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Medicaid Waiver vs. Nursing Home Medicaid

Indiana's PathWays Waiver and nursing-home Medicaid use similar financial eligibility tests but pay for completely different settings, and one is capped while the other is not.

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Short answer

Indiana's PathWays Waiver and long-term-care Medicaid for a nursing home use a similar Special Income Limit and asset test, but pay for very different settings -- the waiver pays for care services inside a licensed community or at home, while nursing-home Medicaid pays for 24-hour skilled nursing care in a Comprehensive Care Facility.

The waitlist difference

Nursing home Medicaid is an entitlement in Indiana -- if a person meets the clinical and financial criteria, coverage is available. The PathWays Waiver is capped and has carried a waitlist historically (9,015 people at its July 2024 launch); confirm current status with CICOA before assuming a short wait.

Room and board

Nursing-home Medicaid covers room and board as part of the facility's daily rate. PathWays does not -- room and board for assisted-living-style care runs through the separate RCAP program instead.

How families pay for care. Indiana's PathWays Waiver pays for care services, RCAP pays for room and board, and VA Aid and Attendance can help veterans and surviving spouses. Read the full explanation →

Questions families ask

Does Indiana require every assisted living community to be licensed?

No. Under 410 IAC 16.2-5-0.5(c), a community that provides only room, board, housekeeping and activities -- without administering medication or providing nursing care -- is not required to hold a Residential Care Facility license at all. Some buildings marketed as assisted living in Indiana may carry no state license, so always confirm directly.

Does Indiana require a separate license for memory care?

No. Indiana requires a written Alzheimer's and Dementia Special Care Disclosure under Indiana Code 12-10-5.5, not a separate state certification. Communities must file the disclosure and meet training requirements, but there is no distinct 'certified memory care' license to check for.

How do I check a facility's Indiana license and inspection history?

Use the Indiana Long Term Care Survey & Inspection Public Search at hoosierusa.isdh.in.gov, run by the Indiana Department of Health. Nursing homes also carry a federal CMS Care Compare star rating; assisted living (Residential Care Facilities) does not.

What's the difference between Indiana's Residential Care Facility and Comprehensive Care Facility licenses?

A Residential Care Facility (RCF) is Indiana's assisted-living-type license, covering personal care, medication administration and ADL help, not 24-hour skilled nursing. A Comprehensive Care Facility is Indiana's nursing-home license, for residents who need 24-hour licensed nursing care.

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