Indiana Medicaid LTC Guide — Miller Trusts, PathWays, and Estate Recovery

Your Parent Needs a Nursing Home. Indiana's Rules Say They Make Too Much — By One Dollar.

Your parent needs long-term care. The nursing home costs $10,000 a month. Their Social Security and pension add up to $3,100. That is $118 over Indiana's hard income cap — and in Indiana, there is no spend-down, no deductible, no partial credit. They are simply disqualified.

You called the Indiana Family and Social Services Administration. They mentioned a "Qualified Income Trust." You searched online and found the term "Miller Trust." But nobody told you how to set one up, what language Indiana requires, which bank account to open, or what happens if you get the monthly disbursement cycle wrong. One mistake and your parent loses Medicaid eligibility retroactively.

Meanwhile, the PathWays for Aging waiver — the program that could keep your parent at home — has a waiting list of more than 12,000 people. And after your parent passes, Indiana's estate recovery program can reach assets that most states cannot touch, thanks to House Enrolled Act 1277.

The Indiana Medicaid Asset Protection Playbook

This is not a pamphlet of eligibility limits you can find on the FSSA website. It is the process around the limits — the part that $300/hour elder law attorneys explain in billable consultations and that free government portals never cover.

The guide covers every financial threshold, every legal instrument, every waiver program, and every asset protection strategy available under Indiana law — organized in the order you will actually need them, from the first hospital discharge through Medicaid approval to estate recovery after your parent passes.

What's Inside

• Miller Trust Setup — Step by Step — Indiana is an income-cap state, not a medically needy state. If your parent's gross income exceeds $2,982/month, they must establish a Qualified Income Trust or be denied outright. The guide walks through the trust language Indiana requires, how to open the dedicated bank account, the monthly deposit-and-disbursement cycle (Personal Needs Allowance → spousal maintenance → medical expenses → patient liability), and naming the State of Indiana as remainder beneficiary. Covers the drafting mistakes that trigger denials and the timing trap when income figures reset on March 1.
• Asset Protection Under HEA 1277 — Indiana expanded its Medicaid Estate Recovery Program beyond probate to include jointly held property and certain trust assets. The guide details which ownership structures are vulnerable, which are protected, and the specific exemptions that shield the family home when a surviving spouse, minor child, or qualifying caretaker child is involved. Includes the Undue Hardship Waiver process and the documentation required to invoke it.
• Spousal Protection Formulas — When one spouse enters care, the community spouse keeps between $32,532 and $162,660 in assets under the CSRA, plus a Monthly Maintenance Needs Allowance of $2,644 to $4,067. The guide walks through the Snapshot Date calculation, the Excess Shelter Allowance, and when to request an administrative hearing for a higher income allocation — because most families never learn they can ask.
• The 60-Month Look-Back Audit — Indiana reviews every financial transaction from the past five years. The guide explains what triggers a penalty (uncompensated transfers), what does not (fair-market-value purchases), the $1,200 annual de minimis exception, and why the IRS $19,000 gift-tax exclusion is a trap — Indiana Medicaid ignores federal tax code entirely and penalizes the full amount.
• Penalty-Free Spend-Down Strategies — The complete list of Indiana-approved ways to legally reduce countable assets without triggering a single day of penalty: paying off debts, prepaying irrevocable funeral trusts, making life-safety home modifications, purchasing a vehicle, and paying for home care with a written Personal Care Agreement at fair market value. Every strategy is executable even if your parent is entering a facility tomorrow.
• PathWays for Aging & Health and Wellness Waivers — Indiana's two major home and community-based services programs, with clinical eligibility requirements (Maximus NFLOC assessment), managed care entity enrollment (Anthem, Humana, UnitedHealthcare), covered services, and the waiting list reality. How to get on the waitlist through your Area Agency on Aging while bridging with private-pay care.
• FSSA Application Walkthrough — The full application sequence from Maximus NFLOC screening through the FSSA benefits portal submission: required documentation (60 months of bank statements, income verification, property deeds, vehicle titles, burial trust paperwork), how to respond to information requests without triggering administrative denial, and the 45-to-90-day processing timeline.
• Legal Authority Chapter — The Indiana Power of Attorney Act (IC § 30-5), the Health Care Representative Appointment requirement (IC § 16-36-7), and the specific POA clauses you need for Medicaid planning. The full guardianship process when capacity is already gone — emergency temporary guardianship, permanent guardianship, bonding, and annual reporting requirements.

Plus: 8 Printable Worksheets

• Miller Trust Setup Guide — Step-by-step QIT creation: trust drafting, bank account setup, monthly disbursement order, and a ledger template
• Income & Asset Eligibility Calculator — Fill-in worksheet for income and assets against Indiana's 2026 Medicaid thresholds
• Asset Inventory Worksheet — Map every account, property, vehicle, and insurance policy with countable-vs-exempt status
• Penalty-Free Spend-Down Planner — Tracker for every Indiana-approved strategy with amounts and completion dates
• Spousal Protection Calculator — CSRA and MMMNA calculation worksheets for married couples
• Five-Year Lookback Audit — 60-month transfer log with penalty calculation formula and common traps
• Estate Recovery Worksheet — Asset vulnerability assessment under HEA 1277 with timeline tracker
• FSSA Application Document Checklist — Every document you need before filing, organized by category

Plus: Printable Quick-Start Checklist

• Indiana Medicaid LTC Eligibility Checklist — A one-page action list with the 20 most critical items: establish legal authority, gather 60 months of financial records, calculate countable assets, set up the Miller Trust, prepare for the Maximus assessment, file with FSSA. Every threshold, phone number, and deadline at a glance.

Who This Is For

• Adult children whose parent is being discharged from the hospital and someone needs to figure out who is paying $10,000 a month
• Families whose parent's income exceeds $2,982/month and they need a Miller Trust set up correctly — not a template that gets rejected
• Spouses trying to avoid impoverishment when one partner enters a nursing home
• Families who made gifts or transfers in the past five years and need to understand the look-back penalty before it's calculated for them
• Caregivers trying to get a parent onto the PathWays for Aging waiver while managing a 12,000-person waiting list
• Out-of-state siblings coordinating Indiana Medicaid applications remotely
• Anyone who has been told "it's too late to protect anything" and wants to know what the law actually allows

Why Not Free Government Resources?

The FSSA publishes eligibility limits. CICOA and your local Area Agency on Aging offer options counseling. Brevy and Medicaid Planning Assistance websites list state-specific thresholds.

Here is what none of them provide:

• A step-by-step Miller Trust setup with the exact language Indiana requires — not a generic "consult an attorney" note
• The specific asset protection strategies that are legal under HEA 1277's expanded estate recovery, with the exemptions and hardship waiver process
• A complete spend-down strategy list distinguishing penalty-free moves from penalized transfers — including the caregiver agreement template that prevents look-back violations
• The FSSA application sequence with the documentation checklist, the March 1 income reset timing trap, and the information request response protocol

Government sites administer rules. Elder law firms explain them for $300 to $500 per hour. This guide bridges the gap — translating hundreds of pages of state policy into a sequence you can execute in an evening.

Satisfaction Guarantee

If the guide doesn't give you a clearer path forward, email [email protected] and we'll make it right.

— Less Than One Hour of an Elder Law Attorney's Time

An initial consultation with an Indiana elder law attorney runs $300 to $500. A full Medicaid planning engagement can cost $10,000 to $15,000. A guardianship proceeding adds $5,000 or more in court costs and legal representation.

This guide won't replace an attorney for complex trust litigation or multi-million dollar estate planning. But for the Miller Trust setup, asset mapping, spend-down documentation, and FSSA application process that most Indiana families need, it covers 90% of the work at a fraction of the cost — and if you do need an attorney, you'll walk in with a fully organized file instead of a box of unsorted bank statements.

Start with the free checklist to see if the approach fits your situation. The full guide goes deeper — every threshold, every strategy, every form, every phone number.