Indiana FSSA Medicaid Application: How to Apply for Long-Term Care Step by Step

The hospital is discharging your parent to a skilled nursing facility next week. You need to file for Medicaid, but the application process looks like a maze of forms, portals, and deadlines that nobody bothered to explain clearly.

Indiana's Medicaid application for long-term care goes through the Family and Social Services Administration (FSSA) Division of Family Resources (DFR). The process has two parallel tracks — financial eligibility (the DFR application) and clinical eligibility (the Maximus Level of Care assessment) — and both must be completed for approval.

Before You File: Required Documents

Gather these before starting the application. Missing documents are the number one cause of delays and denials:

• Identification: Birth certificate, Social Security card, proof of citizenship or immigration status
• Medicare card and any supplemental insurance cards
• 60 months of bank statements for all accounts — checking, savings, money market, CDs, brokerage (this is the lookback documentation)
• Property deeds for any real estate owned
• Vehicle titles and current market values
• Life insurance policies with cash value statements
• Retirement account statements — IRAs, 401(k)s, pensions (current balance plus payout amounts)
• Tax returns for the most recent two years
• Proof of income — Social Security award letter, pension statements, VA benefit letters, annuity contracts
• Funeral trust documentation (if prepaid)
• Power of Attorney or guardianship papers (if someone other than the applicant is filing)

If filing on behalf of your parent, you'll also need to submit an Authorized Representative form (State Form 55366 / DFR 2123HC).

Step 1: Submit the Application

File State Form 55390 (Indiana Application for Health Coverage) through one of three channels:

1. Online: FSSA Benefits Portal at fssabenefits.in.gov
2. Phone: Call 1-800-403-0864
3. In person: Visit your local DFR county office

The online portal is fastest. Create an account, complete the health coverage application, and upload supporting documents directly. Paper applications are also accepted but add processing time.

Step 2: Clinical Level of Care Assessment

Independently of the financial application, your parent must pass the Nursing Facility Level of Care (NFLOC) screening. Contact Maximus (the state's contracted Level of Care Assessment Representative) at 1-833-597-2777 to initiate the PASRR Level I Screen (State Form 45277).

A Maximus assessor will evaluate whether your parent requires daily assistance with at least three of five ADLs: bathing, dressing, eating, toileting, and mobility. Have the treating physician's clinical diagnosis, current medication list, and medical history ready.

If your parent is already in the hospital or a rehabilitation facility, the hospital social worker can often initiate this screening before discharge.

Step 3: Respond to Verification Requests

After the DFR receives your application, a caseworker reviews the financial documentation and five-year lookback history. If anything is missing or needs clarification, they send a Request for Verification.

The response deadline is 10 days from the date the FSSA mails the request. Not 10 business days — 10 calendar days from the mailing date (which means you may have fewer than 10 days to actually respond once the letter arrives). Failure to respond within this window results in automatic denial.

If you receive a verification request, respond immediately with the exact documents requested. Don't send partial responses assuming you can supplement later — each round of back-and-forth resets the clock and delays approval.

Step 4: Approval and Enrollment

Once both the financial and clinical eligibility requirements are confirmed, the FSSA issues an approval notice. If your parent is 60 or older, they'll be enrolled in Indiana PathWays for Aging and must select a Managed Care Entity (Anthem, Humana, or UnitedHealthcare) through the PathWays Enrollment Broker at 1-877-284-9294.

Plan selection must happen within 90 days. If your parent doesn't choose, the state auto-assigns one.

The MCE assigns a Care Coordinator who develops the service plan — whether that's nursing facility coverage or home-based services through the waiver.

Processing Timeline

Standard Medicaid applications for long-term care in Indiana are supposed to be processed within 45 days. In practice, complex cases with lookback issues or missing documentation can take 60–90 days.

Medicaid coverage can be made retroactive up to three months before the application date, covering facility costs incurred during the processing period — but only if the applicant was eligible during those months. This retroactive coverage is critical for families whose parent entered a nursing home before the application was filed.

If You're Denied

Don't panic — denials are common and often fixable. The denial notice must state the specific reason: excess income, excess assets, a transfer penalty, or failure to meet clinical criteria.

You have 30 days from the date on the denial notice to file an administrative appeal. The appeal request goes to the FSSA Office of Administrative Hearings. An Administrative Law Judge reviews the case at a formal hearing where you can present additional documentation or correct errors in the original application.

The Indiana Medicaid Long-Term Care & Asset Protection Guide includes the complete document checklist, application timeline, and a verification-response template to avoid the 10-day deadline trap.

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