Indiana Level of Care Assessment: How the LCAR Process Works for Medicaid Waivers

Before your parent can qualify for Indiana's PathWays for Aging waiver, Medicaid-funded nursing home placement, or the Health & Wellness waiver, they must pass a clinical assessment proving they need a nursing facility level of care. Indiana overhauled this entire process in 2025, and the new system works differently than what most families expect.

What Changed With LCAR

Effective July 1, 2025, Indiana launched Phase 2 of the Indiana Level of Care Assessment Representative (LCAR) process. This was a major shift: local Area Agencies on Aging (AAAs) and Independent Case Management (ICM) agencies no longer perform clinical level-of-care screenings.

Instead, all nursing facility level of care (NFLOC) determinations are now conducted by Maximus, the state's contracted LCAR provider. Maximus uses certified assessors who administer a standardized clinical evaluation tool called the interRAI assessment.

This change was designed to eliminate inconsistencies between regions — previously, different AAAs applied different standards, leading to approval rates that varied significantly by county.

How to Start the LCAR Process

To initiate a level of care assessment, contact the Indiana LCAR Maximus Help Desk at 1-833-597-2777 or access the portal at inlcar.com.

You can also request an assessment through your local AAA, who will submit the referral to Maximus on your behalf. But the assessment itself will be conducted by a Maximus assessor, not AAA staff.

After the referral is submitted, Maximus assigns a certified assessor to schedule an in-person or virtual assessment with your parent. The assessment can be conducted at:

• Your parent's home
• A hospital bedside (common for post-hospitalization transitions)
• A rehabilitation facility
• Via telehealth in some circumstances

What the interRAI Assessment Evaluates

The interRAI is a comprehensive, standardized clinical evaluation tool — not a questionnaire your parent fills out. The assessor conducts a structured interview and functional observation, evaluating:

Physical function

• Ability to perform activities of daily living (ADLs): eating, bathing, dressing, toileting, transferring (bed to chair), and mobility
• Whether assistance is required for each ADL, and at what level (supervision, limited assistance, extensive assistance, or total dependence)

Cognitive function

• Short-term memory
• Decision-making ability
• Communication skills
• Awareness of time, place, and person

Medical complexity

• Current diagnoses and their stability
• Medication regimen complexity
• Frequency of health service needs (nursing visits, therapy, monitoring)
• Recent hospitalizations or emergency department visits

Behavioral symptoms

• Wandering
• Verbal or physical aggression
• Resistance to care
• Socially inappropriate behavior

Mood and psychosocial well-being

• Signs of depression or anxiety
• Social withdrawal
• Quality of social support network

What Qualifies as Nursing Facility Level of Care

To meet the NFLOC standard, your parent must demonstrate one of the following:

• Substantial functional limitations requiring direct, hands-on assistance from others in at least three ADLs (eating, dressing, mobility, toileting, bathing)
• A complex, unstable medical condition requiring daily skilled nursing oversight
• Severe cognitive impairment that creates safety risks (wandering, inability to manage medications, inability to recognize danger)

The key word is "nursing facility level of care" — the assessment determines whether your parent's needs are severe enough that they would otherwise require placement in a nursing home. This standard applies even if your parent will actually receive care at home through the PathWays for Aging waiver.

How to Prepare Your Parent

The LCAR assessment captures a snapshot. If the assessor visits on a good day — when your parent is alert, well-rested, and recently bathed — the assessment may understate their actual daily care needs. This is one of the most common reasons for denial.

Before the assessment:

1. Document the bad days, not the good days. Keep a two-week log of incidents: falls or near-falls, times your parent couldn't manage medications, episodes of confusion or wandering, meals skipped, hygiene refused.

2. Gather medical records. Have recent physician notes, specialist reports, hospital discharge summaries, and a current medication list ready. The assessor will review these alongside their direct observation.

3. Be present and speak up. Your parent may minimize their limitations out of pride or lack of awareness. As the family caregiver, you're allowed (and expected) to provide supplementary information during the assessment. Describe what you observe daily — not what your parent says they can do.

4. Don't clean up before the visit. If the home is cluttered, the refrigerator has expired food, or the bathroom shows signs of difficulty with hygiene — those environmental cues support the clinical picture.

5. Note cognitive fluctuations. If your parent is lucid during the assessment but confuses medications, leaves the stove on, or gets lost driving to familiar places on other days, say so explicitly.

After the Assessment

Maximus submits its NFLOC determination recommendation to FSSA for final review. Once approved, the local AAA is notified through the AssessmentPro system, and you receive a formal approval letter.

If your parent is approved for NFLOC, the next step depends on which program they're applying for:

• PathWays for Aging waiver — Contact the Maximus Enrollment Broker at 1-877-284-9294 to select a Managed Care Entity (Anthem, Humana, or UnitedHealthcare)
• Nursing home Medicaid — Continue with the financial eligibility application through the Division of Family Resources (DFR)
• Health & Wellness waiver (under 60) — Coordinated through the Division of Disability and Rehabilitative Services (DDRS)

If denied, you can request a reconsideration or appeal. Having detailed documentation of daily care needs strengthens your case.

The Full Timeline in Context

The LCAR assessment is one step in a multi-stage process. Before the assessment, you need legal authority to act on your parent's behalf (power of attorney or guardianship). After the assessment, you need to navigate the financial eligibility process. Missing a step or doing them out of order causes delays that can stretch from weeks to months.

The Indiana Elder Care Decision Guide maps the complete timeline from first warning signs through Medicaid approval and facility placement, including preparation checklists for each phase so nothing falls through the cracks.

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