecuted, for not supporting an indigent parent
Indiana keeps both a civil filial-support law (IC 31-16-17; suit can be filed by the parent, township trustee, or the Division of Family Resources) and a criminal statute making knowing nonsupport of a parent who cannot support himself a Class A misdemeanor. Defenses exist if the parent did not support the child as a minor or the child cannot afford it. Enforcement appears rare, but signing nursing-home admission papers as 'responsible party' adds separate contractual risk.
Source and quote
IC 35-46-1-7
A person who knowingly or intentionally fails to provide support to his parent,
Source page · Secondary source · as of 2026 · retrieved 2026-11-04
Estate recovery bill includes PathWays managed-care premiums, not just care received
The State's claim includes monthly capitation payments made to PathWays/Hoosier Care Connect health plans, so heirs can face a claim even for months when little care was used. The claim keeps growing for up to 180 days after death as providers bill. Hardship waivers must be filed within 90 days of the claim notice.
Source and quote
IHCPPM 4705.00.00
This includes any capitation payments made on behalf of the recipient.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
New Medigap birthday rule only lets you switch companies, same letter plan
Since 1-1-2026 Indiana Medigap holders 65+ can change insurers without health questions around their birthday each year, but only to the SAME lettered plan (e.g., G to G). It does not let Medicare Advantage members return to Medigap, and does not apply to under-65 Medigap holders. People who chose Medicare Advantage at 65 and later want Medigap can still be denied.
Source and quote
This does not allow someone on a Medicare Advantage plan guaranteed rights to join a Medigap.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
At a glance
Calculators for Indiana Compare states
Common mistakes
Families most often lose coverage over these mistakes. They apply in every state.
1. Moving money out of the account or giving it to the children
You can't simply give money away (or move it to a child's account) to get under the asset limit. Any transfer for less than fair market value within the 60-month look-back makes the person ineligible for nursing-home and waiver coverage for a penalty period: the total given away divided by the state's penalty divisor (its average monthly private-pay nursing-home cost).
Worked example for Indiana
Giving away $50,000 in Indiana ≈ 6.23 months without nursing-home coverage
$50,000 ÷ $8,027 a month (the penalty divisor). The penalty starts only once the person is otherwise eligible (see the next mistake).
Source and quote
IHCPPM 3006.00.00
The average monthly private pay rate for nursing facilities in the statewide geographic region to be used in computing transfer penalties as explained in Section 2640.10.35 is $8,027. This amount is in effect for applications filed on and after July 1, 2026.
Source page · Agency guidance · as of 2026-07-01 · retrieved 2026-11-04
Divisor changes each July 1 and is fixed by the APPLICATION date, not the transfer date. Applications filed 7-1-25 through 6-30-26 use $7,651. Penalties can end mid-month (partial months, 30.42 days/month).
Source and quote
42 U.S.C. 1396p(c)(1)(A)
disposes of assets for less than fair market value on or after the look-back date specified in subparagraph (B)(i), the individual is ineligible for medical assistance
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(1)(E)(i)
the total, cumulative uncompensated value of all assets transferred by the individual (or individual's spouse) on or after the look-back date specified in subparagraph (B)(i), divided by (II) the average monthly cost to a private patient of nursing facility services in the State
Source page · Official code · as of current statute · retrieved 2026-11-04
2. Giving money away first, then spending the rest down
The penalty clock doesn't start on the day of the gift. It starts only when the person is in a nursing home (or needs that level of care), has spent down to the asset limit, has applied, and would be approved but for the penalty. So giving money away and then spending down is the worst order: the penalty starts exactly when there is no money left to pay the nursing home.
Source and quote
42 U.S.C. 1396p(c)(1)(D)(ii)
the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later
Source page · Official code · as of current statute · retrieved 2026-11-04
3. Adding a child to the bank account
Putting a child's name on the account doesn't protect the money: the whole joint account is generally counted as the applicant's. And when the child (or anyone) takes money out, that can count as a transfer by the applicant, with a penalty.
Source and quote
SSA POMS SI 01140.205C.2
When a claimant or recipient co-owns an account with someone who is not eligible for SSI benefits, we assume that all the funds in the account belong to the SSI claimant or recipient.
Source page · Agency guidance · as of 2023-12-27 · retrieved 2026-11-04
SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.
Source and quote
42 U.S.C. 1396p(c)(3)
the asset (or the affected portion of such asset) shall be considered to be transferred by such individual when any action is taken, either by such individual or by any other person, that reduces or eliminates such individual's ownership or control of such asset.
Source page · Official code · as of current statute · retrieved 2026-11-04
4. Paying family for care without a written agreement
Relatives can be paid for caregiving, but care given for free is presumed to have been free. Paying a child afterwards for past care, or paying without a written agreement made at the time the care was given, is treated as a gift. Put a written agreement in place before the care starts, pay a fair market rate as the care is given, and keep records.
Source and quote
CMS State Medicaid Manual § 3258.1.A.1 (Rev. 64)
Also, while relatives and family members legitimately can be paid for care they provide to the individual, HCFA presumes that services provided for free at the time were intended to be provided without compensation. Thus, a transfer to a relative for care provided for free in the past is a transfer of assets for less than fair market value. However, an individual can rebut this presumption with tangible evidence that is acceptable to the State. For example, you may require that a payback arrangement had been agreed to in writing at the time services were provided.
Source page · Agency guidance · as of 1994-11 · retrieved 2026-11-04
CMS State Medicaid Manual, Chapter 3 (download p45_03.zip, file "sm 03 3 325 to 3259.8.doc"), Transmittal 64, November 1994. Still the posted federal manual; many states have since adopted stricter written personal-care-agreement rules, so check the state.
5. Giving away or underselling the home
Deeding the house to the kids, or selling it to them for less than it's worth, is a transfer with a penalty. The only home transfers that are allowed without penalty are to: a spouse; a child under 21 or a blind or disabled child; a sibling with an equity interest who lived there at least a year before the move to a nursing home; or a son or daughter who lived there at least two years and whose care kept the parent out of a nursing home.
Source and quote
42 U.S.C. 1396p(c)(2)(A)
(A) the assets transferred were a home and title to the home was transferred to— (i) the spouse of such individual; (ii) a child of such individual who (I) is under age 21, or (II) (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(2)(A)(iv)
a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility
Source page · Official code · as of current statute · retrieved 2026-11-04
6. Annuities, promissory notes and life estates that don't meet the rules
Buying an annuity, lending money to family on a note, or buying a life estate in a child's home all count as gifts unless they meet strict federal rules: annuities must name the state as remainder beneficiary and be irrevocable, non-assignable, actuarially sound and paid in equal amounts; notes must be actuarially sound, paid in equal amounts and not forgiven at death; a life-estate buyer must live in the home for at least a year after buying.
Source and quote
42 U.S.C. 1396p(c)(1)(F)
the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless— (i) the State is named as the remainder beneficiary in the first position
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(1)(I)
the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(1)(J)
the term "assets" includes the purchase of a life estate interest in another individual's home unless the purchaser resides in the home for a period of at least 1 year after the date of the purchase.
Source page · Official code · as of current statute · retrieved 2026-11-04
7. Forgetting estate recovery after death
After a person who got Medicaid at 55 or older dies, the state must try to recover what it paid for nursing-home and home-care services from the estate, usually the house. Recovery waits while a spouse, a child under 21 or a blind or disabled child survives. Some states also reach assets that skip probate (joint accounts, life estates, living trusts).
Source and quote
42 U.S.C. 1396p(b)(4)(B)
any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
Medicaid.gov, Estate Recovery
For individuals age 55 or older, states are required to seek recovery of payments from the individual's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services.
Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04
8. Missing records for the look-back
States typically ask for up to five years (60 months) of statements for every account, including closed ones. Money that left an account for less than fair value is presumed to be a penalized transfer unless you can show what it was for, so withdrawals you can't explain can be treated as gifts. Keep receipts and statements from the start.
Source and quote
Oklahoma Human Services, Long-Term Care
We will need the last sixty (60) months of statements on all accounts held in the past 60 months. If any asset has been sold, traded, or given away within the last 60 months prior to entry into the nursing home and application for Medicaid, we will require documentation of the transfer.
Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04
A state example, not a federal rule: we found no federal source setting how many months of statements states must request. Other states ask similar.
Source and quote
Ohio Adm.Code 5160:1-6-06(B)
any such transfer will be presumed an improper transfer and will result in a restricted medicaid coverage period (RMCP)
Source page · Official regulation · as of 2025-10-01 · retrieved 2026-11-04
A state example of how agencies treat transfers they can't verify.
Source and quote
42 U.S.C. 1396p(c)(2)(C)
a satisfactory showing is made to the State (in accordance with regulations promulgated by the Secretary) that (i) the individual intended to dispose of the assets either at fair market value, or for other valuable consideration, (ii) the assets were transferred exclusively for a purpose other than to qualify for medical assistance
Source page · Official code · as of current statute · retrieved 2026-11-04
In Indiana specifically
- Estate recovery reaches joint accounts, POD accounts, post-2002 joint real estate and revocable trusts
- Income over $2,982/month means a Miller trust, funded every month
- Caregiver agreements: must be written, notarized up front, logged, at fair market value; lump sums are penalized
- Penalty divisor jumps every July 1 and is locked by the application date
- Waiver waitlists: over 12,000 waiting for the PathWays waiver
- Adult children can be sued, or prosecuted, for not supporting an indigent parent
- Estate recovery bill includes PathWays managed-care premiums, not just care received
- New Medigap birthday rule only lets you switch companies, same letter plan
Details and sources are in the cards at the top of this page.
What is allowed instead
Spend at fair market value, on the person who needs care
Money spent on the applicant and for full value is not a gift: paying the nursing home, paying debts, buying things the applicant needs. Keep receipts.
Source and quote
42 U.S.C. 1396p(c)(2)(C)
the individual intended to dispose of the assets either at fair market value, or for other valuable consideration
Source page · Official code · as of current statute · retrieved 2026-11-04
Pay bills and care costs, prepay the funeral
Over-limit money can go to the cost of care, to bills the person owes, and to prepaying their funeral, as long as nothing is given away or sold for less than it's worth.
Source and quote
Maryland Department of Health, Some Questions and Answers about Financial Eligibility (nursing home)
Resources over the $2,500 limit may be used in several ways as long as they are not given away or exchanged for something of lesser value. For example, you may use your excess resources to pay for the cost of care in the nursing home, to pay other bills that you may have, or to prepay your funeral expenses.
Source page · Agency guidance · as of 2006 · retrieved 2026-11-04
A state example (2006 publication; the $2,500 figure is Maryland's and dated). The principle (spending for fair value) is federal: 42 U.S.C. 1396p(c)(2)(C).
An irrevocable prepaid funeral
A prepaid funeral contract that can't be cancelled or sold doesn't count as an asset (a revocable one does, above small burial-fund limits). States set the maximum that can be made irrevocable.
Source and quote
SSA POMS SI 01130.420B.2
If a burial contract cannot be revoked and cannot be sold without significant hardship, it is not a resource.
Source page · Agency guidance · as of 2011-06-17 · retrieved 2026-11-04
SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.
Things that don't count: the home, one car, household goods
The home the person lives in (up to the equity cap), one car used for transportation, and household goods are excluded. Spending countable cash at fair value on these (for example, repairs or accessibility changes to the home the person lives in, or replacing the one car) generally turns it into an excluded asset. Check the state's rules before a large purchase.
Source and quote
20 CFR 416.1210(a)-(c)
(a) The home (including the land appertaining thereto) to the extent its value does not exceed the amount set forth in § 416.1212; (b) Household goods and personal effects as defined in § 416.1216; (c) An automobile, if used for transportation, as provided in § 416.1218
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Text read through the eCFR API (ecfr.gov), current as of 2026-11-02. SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.
Pay medical bills
Unpaid and current medical bills the person owes can use up excess resources. Some states count them directly against the excess.
Source and quote
New York State Department of Health, LDSS-4321 attachment (11 ADM-4)
you may be eligible for Medicaid coverage if you have medical bills that are equal to or higher than the amount of your excess resources, or if you spend excess resources on certain expenses set aside for your and your spouse’s burial.
Source page · Agency form · as of 2011-07 · retrieved 2026-11-04
A state example (New York notice language, 2011).
Transfers to a spouse
Moving assets to a spouse (or to someone else for the spouse's sole benefit) is not penalized. It doesn't hide them at application, because both spouses' assets are counted together, but after approval the at-home spouse can keep the protected share (CSRA).
Source and quote
42 U.S.C. 1396p(c)(2)(B)(i)
were transferred to the individual's spouse or to another for the sole benefit of the individual's spouse
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396r-5(f)(1)
An institutionalized spouse may, without regard to section 1396p(c)(1) of this title, transfer an amount equal to the community spouse resource allowance (as defined in paragraph (2)), but only to the extent the resources of the institutionalized spouse are transferred to (or for the sole benefit of) the community spouse.
Source page · Official code · as of current statute · retrieved 2026-11-04
Who to call
- Medicaid agency
Indiana Family and Social Services Administration (FSSA), Division of Family Resources (eligibility) / Office of Medicaid Policy and Planning (Indiana Health Coverage Programs (Medicaid); Indiana PathWays for Aging (managed LTSS, age 60+)) - Free Medicare counseling (SHIP)
Indiana SHIP (State Health Insurance Assistance Program), Indiana Department of Insurance · 1-800-452-4800 - Aging services
FSSA Division of Disability, Aging and Rehabilitative Services (DDARS) - Insurance regulator
Indiana Department of Insurance (IDOI)
Eligibility figures and notes
Source and quote
IHCPPM 2615.75.15
A Miller Trust (or Qualified Income Trust (QIT)) is a unique trust that allows persons residing in long-term care facilities, PACE members or receiving home-and- community-based-services through a 1915(c) waiver (see IHCPPM sections 3305.00.00 and 3320.10.00) who have personal income above the Special Income Level (SIL) (see IHCPPM sections 3455.14.00 and 3010.20.15) to be considered Medicaid eligible.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Indiana uses the 300% SSI Special Income Level for institutional/PACE/waiver eligibility; income above it requires a Miller trust. No medically-needy spend-down path for LTC was found in the manual sections reviewed (Indiana converted to 1634 status in 2014; not separately verified from an official page here).
Source and quote
IHCPPM 3010.20.15
The Special Income Level (SIL) used in determining eligibility for Institutional Residents, PACE members and for certain HCBS waivers is 300% of the SSI Maximum Benefit Rate. Effective 1-1- 26, the SIL is $2982
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
IHCPPM 2615.75.15
A Miller trust must be funded at least each month in the amount of the beneficiary's monthly income exceeding the SIL.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Trust may be revocable or irrevocable; funds must be in a separate, non-commingled account; State is remainder beneficiary up to Medicaid paid.
Source and quote
IHCPPM 3005.10.00
$2000 for an applicant/member, who is single or whose spouse qualifies as a "community spouse". For those in an institution, PACE members or on an HCBS waiver, MCCA rules apply.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
IHCPPM 3005.10.00
Leo and Ann have both applied for Medicaid. Leo is in a nursing facility and Ann has an approved HCBS waiver. They are both applying for Med 1. Both Leo and Ann would have a combined $3000 resource limit.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Manual Example 1 also says that when both spouses apply but one is a community spouse, after the 90-day protective period each has a $2,000 limit.
Source and quote
IHCPPM 3010.20.10; IC 12-15-7-2; 405 IAC 2-3-17
Effective 7-1-02 ($50 effective 7-1-99) this is the minimum amount allowed for all applicants/members.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Text extraction renders the bullet as "$525" because superscript footnote 5 (IC 12-15-7-2; 405 IAC 2-3-17) is appended to "$52". Value $52 is the nursing-facility PNA, unchanged since 7-1-02. For HCBS waiver members the PNA equals the SIL ($2,982 in 2026).
Source and quote
IHCPPM 3005.10.05
An applicant will be ineligible for long-term care services, if the applicant’s equity interest in the real property is greater than $752,000 effective 1/1/2026.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Indiana uses the federal minimum home-equity figure. Does not apply if spouse, child under 21, or blind/disabled child lawfully resides in the home (IHCPPM 2640.10.15.06). Equity is measured using the most current property tax assessment unless an arm's-length appraisal is submitted.
Source and quote
IHCPPM 2620.15.10
Such property remains exempt until it is verified that none of the people listed above intends to reside there or is physically able to reside there.54 Whenever there is a conflict between an individual's stated intent to return home and their apparent physical capability to do so, the worker is to obtain documentation from the individual's physician.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
IHCPPM 2640.10.20.20; 2615 AVS sections
All agreements must be sent to PAL for review. If there is an agreement in place, even if it has not been paid, it must be provided at the time of application for review.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Processing-time standards (45/90 days) and the number of retroactive months were not verified from an Indiana page.
Protecting the spouse at home
Source and quote
IHCPPM 2635.10.10.05
a "spousal share" for the community spouse, equaling one-half of the couple's combined countable resources, is then established for use in determining the institutionalized spouse's resource eligibility.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Snapshot taken as of the beginning of the first continuous period of institutionalization. CSRA = greatest of state standard ($32,532), spousal share up to $162,660, court order, or ALJ amount.
Source and quote
IHCPPM 3005.10.00
The state standard of $32,532 effective 1/1/26
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Equals the federal 2026 minimum.
Source and quote
IHCPPM 3005.10.00
The spousal share, up to a maximum of $162,660 effective 1/1/26
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
IHCPPM 3010.20.10
Spousal Income Standard -- $2705 effective 7-1-26 ($2644 effective 7-1-25;
Source page · Agency guidance · as of 2026-07-01 · retrieved 2026-11-04
Shelter standard $812 effective 7-1-26. Jan-Jun 2026 the figure was $2,644.
Source and quote
IHCPPM 3010.20.10
Maximum Maintenance Standard – $4,067 effective 1-1-26
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Indiana rounds the federal $4,066.50 to $4,067.
Gifts, the look-back and the penalty
Source and quote
IHCPPM 2640.10.10
Upon November 1, 2014, the review period for looking at a transfer involving non-trust property is 60 months prior to the first date when the individual was institutionalized and had applied for Medicaid and continues indefinitely thereafter (referred to as the baseline date).
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Baseline date requires BOTH an application and institutionalization/PACE/HCBS waiver services.
Source and quote
IHCPPM 3006.00.00
The average monthly private pay rate for nursing facilities in the statewide geographic region to be used in computing transfer penalties as explained in Section 2640.10.35 is $8,027. This amount is in effect for applications filed on and after July 1, 2026.
Source page · Agency guidance · as of 2026-07-01 · retrieved 2026-11-04
Divisor changes each July 1 and is fixed by the APPLICATION date, not the transfer date. Applications filed 7-1-25 through 6-30-26 use $7,651. Penalties can end mid-month (partial months, 30.42 days/month).
Source and quote
IHCPPM 2640.10.35
The date on which the individual would be otherwise eligible for Long Term Care Services under Medicaid based on an approved application were it not for the imposition of the penalty period, or
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
All improper transfers on/after 11-01-09 are aggregated into one total (IHCPPM 2640.10.35.05).
Source and quote
IHCPPM 2640.10.15, 2640.10.15.05, 2640.10.15.10
This is referred to as the de minimis transfer allowance; the annual amount allowed per year is $1200.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
After death: estate recovery and liens
Source and quote
IC 12-15-9-0.5
regardless if the account has a payable on death provision or has a joint owner
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
FSSA page: estate includes non-probate transfers; real property passing by joint tenancy with right of survivorship if created after June 30, 2002; remaining Miller trust funds; revocable-trust assets transferred in after May 1, 2002; leftover funeral-trust funds. Real property 'subject to a life estate' is NOT recoverable. Recovery is for Medicaid paid after age 55 (all ages for QIT/SNT/pooled trust remainders). Statute IC 12-15-9-0.5(a) (FindLaw copy current as of 1-1-2026) also includes 'any real or personal property conveyed through a nonprobate transfer' and annuity sums for annuities bought after May 1, 2005. Note: IHCPPM 4705.00.00 still says the estate 'does not include property held jointly with rights of survivorship, property held in trust, or life insurance proceeds' — this conflicts with the statute and FSSA page; see openQuestions.
- Tefra liens
- Yes
- Detail
- FSSA may obtain a lien on real property of a recipient residing in a medical institution who cannot reasonably be expected to return home; lien expires unless foreclosure started within 2 years after death; released if recipient returns home.
Source and quote
IC 12-15-8.5-2
from a medical institution and return home, the office may obtain a lien on the Medicaid recipient's real property
Source page · Secondary source · as of 2026 · retrieved 2026-11-04
Statute text read via FindLaw (current as of 1-1-2026); official iga.in.gov is JavaScript-only and could not be fetched. Lien-expiry and release details come from search summaries of IC 12-15-8.5-4/-7/-9, not fetched directly.
Source and quote
IHCPPM 4710.00.00, 4725.10.00; IC 12-15-9-2; 405 IAC 2-8-2
If a spouse survives the recipient, recovery shall be made after the death of the surviving spouse. Only those assets that were included in the recipient’s probate estate are subject to recovery after the surviving spouse’s death.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
An undue hardship does not exist merely because heirs lose an expected inheritance or standard of living.
Source and quote
IHCPPM 4705.00.00, 4715.00.00
Beginning July 1, 2026, the Medicaid Estate Recovery Unit has nine (9) months after the date of death of the decedent to file a claim in a probated estate.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
The FSSA estate recovery web page says the nine-month window began July 1, 2025; the manual says July 1, 2026. Contact: Estate Recovery Unit 877-267-0013, EstateRecovery@fssa.in.gov (per FSSA page summary).
Family liability
Source and quote
IC 35-46-1-7; IC 31-16-17-1
when the parent is unable to support himself, commits nonsupport of a parent, a Class A misdemeanor.
Source page · Secondary source · as of 2026 · retrieved 2026-11-04
FindLaw copies current as of 1-1-2026. IC 31-16-17-1: an adult child 'shall contribute to the support of the individual's parents if either parent is financially unable'. Defenses include that the child was not supported by the parent as a minor, or is unable to provide support. No reported recent enforcement against nursing-home debt found; enforcement frequency not researched.
Care at home and other programs
- PathWays for Aging Medicaid Waiver (age 60+, delivered through PathWays managed care) Waitlist
Home and community-based services for people meeting nursing-facility level of care; reserved capacity for assisted-living residents from 7-1-2025 - Health and Wellness Medicaid Waiver (under 60, aged/disabled; formerly A&D waiver) Waitlist
Home and community-based services for people meeting nursing-facility level of care
Source and quote
As of October 2026 there are 12,680 individuals on the PathWays Medicaid Waiver Waiting List.
Source page · Agency guidance · as of 2026-10 · retrieved 2026-11-04
Health and Wellness waiver waitlist: 7,141 as of October 2026. Priority invitations go to people transitioning from nursing facilities, CHOICE, or hospital discharge; others are invited by original level-of-care assessment date. 39,842 PathWays waiver slots allotted for 7/1/2025-6/30/2026.
Source and quote
designated reserved waiver capacity for individuals residing in assisted living
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Room-and-board exclusion is the general federal HCBS rule; not separately verified on an Indiana page.
Source and quote
PACE serves individuals who: are ages 55 or older; certified by their state to need nursing home care;
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- Participates
- Yes
- Program name
- Indiana Long Term Care Program (ILTCP)
- Detail
- Qualified policies give either Total Asset Protection (if max benefit at least the state-set amount at policy issue) or dollar-for-dollar protection; protected assets are also exempt from estate recovery.
Source and quote
IHCPPM 2615.25.15; IHCPPM 4710.00.00
There are two types of disregards depending on the policy: 1) total asset protection; and 2) dollar-for-dollar asset protection. The available policy disregard is in effect for the lifetime of the member and their spouse.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Indiana's partnership predates the 2005 DRA (original 1993-era program); start year not verified on an official page.
Medicare and Medigap
- Description
- Starting 1-1-2026 (HEA 1226-2025), people 65+ who already have a Medigap policy may switch to the SAME lettered plan at another company, guaranteed issue, from one month before to one month after their birthday each year. Does not apply to Medicare Advantage enrollees or to Medigap holders under 65. Premiums can still vary by age, gender, ZIP, tobacco.
Source and quote
HEA 1226 (2025); reportedly amended by HEA 1260 (2026)
Beginning 1-month before your birthday and lasting until 1-month after your birthday EACH year, you have an opportunity to go from one company's Medigap to another—- guaranteed.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Search results indicated HEA 1260 (2026) changed the window to 31 days before/after the birthday effective 3-15-2026; the July 2026 SHIP article describes 1 month before/after. Not confirmed from the enrolled text.
Source and quote
Under past federal rules, someone is NOT guaranteed enrollment into a Medigap policy after their first 6-months on Medicare Part B or during other special circumstance- based situations.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
No year-round guaranteed issue; the birthday rule only lets existing Medigap holders change companies. Someone leaving Medicare Advantage outside federal trial rights can be underwritten.
- Required
- Yes
- Detail
- Since 1-1-2025 (SEA 215-2024), any Medigap plan sold to people 65+ must also be sold to people under 65 with Medicare due to disability or ESRD, with a 6-month guaranteed enrollment window starting when Medicare begins; Plans A, B, D premiums capped at the age-65 rate and other plans at 200% of the age-65 rate; no preexisting-condition waiting periods.
Source and quote
SEA 215 (2024)
This means that after December 31, 2024, any Medigap plan that is available to individuals with Medicare at 65 or older, must also be available to those with Medicare due to disability or ESRD under the age of 65.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- Qmb
- Income individual
- 1,995
- Basis
- 150% FPL
- Slmb
- Income individual
- 2,261
- Basis
- 170% FPL
- Qi
- Income individual
- 2,461
- Basis
- 185% FPL
- Asset limit individual
- 9,950
- Asset limit couple
- 14,910
Source and quote
IHCPPM 3005.25.00, 3010.35.05-.20
This chart lists the monthly income standards to be used for the QMB (MA L) category of assistance effective March 1, 2026. This standard is based on 150% of the Federal Poverty Income Guidelines.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Indiana's MSP income limits are well above the federal floors (QMB 150% vs 100% FPL). Couple: QMB $2,705, SLMB $3,066, QI $3,337 (net income, effective 3-1-2026). Asset test still applies ($9,950 / $14,910 effective 1-1-2026).
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
No other Indiana-specific Medicare rules researched beyond Medigap and MSP.
Ambulance bills and rides
- Scope
- State-regulated health plans (fully insured; not self-funded ERISA plans, not Medicaid, not ambulance services owned by a health system billing under it). Plan pays a nonparticipating ground ambulance the least of the county/municipal set rate, 400% of the Medicare rate, or billed charges; that is payment in full and the provider may not bill the patient beyond in-network cost sharing.
- Effective
- 2025-01-01 (P.L. 163-2024, HEA 1385)
Source and quote
IC 27-1-2.3-8.1, 27-1-2.3-8.2, 27-1-2.3-0.5
the nonparticipating ambulance service provider is prohibited from billing the covered individual for any additional amount
Source page · Secondary source · as of 2026 · retrieved 2026-11-04
Statute text read via FindLaw (current as of 1-1-2026); official iga.in.gov and LegiScan enrolled PDF could not be fetched. Effective date and exclusions list (IC 27-1-2.3-0.5) come from search-result excerpts. Does not change Original Medicare billing rules.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
No Indiana-specific air-ambulance rule beyond the federal No Surprises Act was researched.
Source and quote
Verida contracts with independent transportation providers to deliver a range of transportation services.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Managed-care transport routing inferred from PathWays page ('may qualify for support like transportation to their doctor's office'); specific PathWays plan brokers not verified.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Other protections
Source and quote
IC 12-10-3-2(a)
Indiana is a mandatory report state
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Bed-hold and involuntary discharge rules not researched.
Federal rules that apply everywhere
These federal rules apply nationwide, DC included.
Federal gotchas
Observation status can wipe out SNF coverage
A parent can spend several nights in a hospital bed 'under observation' (outpatient) and never meet the 3-day INPATIENT requirement, so Medicare pays nothing for the rehab/nursing home stay that follows. Ask every day: 'Is she inpatient or observation?' Read the MOON notice (required after 24 hours of observation), ask the doctor to reconsider admission, check if a Medicare Advantage plan or ACO waives the 3-day rule, and if a stay was switched from inpatient to observation, appeal.
Source and quote
42 CFR 409.30(a)
This means a prior medically necessary inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, but not including the day you leave the hospital).
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight.' ACO waivers and Medicare Advantage plans may waive the 3-day rule.
Medicare does not pay for long-term nursing home care
Medicare (and Medigap) covers only short-term skilled care (max 100 days per benefit period, $217/day from day 21 in 2026, and only while daily skilled care is needed). Custodial care in a nursing home, assisted living, or at home is private-pay, LTC insurance, VA, or Medicaid. Plan for Medicaid before the money runs out.
Source and quote
Since most long-term care is non-medical, Medicare and most health insurance, including Medicare Supplement Insurance (Medigap) , don’t pay for long-term care services, including care in a nursing home or in the community.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
SNF coverage often ends long before day 100
Coverage stops as soon as the facility decides daily skilled care is no longer needed ('plateaued'); there is no right to 100 days. Request a fast appeal from the notice of non-coverage, and remember 'improvement' isn't required: maintenance therapy can qualify.
Source and quote
Days 21–100: You pay $217 each day. Days 101 and beyond: You pay all costs. Part A limits SNF coverage to 100 days in each benefit period.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Days 1-20: 'You pay $0 each day after you pay the $1,736 deductible' (deductible not owed again if already paid for the hospital stay in the same benefit period). CMS fact sheet: '$217.00 in 2026 ($209.50 in 2025)'. The 100 days are a maximum, not a guarantee: coverage ends when daily skilled care is no longer needed.
Gifts within 5 years delay Medicaid, and the penalty clock starts late
Any gift (cash to grandkids, deeding the house) within 60 months of applying triggers a penalty. The penalty doesn't start when the gift is made; it starts only once the parent has spent down, applied, and would otherwise be eligible, which leaves a stretch with no money and no Medicaid. Partial months can't be rounded away.
Source and quote
42 U.S.C. 1396p(c)(1)(D)(ii)
the date specified in this subparagraph is the first day of a month during or after which assets have been transferred for less than fair market value, or the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later
Source page · Official code · as of current statute · retrieved 2026-11-04
Gifting the house can cost the kids capital-gains tax
A gifted house keeps the parent's old (low) basis; an inherited house gets a stepped-up basis at death. Gifting a house to dodge Medicaid can create a large taxable gain when the child sells, plus a look-back penalty. Consider exempt transfers (caregiver child, disabled child, spouse) or other planning with an elder-law attorney.
Source and quote
IRC 1015 (gifts), 1014 (inherited); IRS Pub. 551
If the FMV of the property is equal to or greater than the donor's adjusted basis, your basis is the donor's adjusted basis at the time you received the gift.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Inherited: 'Generally, the basis of property inherited from a decedent is one of the following. The FMV of the property at the date of the individual's death.' Why it matters: a house bought for $80k and gifted to a child while worth $400k carries the $80k basis; if the child sells, ~$320k gain is taxable (and the child usually can't use the parent's IRC 121 exclusion). If inherited instead, basis steps up to ~$400k and little or no gain results. Gifting also starts a 60-month Medicaid look-back penalty.
Joint bank accounts are treated as the parent's money
Under SSI rules (which most state Medicaid programs follow), all funds in a joint account are presumed to belong to the applicant unless rebutted with evidence. Adding a child's name doesn't protect money, and removing money from a joint account can count as a gift.
Source and quote
SSA POMS SI 01140.205
Account holders include one or more claimants or recipients If there is more than one claimant or recipient, assume that all the funds in the account belong to the claimant(s) or recipient(s), in equal shares.
Source page · Agency guidance · as of 2023-12-27 · retrieved 2026-11-04
SSI rule; Medicaid aged/blind/disabled eligibility generally follows SSI methodology (42 CFR 435.601), but states can differ: check state files.
A power of attorney without explicit gifting power can block Medicaid planning
Under Uniform Power of Attorney Act states, an agent can make gifts, change beneficiaries, or create/change survivorship rights ONLY if the POA expressly says so. If the parent has lost capacity, the family may need a costly guardianship to do planning. Review the POA now while the parent can sign a new one.
Source and quote
N.C. Gen. Stat. 32C-2-201 (example of UPOAA sec. 201)
An agent may do the following on behalf of the principal or with the principal's property only if the power of attorney expressly grants the agent that authority: a. Make a gift. b. Create or change rights of survivorship. c. Create or change a beneficiary designation.
Source page · Official code · as of current statute · retrieved 2026-11-04
State law, not federal; shown as a representative UPOAA enactment. Check each state's POA statute.
Don't sign the nursing home admission agreement as a guarantor
Federal rules bar Medicare/Medicaid nursing facilities from requiring a third-party guarantee of payment. Facilities still use 'Responsible Party' language. Sign only as the resident's representative/agent (using the resident's funds), cross out personal guarantees, and never agree to pay personally.
Source and quote
42 CFR 483.15(a)(3)
The facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Arbitration clauses are optional, and you can rescind within 30 days
Nursing homes may not require binding arbitration as a condition of admission or continued care, and the agreement must allow rescission within 30 calendar days. Decline or rescind to keep the right to sue over neglect or abuse.
Source and quote
42 CFR 483.70(m)
The facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Same section: 'The agreement must explicitly grant the resident or his or her representative the right to rescind the agreement within 30 calendar days of signing it.'
IRMAA surprise two years after selling the house or cashing out an IRA
Medicare premiums are based on income from 2 years earlier. A home sale gain above the $250k/$500k exclusion, a big IRA withdrawal, or a Roth conversion can raise Part B to as much as $689.90/month plus a Part D surcharge two years later. A one-time sale is NOT a life-changing event for an SSA-44 appeal (but a spouse's death, retirement, or lost pension is). Spread income across years when possible.
Source and quote
20 CFR 418.1205; SSA POMS HI 01120.001
You or your spouse experiences a loss of income-producing property, provided the loss is not at the direction of you or your spouse (e.g., due to the sale or transfer of the property) and is not a result of the ordinary risk of investment.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Selling a house or other property is NOT a life-changing event. POMS HI 01120.001: 'the SSA-44 , Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available online' and 'The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on a valid LCE'.
Switching from Medicare Advantage back to Original Medicare can leave you without a Medigap
Federal Medigap guaranteed issue lasts only 6 months from Part B at 65, plus narrow situations. After the 12-month MA 'trial right' passes, a parent with health problems who leaves Medicare Advantage (e.g., to use an out-of-network specialist or nursing home) can be denied Medigap in most states. Choose carefully at 65.
Source and quote
There’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet their medical underwriting requirements. They may deny you a policy unless you have a guaranteed issue right
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Medicare.gov 'Choosing a Medigap Policy' guide (2026 edition).
Ground ambulance bills aren't covered by the No Surprises Act
The federal No Surprises Act protects against surprise air-ambulance and ER bills, but generally not ground ambulance. Out-of-network ground ambulances can balance-bill privately insured patients unless state law protects them. With Original Medicare, the patient owes 20% coinsurance after the deductible.
Source and quote
Generally, ground ambulance services aren't covered by billing protections in the No Surprises Act (unless a state law has different rules). They're still allowed to charge out-of-network rates.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: the NSA protects against surprise out-of-network bills from 'emergency room visits; non-emergency care related to visits at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers; and air ambulance services.' NSA applies to private/commercial coverage; Medicare and Medicaid already limit balance billing by participating ambulance suppliers.
Scheduled non-emergency ambulance trips can be billed to you if prior authorization is denied
For repeated scheduled trips (e.g., dialysis), Medicare requires prior authorization by the 4th round trip in 30 days; if denied and the trips continue, the company may bill the full charge. Non-emergency trips also need a physician certification and an ABN when Medicare may not pay.
Source and quote
If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'You get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more You get this transportation from any ambulance company nationwide'.
Retroactive Medicaid shrinks from 3 months to 2 starting with 2027 applications
For applications made on or after Jan. 1, 2027, Medicaid for older/disabled applicants can reach back only to the 2nd month before the application month (1 month for expansion adults). Nursing home bills from earlier months may not be covered, so apply as soon as the parent might qualify.
Source and quote
Pub. L. 119-21 sec. 71112, amending 42 U.S.C. 1396a(a)(34) and 1396d(a)
is not described in subparagraph (A), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the second month before the month in which the individual made application
Source page · Official code · as of 2027 · retrieved 2026-11-04
Applies to eligibility 'based on an application made on or after the first day of the first quarter that begins after December 31, 2026' (i.e., Jan. 1, 2027). Older adults needing nursing-home Medicaid fall in the 'not described in subparagraph (A)' (2-month) group. The replaced statutory text was 'in or after the third month before the month in which the recipient makes application'.
Home equity cap drops to a flat $1,000,000 in 2028
Nursing-home Medicaid is denied if home equity exceeds the state's limit (2026: $752,000 to $1,130,000) unless a spouse or minor/disabled child lives there. From Jan. 1, 2028, the cap for non-agricultural homes can't exceed $1,000,000 and won't rise with inflation. A reverse mortgage or home equity loan can reduce equity.
Source and quote
Pub. L. 119-21 (One Big Beautiful Bill Act) sec. 71108, amending 42 U.S.C. 1396p(f)
A State may elect, without regard to the requirements of section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), to apply subparagraph (A), in the case of an individual's home that is not described in clause (i), by substituting for the amount specified in such subparagraph, an amount that exceeds such amount, but does not exceed $1,000,000.
Source page · Official code · as of 2028 · retrieved 2026-11-04
Effective-date text: 'The amendments made by subsection (a) shall apply beginning on January 1, 2028.' Also adds: inflation-indexed amounts (other than for agricultural-lot homes) exceeding $1,000,000 'shall be deemed to be equal to $1,000,000'. States currently above $1M (2026 max is $1,130,000) will have to drop to $1M for non-agricultural homes.
Estate recovery can reach the house and more
States must recover nursing home and home-care costs from the estates of people who got Medicaid at 55+. Many states expand 'estate' beyond probate to joint property, life estates, and living trusts. Recovery waits until a surviving spouse dies and doesn't apply while a child under 21 or a blind/disabled child survives; ask about hardship waivers.
Source and quote
42 U.S.C. 1396p(b)(4)(B)
may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.
Source page · Official code · as of current statute · retrieved 2026-11-04
Partnership LTC policyholders (1396p(b)(1)(C)(i)) are subject to the expanded definition for non-protected assets.
Annuities and promissory notes must meet strict rules or they count as gifts
A Medicaid-compliant annuity must name the state as remainder beneficiary and be irrevocable, nonassignable, actuarially sound, and pay equal installments. Family loans/promissory notes must be actuarially sound, pay equal installments, and can't be forgiven at death, or the money counts as a transfer.
Source and quote
42 U.S.C. 1396p(c)(1)(I)
the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); (ii) provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and (iii) prohibits the cancellation of the balance upon the death of the lender.
Source page · Official code · as of current statute · retrieved 2026-11-04
Caregiver-child home transfer requires 2 years of live-in care
A parent can deed the home to a child without penalty only if the child lived there for at least 2 years immediately before the parent's institutionalization and provided care that kept the parent out of a facility, as the state determines. Document the care (doctor letters, care logs) now.
Source and quote
42 U.S.C. 1396p(c)(2)(A)-(D)
(iv) a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility
Source page · Official code · as of current statute · retrieved 2026-11-04
Quote shows the caregiver-child exemption; the other listed exemptions are in the same subsection (c)(2)(A)(i)-(iii), (B)(i)-(iv), (C)(i)-(iii), (D).
Hospice doesn't pay nursing home room and board
Choosing hospice in a nursing home or at home doesn't cover room and board. The family or Medicaid still pays the facility's daily rate.
Source and quote
Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).'
Income just over the cap needs a Miller trust (QIT)
In income-cap states, a parent with income even $1 over $2,982/month (2026) is ineligible for nursing-home Medicaid unless the excess goes into a Qualified Income (Miller) Trust each month. Missing a month's deposit can cause ineligibility for that month.
Source and quote
42 U.S.C. 1396p(d)(4)(B)
A trust established in a State for the benefit of an individual if— (i) the trust is composed only of pension, Social Security, and other income to the individual (and accumulated income in the trust), (ii) the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter; and (iii) the State makes medical assistance available to individuals described in section 1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to individuals for nursing facility services under section 1396a(a)(10)(C) of this title.
Source page · Official code · as of current statute · retrieved 2026-11-04
Medicare (all states)
Source and quote
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,736 in 2026, an increase of $60 from $1,676 in 2025.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- Days61to90
- $434/day
- Lifetime reserve per day
- $868/day
Source and quote
In 2026, beneficiaries must pay a coinsurance amount of $434 per day for the 61 st through 90 th day of a hospitalization ($419 in 2025) in a benefit period and $868 per day for lifetime reserve days ($838 in 2025).
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- Premium free if40 quarters
- $0/month
- Reduced30to39 quarters
- $311/month
- Full
- $565/month
Source and quote
may buy into Part A at a reduced monthly premium rate, which will be $311 in 2026, a $26 increase from 2025. Certain uninsured aged individuals who have fewer than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements, will pay the full premium, which will be $565 a month in 2026
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
42 CFR 409.30(a)
This means a prior medically necessary inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, but not including the day you leave the hospital).
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight.' ACO waivers and Medicare Advantage plans may waive the 3-day rule.
Source and quote
42 CFR 409.30(a)(1)
Have been hospitalized in a participating or qualified hospital or participating CAH, for medically necessary inpatient hospital or inpatient CAH care, for at least 3 consecutive calendar days, not counting the date of discharge
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
- Days1to20
- $0/day
- Days21to100 per day
- $217/day
- After100
- beneficiary pays all costs
Source and quote
Days 21–100: You pay $217 each day. Days 101 and beyond: You pay all costs. Part A limits SNF coverage to 100 days in each benefit period.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Days 1-20: 'You pay $0 each day after you pay the $1,736 deductible' (deductible not owed again if already paid for the hospital stay in the same benefit period). CMS fact sheet: '$217.00 in 2026 ($209.50 in 2025)'. The 100 days are a maximum, not a guarantee: coverage ends when daily skilled care is no longer needed.
Source and quote
42 CFR 489.20(y) (NOTICE Act)
to provide notice, as specified in paragraphs (y)(1) and (2) of this section, to each individual entitled to Medicare benefits under Title XVIII of the Act when such individual receives observation services as an outpatient for more than 24 hours. Notice must be provided to the individual not later than 36 hours after observation services are initiated or sooner if the individual is transferred, discharged, or admitted.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Source and quote
If you’re a Medicare patient who was admitted to the hospital as an inpatient, and the hospital changed your status to “outpatient getting observation services,” you may be able to appeal the denial of Part A (Hospital Insurance) inpatient coverage that came from the change in your status.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Page heading: 'You can appeal past hospital stays back to January 2009'. Appeal right applies to inpatient-then-reclassified stays, not to people who were in observation from the start.
Source and quote
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
No quote captured.
Source page · Agency guidance · as of 2027 · retrieved 2026-11-04
CMS had not published 2027 Part A/B premiums and deductibles as of 2026-11-04 (expected fact-sheet URL returned 404). Only Trustees Report projections exist; not recorded.
- Part b
- Single
- <=109000
- Joint
- <=218000
- Total premium
- $202.90/month
- Part dadd
- $0/month
- Single
- 109001-137000
- Joint
- 218001-274000
- Total premium
- $284.10/month
- Part dadd
- $14.50/month
- Single
- 137001-171000
- Joint
- 274001-342000
- Total premium
- $405.80/month
- Part dadd
- $37.50/month
- Single
- 171001-205000
- Joint
- 342001-410000
- Total premium
- $527.50/month
- Part dadd
- $60.40/month
- Single
- 205001-499999
- Joint
- 410001-749999
- Total premium
- $649.20/month
- Part dadd
- $83.30/month
- Single
- >=500000
- Joint
- >=750000
- Total premium
- $689.90/month
- Part dadd
- $91/month
- Married filing separately
- Magi
- <=109000
- Total premium
- $202.90/month
- Part dadd
- $0/month
- Magi
- 109001-390999
- Total premium
- $649.20/month
- Part dadd
- $83.30/month
- Magi
- >=391000
- Total premium
- $689.90/month
- Part dadd
- $91/month
Source and quote
Less than or equal to $109,000 Less than or equal to $218,000 $0.00 $202.90 Greater than $109,000 and less than or equal to $137,000 Greater than $218,000 and less than or equal to $274,000 $81.20 $284.10
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Total monthly Part B premium per person; partDAdd is the Part D income-related adjustment added to the plan premium. Full table on the CMS fact sheet; also in SSA POMS HI 01101.020.
Source and quote
20 CFR 418.1135(a)
In general, we will use your modified adjusted gross income provided by IRS for the tax year 2 years prior to the effective year of the income-related monthly adjustment amount determination.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
SSA POMS HI 01101.020 (2026 tables): 'If MAGI in 2024 (or 2023 if 2024 is not available) was:'. MAGI = AGI plus tax-exempt interest (20 CFR 418.1010), so capital gains from selling a home (above the IRC 121 exclusion), IRA withdrawals, and Roth conversions all count.
- Form
- SSA-44
- Qualifying events
- death of spouse
- marriage
- divorce/annulment
- work stoppage
- work reduction
- loss of income-producing property (not by sale)
- loss of employer pension
- employer settlement payment
Source and quote
20 CFR 418.1205; SSA POMS HI 01120.001
You or your spouse experiences a loss of income-producing property, provided the loss is not at the direction of you or your spouse (e.g., due to the sale or transfer of the property) and is not a result of the ordinary risk of investment.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Selling a house or other property is NOT a life-changing event. POMS HI 01120.001: 'the SSA-44 , Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available online' and 'The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on a valid LCE'.
- 2026
- $2,100/year
- 2027
- $2,400/year
Source and quote
CMS CY 2027 Rate Announcement (Apr. 6, 2026), Attachment V, Table V-2
Table V-2. Updated Part D Benefit Parameters for Defined Standard Benefit, Low-Income Subsidy (LIS) and Retiree Drug Subsidy 2026 202713 Standard Benefit Deductible $615 $700 Out-of-Pocket Threshold $2,100 $2,400
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
'202713' in the quote is '2027' followed by footnote marker 13. Standard deductible: $615 (2026), $700 (2027).
Source and quote
42 U.S.C. 1395ss(s)(2)(A)
The issuer of a medicare supplemental policy may not deny or condition the issuance or effectiveness of a medicare supplemental policy, or discriminate in the pricing of the policy, because of health status, claims experience, receipt of health care, or medical condition in the case of an individual for whom an application is submitted prior to or during the 6 month period beginning with the first month as of the first day on which the individual is 65 years of age or older and is enrolled for benefits under part B.
Source page · Official code · as of current statute · retrieved 2026-11-04
Medicare.gov guide: 'This is a one-time enrollment period; it doesn’t repeat every year.' Federal law gives no Medigap open enrollment to under-65 disabled beneficiaries; some states do.
- Employer/union retiree plan supplementing Medicare ends
- Medicare Advantage plan leaves the area/terminates or person moves out of service area (or PACE)
- Medigap insurer goes bankrupt/coverage ends involuntarily, or insurer violated policy or misled the person
- Trial right: dropped Medigap to join Medicare Advantage for the first time and leaves within 12 months
- Trial right: joined Medicare Advantage/PACE when first eligible at 65 and leaves within 12 months
Source and quote
42 U.S.C. 1395ss(s)(3)(B)(i)-(vi)
The individual, upon first becoming eligible for benefits under part A at age 65, en rolls in a Medicare+Choice plan under part C or in a PACE program under section 1395eee of this title, and disenrolls from such plan or such program by not later than 12 months after the effective date of such enrollment.
Source page · Official code · as of current statute · retrieved 2026-11-04
Quote reproduces an 'en rolls' word-break artifact in the govinfo HTML. Guaranteed-issue applicants are limited to certain plans (statute lists A, B, C, F; Medicare.gov guide lists current equivalents including G for those new to Medicare after 2020). States may add rights.
Source and quote
In most cases, you won’t have a right under federal law to switch Medigap policies, unless: You're within your 6-month Medigap open enrollment period, or You're eligible under a specific situation or guaranteed issue right (when an insurance company can’t deny you a Medigap policy).
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
There’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet their medical underwriting requirements. They may deny you a policy unless you have a guaranteed issue right
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Medicare.gov 'Choosing a Medigap Policy' guide (2026 edition).
Source and quote
Since most long-term care is non-medical, Medicare and most health insurance, including Medicare Supplement Insurance (Medigap) , don’t pay for long-term care services, including care in a nursing home or in the community.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).'
Source and quote
Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Listed under 'Medicare doesn't pay for:' along with '24-hour-a-day care at your home'. Same page: 'up to 8 hours a day (combined), for a maximum of 28 hours a week.'
Federal Medicaid rules (all states)
Source and quote
CMCS Informational Bulletin, Apr. 27, 2026 (2026 SSI and Spousal Impoverishment Standards chart, effective 1-1-26)
Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Table columns: SSI FBR, SSI resource standard, income cap limit (300%), earned and unearned income break-even points. Whitespace normalized from PDF table.
Source and quote
CMCS Informational Bulletin, Apr. 27, 2026
Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
SSA Notice, Cost-of-Living Increase and Other Determinations for 2027, Docket No. SSA-2026-1024 (FR Doc. 2026-21796)
The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual; $1,544 for an eligible individual with an eligible spouse; and $516 for an essential person.
Source page · Official regulation · as of 2027 · retrieved 2026-11-04
Federal Register public-inspection copy. 3.6% COLA. CMS has not yet (as of 2026-11-04) published its 2027 SSI and Spousal Impoverishment Standards chart.
Source and quote
SSA Notice, Docket No. SSA-2026-1024
The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual; $1,544 for an eligible individual with an eligible spouse; and $516 for an essential person.
Source page · Official regulation · as of 2027 · retrieved 2026-11-04
- Individual
- $2,000
- Couple
- $3,000
Source and quote
Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Most states use $2,000 as the nursing-home Medicaid asset limit for a single applicant, but states vary; see state files.
Source and quote
SSA 1902(a)(10)(A)(ii)(V); CMCS chart 'Income Cap Limit (300%)'
Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
In income-cap states, income above this requires a Miller trust / QIT.
Source and quote
The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual
Source page · Official regulation · as of 2027 · retrieved 2026-11-04
DERIVED: 3 x $1,029 = $3,087. Not yet published by CMS; confirm against the CMS 2027 SSI and Spousal Impoverishment Standards chart (normally issued in December).
- Individual
- $30/month
- Couple
- $60/month
Source and quote
42 U.S.C. 1396a(q)(2)
is $30 for an institutionalized individual and $60 for an institutionalized couple (if both are aged, blind, or disabled, and their incomes are considered available to each other in determining eligibility)
Source page · Official code · as of current statute · retrieved 2026-11-04
Federal floor only; nearly all states set higher amounts (see state files).
Source and quote
42 U.S.C. 1396r-5(f)(2), (g); CMCS 2026 chart
Community Spouse Resources: Minimum Resource Standard: 32,532.00 Maximum Resource Standard 162,660.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396r-5(g); CMCS 2026 chart
Community Spouse Resources: Minimum Resource Standard: 32,532.00 Maximum Resource Standard 162,660.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- From2026-07-01
- Contiguous states
- $2,705/month
- Alaska
- $3,381.25/month
- Hawaii
- $3,111.25/month
- 2026-01-01to2026-06-30
- Contiguous states
- $2,643.75/month
- Alaska
- $3,303.75/month
- Hawaii
- $3,040/month
Source and quote
Minimum Monthly Maintenance Needs Allowance 2,705.00 All States (Except Alaska and Hawaii) (Effective 7-1-26) 3,381.25 Alaska 3,111.25 Hawaii
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
MMMNA minimum changes each July 1 with the poverty guidelines. The Dec. 9, 2025 chart (cib12092025.pdf) lists 2,643.75 / 3,303.75 / 3,040.00 '(Effective 7-1-25)' for January-June 2026.
Source and quote
Maximum Monthly Maintenance Needs Allowance: 4,066.50
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- From2026-07-01
- Contiguous states
- $811.50/month
- Alaska
- $1,014.38/month
- Hawaii
- $933.38/month
- 2026-01-01to2026-06-30
- Contiguous states
- $793.13/month
- Alaska
- $991.13/month
- Hawaii
- $912/month
Source and quote
Community Spouse Monthly Housing Allowance: 811.50 All States (Except Alaska and Hawaii) (Effective 7-1-26) 1,014.38 Alaska 933.38 Hawaii
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Basis for the excess shelter allowance.
Source and quote
42 U.S.C. 1396r-5(c)(1)(A)
There shall be computed (as of the beginning of the first continuous period of institutionalization (beginning on or after September 30, 1989) of the institutionalized spouse)— (i) the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest, and (ii) a spousal share which is equal to ½ of such total value.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396r-5(b)(1)
During any month in which an institutionalized spouse is in the institution, except as provided in paragraph (2), no income of the community spouse shall be deemed available to the institutionalized spouse.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(f); CMCS 2026 chart
Home Equity Limits: Minimum: 752,000.00 Maximum: 1,130,000.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(f); CMCS 2026 chart
Home Equity Limits: Minimum: 752,000.00 Maximum: 1,130,000.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(f)(2)
Paragraph (1) shall not apply with respect to an individual if— (A) the spouse of such individual, or (B) such individual's child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1382c of this title, is lawfully residing in the individual's home.
Source page · Official code · as of current statute · retrieved 2026-11-04
- Effective
- 2028-01-01
- Non agricultural home cap
- 1,000,000
- Indexed
- No
- Agricultural lot homes
- keep the existing indexed state-option range
Source and quote
Pub. L. 119-21 (One Big Beautiful Bill Act) sec. 71108, amending 42 U.S.C. 1396p(f)
A State may elect, without regard to the requirements of section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), to apply subparagraph (A), in the case of an individual's home that is not described in clause (i), by substituting for the amount specified in such subparagraph, an amount that exceeds such amount, but does not exceed $1,000,000.
Source page · Official code · as of 2028 · retrieved 2026-11-04
Effective-date text: 'The amendments made by subsection (a) shall apply beginning on January 1, 2028.' Also adds: inflation-indexed amounts (other than for agricultural-lot homes) exceeding $1,000,000 'shall be deemed to be equal to $1,000,000'. States currently above $1M (2026 max is $1,130,000) will have to drop to $1M for non-agricultural homes.
- Before2027
- 3 months before application month
- For applications on or after2027-01-01
- Expansion adults
- 1 month before application month
- Aged_blind_disabled_and_other_non_expansion
- 2 months before application month
Source and quote
Pub. L. 119-21 sec. 71112, amending 42 U.S.C. 1396a(a)(34) and 1396d(a)
is not described in subparagraph (A), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the second month before the month in which the individual made application
Source page · Official code · as of 2027 · retrieved 2026-11-04
Applies to eligibility 'based on an application made on or after the first day of the first quarter that begins after December 31, 2026' (i.e., Jan. 1, 2027). Older adults needing nursing-home Medicaid fall in the 'not described in subparagraph (A)' (2-month) group. The replaced statutory text was 'in or after the third month before the month in which the recipient makes application'.
Source and quote
42 U.S.C. 1396p(c)(1)(B)(i)
The look-back date specified in this subparagraph is a date that is 36 months (or, in the case of payments from a trust or portions of a trust that are treated as assets disposed of by the individual pursuant to paragraph (3)(A)(iii) or (3)(B)(ii) of subsection (d) or in the case of any other disposal of assets made on or after February 8, 2006, 60 months) before the date specified in clause (ii).
Source page · Official code · as of current statute · retrieved 2026-11-04
California has historically used a different (shorter) look-back for Medi-Cal; see state files.
Source and quote
42 U.S.C. 1396p(c)(1)(D)(ii)
the date specified in this subparagraph is the first day of a month during or after which assets have been transferred for less than fair market value, or the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(1)(E)(iv)
A State shall not round down, or otherwise disregard any fractional period of ineligibility determined under clause (i) or (ii) with respect to the disposal of assets.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
No quote captured.
Source page · Official code · as of 2026 · retrieved 2026-11-04
Divisor (average monthly private-pay nursing home cost) is set by each state; there is no federal figure. See state files.
- Home to spouse
- Home to child under 21 or blind/disabled child
- Home to sibling with equity interest who lived in the home at least 1 year before institutionalization
- Home to 'caregiver child' who lived in the home at least 2 years before institutionalization and provided care that kept the parent out of a facility
- Any asset to spouse or to another for the sole benefit of spouse
- Any asset to (or trust solely for) a blind/disabled child
- Any asset to a trust solely for a disabled person under 65
- Showing that the transfer was intended for fair market value, or exclusively for a non-Medicaid purpose, or that assets were returned
- Undue hardship waiver
Source and quote
42 U.S.C. 1396p(c)(2)(A)-(D)
(iv) a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility
Source page · Official code · as of current statute · retrieved 2026-11-04
Quote shows the caregiver-child exemption; the other listed exemptions are in the same subsection (c)(2)(A)(i)-(iii), (B)(i)-(iv), (C)(i)-(iii), (D).
- State remainder beneficiary
- State must be named remainder beneficiary in first position (or second after community spouse/minor or disabled child) for at least the Medicaid paid
- Safe harbor
- irrevocable, nonassignable, actuarially sound per SSA Chief Actuary tables, equal payments with no deferral and no balloon (or qualifying IRA/retirement annuity)
Source and quote
42 U.S.C. 1396p(c)(1)(F)-(G) (DRA 2005)
the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless— (i) the State is named as the remainder beneficiary in the first position for at least the total amount of medical assistance paid on behalf of the institutionalized individual under this subchapter
Source page · Official code · as of current statute · retrieved 2026-11-04
Related text in (G)(ii): 'the annuity— (I) is irrevocable and nonassignable; (II) is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); and (III) provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.'
Source and quote
42 U.S.C. 1396p(c)(1)(I)
the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); (ii) provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and (iii) prohibits the cancellation of the balance upon the death of the lender.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(c)(1)(J)
the term "assets" includes the purchase of a life estate interest in another individual's home unless the purchaser resides in the home for a period of at least 1 year after the date of the purchase.
Source page · Official code · as of current statute · retrieved 2026-11-04
Life estates retained when a parent deeds the remainder to children are still a transfer of the remainder interest (look-back applies) and may be reached by expanded estate recovery; see estateRecovery.optionalExpandedEstate.
Source and quote
42 U.S.C. 1396p(b)(1)(B)
In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual's estate, but only for medical assistance consisting of— (i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or (ii) at the option of the State, any items or services under the State plan
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(b)(4)(A)
shall include all real and personal property and other assets included within the individual's estate, as defined for purposes of State probate law
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(b)(4)(B)
may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.
Source page · Official code · as of current statute · retrieved 2026-11-04
Partnership LTC policyholders (1396p(b)(1)(C)(i)) are subject to the expanded definition for non-protected assets.
Source and quote
42 U.S.C. 1396p(b)(2)-(3)
Any adjustment or recovery under paragraph (1) may be made only after the death of the individual's surviving spouse, if any, and only at a time— (A) when he has no surviving child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or per manently and totally disabled
Source page · Official code · as of current statute · retrieved 2026-11-04
Quote reproduces a line-break artifact ('per manently') present in the govinfo HTML. Hardship: '(3)(A) The State agency shall establish procedures ... under which the agency shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship'.
Source and quote
42 U.S.C. 1396p(d)(4)(B)
A trust established in a State for the benefit of an individual if— (i) the trust is composed only of pension, Social Security, and other income to the individual (and accumulated income in the trust), (ii) the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter; and (iii) the State makes medical assistance available to individuals described in section 1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to individuals for nursing facility services under section 1396a(a)(10)(C) of this title.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(d)(4)(A)
A trust containing the assets of an individual under age 65 who is disabled (as defined in section 1382c(a)(3) of this title) and which is established for the benefit of such individual by the individual, a parent, grandparent, legal guardian of the individual, or a court if the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter.
Source page · Official code · as of current statute · retrieved 2026-11-04
Source and quote
42 U.S.C. 1396p(d)(4)(C)
A trust containing the assets of an individual who is disabled (as defined in section 1382c(a)(3) of this title) that meets the following conditions: (i) The trust is established and managed by a non-profit association. (ii) A separate account is maintained for each beneficiary of the trust, but, for purposes of investment and management of funds, the trust pools these accounts.
Source page · Official code · as of current statute · retrieved 2026-11-04
Treatment of pooled-trust funding by people 65+ varies by state; check state files.
Source and quote
42 U.S.C. 1396p(b)(1)(C)(iii) (DRA 2005)
the term "qualified State long-term care insurance partnership" means an approved State plan amendment under this subchapter that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a long-term care insurance policy if the following requirements are met: (I) The policy covers an insured who was a resident of such State when coverage first became effective under the policy.
Source page · Official code · as of current statute · retrieved 2026-11-04
- Qmb
- Income individual
- $1,350/month (income); USD (resources)
- Income couple
- $1,824/month (income); USD (resources)
- Slmb
- Income individual
- $1,616/month (income); USD (resources)
- Income couple
- $2,184/month (income); USD (resources)
- Qi
- Income individual
- $1,816/month (income); USD (resources)
- Income couple
- $2,455/month (income); USD (resources)
- Resource individual
- $9,950/month (income); USD (resources)
- Resource couple
- $14,910/month (income); USD (resources)
- Qdwi
- Resource individual
- $4,000/month (income); USD (resources)
- Resource couple
- $6,000/month (income); USD (resources)
Source and quote
Monthly income and resource limits for 2026: Your situation: Monthly income limit:* Resource limit: What counts in resource limits? Individual $1,350 $9,950 Married couple $1,824 $14,910
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
QMB shown in quote. Same page: SLMB 'Individual $1,616 $9,950 Married couple $2,184 $14,910'; QI 'Individual $1,816 $9,950 Married couple $2,455 $14,910'. '* Income limits slightly higher in Alaska and Hawaii.' Resource limits confirmed by CMCS CIB Dec. 9, 2025: 'Effective January 1, 2026, the resource standards for single and married QMBs, SLMBs, and QIs will be, respectively, $9,950 and $14,910.' QDWI resource standard 'remains $4,000 for a single individual and $6,000 for a married individual.' Many states use higher limits or no asset test.
Ambulance (federal)
Source and quote
Part B covers ground ambulance transportation when traveling in any other vehicle could endanger your health, and you need medically necessary services from one of the following: A hospital A critical access hospital A rural emergency hospital A skilled nursing facility
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
42 CFR 410.40(e)(1)-(2); 410.41 (vehicle/staff)
Medicare covers ambulance services, including fixed wing and rotary wing ambulance services, only if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
Source and quote
42 CFR 410.40(f)
From any point of origin to the nearest hospital, CAH, rural emergency hospital (REH), or SNF that is capable of furnishing the required level and type of care for the beneficiary's illness or injury.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
If the patient chooses a farther facility, Medicare generally pays only the mileage to the nearest appropriate one.
Source and quote
The ambulance company must give you an "Advance Beneficiary Notice of Noncoverage (ABN)" when both of these apply: You get ambulance services in a non-emergency situation. The ambulance company believes that Medicare may not pay for your specific ambulance service.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: 'You get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more You get this transportation from any ambulance company nationwide'.
- Air ambulance
- covered
- Ground ambulance
- NOT covered (unless state law)
Source and quote
Generally, ground ambulance services aren't covered by billing protections in the No Surprises Act (unless a state law has different rules). They're still allowed to charge out-of-network rates.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Same page: the NSA protects against surprise out-of-network bills from 'emergency room visits; non-emergency care related to visits at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers; and air ambulance services.' NSA applies to private/commercial coverage; Medicare and Medicaid already limit balance billing by participating ambulance suppliers.
- Report issued
- 2024-08-28 (report document dated March 29, 2024)
- Status
- Currently Inactive
Source and quote
The Committee issued its Report to the Secretaries containing Recommendations on preventing balance billing for ground ambulance services and protecting consumers on August 28, 2024. Committee Status - Currently Inactive
Source page · Agency guidance · as of 2026-11 · retrieved 2026-11-04
Report PDF: https://www.cms.gov/files/document/report-advisory-committee-ground-ambulance-and-patient-billing.pdf (recommends prohibiting ground-ambulance balance billing with cost-sharing caps; not self-executing).
- Enacted
- No
Source and quote
Committee Status - Currently Inactive
Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04
No enacted federal law extending NSA-style protection to ground ambulances was found as of 2026-11-04 (CMS consumer page still says ground ambulance is generally not covered). Could not confirm any pending 119th Congress consumer-protection bill; the 119th-Congress 'Protecting Access to Ground Ambulance Medical Services Act' (H.R. 2232 / S. 1643) concerns Medicare rate add-ons, not balance billing. State laws fill the gap; see state files.
Source and quote
42 CFR 431.53; 42 U.S.C. 1396a(a)(4)(A)
A State plan must— ( a ) Specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers; and ( b ) Describe the methods that the agency will use to meet this requirement.
Source page · Official regulation · as of current regulation · retrieved 2026-11-04
eCFR spacing artifacts '( a )' kept as rendered. Statute 1396a(a)(4) likewise requires the state agency to 'ensure necessary transportation for beneficiaries under the State plan to and from providers'.
Taxes
Source and quote
IRC 213(a); IRS Pub. 502 (2025)
You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI).
Source page · Agency guidance · as of 2025 · retrieved 2026-11-04
Pub 502 for tax year 2026 not yet published; 7.5% floor is permanent in IRC 213(a). Nursing home: 'This includes the cost of meals and lodging in the home if a principal reason for being there is to get medical care.' Qualified long-term care services for a chronically ill person are also includible.
- Age40 or less
- $500/year per person
- 41to50
- $930/year per person
- 51to60
- $1,860/year per person
- 61to70
- $4,960/year per person
- Over70
- $6,200/year per person
Source and quote
Rev. Proc. 2025-32 sec. 4.27; IRC 213(d)(10)
Attained Age Before the Close of the Taxable Year Limitation on Premiums 40 or less $500 More than 40 but not more than 50 $930 More than 50 but not more than 60 $1,860 More than 60 but not more than 70 $4,960 More than 70 $6,200
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Only the portion within these limits counts as a medical expense (still subject to the 7.5%-of-AGI floor). 2027 limits not located as of 2026-11-04.
Source and quote
Rev. Proc. 2025-32 sec. 4.62
For calendar year 2026, the stated dollar amount of the per diem limitation under § 7702B(d)(4), regarding periodic payments received under a qualified long-term care insurance contract or periodic payments received under a life insurance contract that are treated as paid by reason of the death of a chronically ill individual, is $430.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- Qualifying relative gross income limit2026
- $5,300
- Parent need not live with you
- Yes
- Support test
- you must provide more than half of support (or use a multiple support agreement)
Source and quote
Rev. Proc. 2025-32 sec. 4.23; IRC 152(d); IRS Pub. 501
For taxable years beginning in 2026, the exemption amount referred to in § 152(d)(1)(B) is $5,300.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Pub 501 lists 'Your father, mother, grandparent, or other direct ancestor, but not foster parent' among relatives who need not live with you. Social Security that is not taxable generally isn't gross income for this test (check Pub 501). Pub 502: you may deduct medical expenses paid for a parent who would be your dependent except for the gross-income test.
Source and quote
IRS Pub. 501 (2025)
If you pay more than half the cost of keeping your parent in a rest home or home for the elderly, that counts as paying more than half the cost of keeping up your parent’s main home.
Source page · Agency guidance · as of 2025 · retrieved 2026-11-04
Source and quote
IRS Pub. 503 (2025); IRC 21
A person who wasn't physically or mentally able to care for themselves, lived with you for more than half the year, and either: Was your dependent, or Would have been your dependent except that: They received gross income of $5,200 or more
Source page · Agency guidance · as of 2025 · retrieved 2026-11-04
2025 publication shows the 2025 gross income figure ($5,200); 2026 figure is $5,300 per Rev. Proc. 2025-32.
- Per person
- 6,000
- Married both eligible
- 12,000
- Years
- 2025-2028
Source and quote
Pub. L. 119-21; IRS Pub. 501 (2025)
Beginning in 2025, taxpayers who are age 65 or older may be eligible for the enhanced deduction for seniors. The maximum amount of the deduction is $6,000 ($12,000 if married filing jointly and both spouses are eligible).
Source page · Agency guidance · as of 2025 · retrieved 2026-11-04
Income phase-out applies; OBBBA provides it for tax years 2025-2028 (end year not quoted from the fetched page).
- Gift
- carryover basis (donor's adjusted basis) when FMV >= donor basis
- Inheritance
- basis generally = FMV at date of death (step-up)
Source and quote
IRC 1015 (gifts), 1014 (inherited); IRS Pub. 551
If the FMV of the property is equal to or greater than the donor's adjusted basis, your basis is the donor's adjusted basis at the time you received the gift.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Inherited: 'Generally, the basis of property inherited from a decedent is one of the following. The FMV of the property at the date of the individual's death.' Why it matters: a house bought for $80k and gifted to a child while worth $400k carries the $80k basis; if the child sells, ~$320k gain is taxable (and the child usually can't use the parent's IRC 121 exclusion). If inherited instead, basis steps up to ~$400k and little or no gain results. Gifting also starts a 60-month Medicaid look-back penalty.
- Single
- $250,000
- Married joint
- $500,000
Source and quote
IRC 121; IRS Pub. 523
If you meet certain conditions, you may exclude the first $250,000 of gain from the sale of your home from your income and avoid paying taxes on it. The exclusion is increased to $500,000 for a married couple filing jointly.
Source page · Agency guidance · as of 2025 · retrieved 2026-11-04
Gain above the exclusion raises MAGI and can trigger IRMAA two years later.
What we could not confirm
- IHCPPM 4705.00.00 says the estate 'does not include property held jointly with rights of survivorship, property held in trust, or life insurance proceeds', contradicting IC 12-15-9-0.5 and the FSSA estate recovery web page (which include post-6/30/2002 joint tenancy real estate, POD/joint accounts, and post-5/1/2002 revocable trust assets). Which governs in practice?
- Nine-month estate claim deadline: FSSA web page says it began July 1, 2025; IHCPPM 4715.00.00 says July 1, 2026. Confirm from IC 29-1-14-1 (official text not fetchable from iga.in.gov).
- Medigap birthday window: SHIP July 2026 article says 1 month before/after birthday; search results report HEA 1260 (2026) set 31 days before/after effective 3-15-2026. Confirm from enrolled HEA 1260.
- HEA 1385 (2024) ground ambulance law: verify effective date (1-1-2025 per search excerpts) and full exclusion list in IC 27-1-2.3-0.5 against official code text; statute read only via FindLaw.
- Application processing standards (45/90 days) and number of retroactive months not verified; also whether federal 2025 reconciliation law changes to retroactive coverage affect Indiana LTC applicants in 2027.
- PathWays for Aging managed-care NEMT vendors (per health plan) not identified.
- Filial-support enforcement frequency in Indiana (any recent nursing-home suits) not researched.