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FreedomCare helps Elkhart County families get paid through Indiana Medicaid for the care they're already giving a parent, sibling, or other loved one at home.
Elkhart County families often care for parents and grandparents in the same house, and many are already doing the work that Indiana Medicaid may help cover. FreedomCare helps families in Elkhart, Goshen, Nappanee, and the surrounding townships understand which program fits and how to get the process started.
This page covers the Indiana Medicaid programs that pay for care at home, who may qualify, how families take part in care, and where to start in Elkhart County specifically. For the statewide picture, see our Indiana Medicaid home care overview.
Not sure where your family fits? We can walk you through Indiana's home care programs and what they mean for your situation. Call (866) 506-9284 or check your eligibility online.
Indiana Medicaid pays for care at home through home and community-based services, usually shortened to HCBS. The principle is simple. If someone needs the level of care a nursing facility provides but can stay safely at home with the right support, Indiana Medicaid can cover that support at home instead.
Indiana reorganized these programs on July 1, 2024. The old Aged and Disabled Waiver ended and split into two programs divided by age. Which one applies to your family depends almost entirely on how old the person receiving care is.
This is a manufacturing county, and the RV and trailer plants set the rhythm of daily life. Shift work makes caregiving harder to schedule around, and a layoff cycle can change a family's finances quickly. Both of those things affect what kind of care arrangement actually works.
| Topic | PathWays for Aging | Health & Wellness Waiver |
|---|---|---|
| Who it serves | Hoosiers 60 and older on Medicaid who need a nursing facility level of care | Hoosiers 59 and younger with a disability who need a nursing facility level of care |
| How it is run | Medicaid managed care, through a health plan you choose | A traditional HCBS waiver, run through the state |
| Administered by | Office of Medicaid Policy and Planning (OMPP) | Division of Disability and Rehabilitative Services (DDRS) |
| Typical services | Personal care, homemaker help, respite, service coordination, structured family care | Personal care, respite, therapies, home modifications as authorized |
Indiana PathWays for Aging is a Medicaid managed care program for Hoosiers aged 60 and older who qualify for Medicaid based on age, blindness, or disability. Rather than the state managing services directly, each member has a health plan that coordinates their medical care and their long-term services and supports in one place.
Three health plans serve PathWays statewide: Anthem, Humana, and UnitedHealthcare. Enrollment is automatic for people who meet Medicaid eligibility and are 60 or older, and members receive a letter from the Division of Family Resources or the enrollment broker. Members who meet functional eligibility are assigned a service coordinator who builds a service plan. Our guide to the Indiana PathWays for Aging Waiver goes into more detail.
The Health & Wellness Waiver serves Hoosiers aged 59 and younger who have a disability and meet a nursing facility level of care. It is a traditional HCBS waiver rather than a managed care program, and it is administered by the Division of Disability and Rehabilitative Services. Families usually reach it after a serious injury, a progressive diagnosis, or a stroke in a younger adult. Our guide to the Health & Wellness Waiver covers how it works in practice.
When someone on the Health & Wellness Waiver approaches 60, the move to PathWays becomes part of planning. Indiana sends a letter about 90 days before a person's 60th birthday explaining the transition.
Indiana also runs a Traumatic Brain Injury Waiver for people of any age with a TBI diagnosis, and the Community Integration and Habilitation and Family Supports waivers for people with intellectual and developmental disabilities. These are separate tracks with their own eligibility rules. Notably, people on DDRS waivers, the TBI waiver, or PACE are not enrolled in PathWays even if they are over 60. We cover the Indiana Traumatic Brain Injury Waiver separately, along with adult foster care as another community option.
This changed recently and trips up families working from older guidance. Since July 1, 2025, Indiana uses a single statewide Level of Care Assessment Representative, or LCAR, to conduct nursing facility level of care assessments for PathWays, the Health & Wellness Waiver, and the TBI Waiver. The vendor is Maximus. Area agencies on aging no longer perform these assessments themselves, though they remain a first point of contact and continue to help with referrals, service planning, case management, and Medicaid applications.
If you are seeking new home and community-based services, you or someone helping you can request an assessment directly from Maximus at (833) 597-2777 or through inlcar.com. Assessors meet people virtually or in person and use a standard assessment tool covering physical, functional, and cognitive needs. A determination arrives by mail, typically within 11 calendar days of the request. If you disagree with the outcome, the letter explains your appeal rights.
The criteria themselves did not change. What changed is who performs the assessment and how the request is submitted. For someone already enrolled in PathWays, the health plan conducts the assessment and the LCAR issues a determination recommendation, so there is no duplicate visit.
This matters and it is often left out. Indiana's HCBS waivers have a federally approved number of slots, and both PathWays and the Health & Wellness Waiver have had waiting lists. FSSA invites people from the list each month as capacity allows. People moving out of a nursing facility or hospital are given priority by application date.
One detail worth understanding: the list is not a static queue where you hold a fixed number. People are added daily with differing levels of care need, and invitations account for that, so neither your area agency on aging nor FSSA can tell you your position in line. They can tell you your original level of care date and your priority category, which is the useful thing to ask for.
Getting assessed and on the list early is still the practical response, because your original date matters. Starting now costs a phone call.
Qualifying rests on three separate things at once. All three have to be met, and families often assume they fail one when they actually do not.
Indiana Medicaid looks at the applicant's own income and countable assets. HCBS and nursing facility applicants are assessed under special income and asset limits that differ from standard Medicaid rules, and there are protections for a spouse who remains at home. Household income as a whole is not the test.
Functional eligibility means the person needs help with at least three activities of daily living, such as eating, dressing, bathing, toileting, or moving around, or that they are unable to care for themselves medically. This is determined by assessment.
Families routinely underestimate this. Someone who appears to be managing because a daughter comes by twice a day may well meet the criteria, because the assessment measures what the person needs, not whether an unpaid relative is currently filling the gap.
Beyond finances and function, each program has its own rules: age 60 and older for PathWays, 59 and younger for the Health & Wellness Waiver, a TBI diagnosis for the TBI waiver, and a developmental disability determination for the DDRS waivers.
What a person actually receives comes out of an assessment and an approved service plan, not a standard package. Services commonly available through Indiana Medicaid HCBS include:
Service plans are reviewed at least every 90 days and annually, and are reassessed when someone's condition changes. If your family member's needs increase, that reassessment is the mechanism for adjusting the plan.
This is the question families ask first, and the honest answer is that Indiana allows family involvement in specific, defined ways. The rules changed in 2024 and are more precise than most summaries suggest, so it is worth being exact.
Structured family care is available under both PathWays and the Health & Wellness Waiver. It allows a caregiver who lives in the home with the person receiving care to be supported through an approved provider agency for providing daily care. The caregiver may be a family member or a non-family member, but living in the home is a requirement, not a preference. The provider agency trains the caregiver based on the individual's needs and conducts quarterly home visits through a caregiver coach or registered nurse.
Attendant care covers hands-on help with daily activities and can be provided by a relative in some circumstances. Indiana applies specific limits here. A spouse, defined as a legally responsible individual, cannot provide attendant care. Legal guardians of adults may provide attendant care up to 40 hours per week. Other relatives providing attendant care are not subject to that weekly cap.
Under participant-directed attendant care, Indiana does not permit payment to legally responsible individuals, legal guardians, holders of power of attorney, health care representatives, or authorized representatives. If one person in the family holds both the decision-making role and the caregiving role, that combination needs to be worked through with the service coordinator before anything is arranged.
Because these rules turn on the exact relationship, the program, and the living situation, no one should be told flatly that a family member either can or cannot take part. The determination belongs to the service coordinator or managed care entity. Our guide on becoming a paid family caregiver in Indiana walks through how the options compare, and official guidance is at in.gov/medicaid.
Elkhart County has about 207,436 residents across 72,379 households. Median household income is $69,872, close to the Indiana figure, and 10.7% of residents live below the poverty line, slightly under the state rate of 12.2%.
One figure here stands apart. Elkhart County averages 2.8 people per household, roughly 20% above the Indiana average of 2.4 and the largest household size of any county we cover. Larger households usually mean more generations under one roof, and that changes the caregiving picture. Many families here are not deciding whether to bring a parent home. The parent is already home, and the question is whether Medicaid can support the care being provided.
That matters for one program in particular. Structured family care, available under both PathWays and the Health & Wellness Waiver, requires the caregiver to live in the home with the person receiving care. In a county where multigenerational households are already common, families often meet that condition without having changed anything about their living arrangement.
About 9.5% of Elkhart County residents were born outside the United States, roughly 1.4 times the Indiana rate, and Spanish is widely spoken across the county. If English is not the first language at home, ask FSSA, your health plan, and REAL Services for interpretation services and translated materials at the start of the process rather than partway through. You are entitled to them and it is far easier to arrange up front.
The practical argument for home care in Elkhart County is not sentimental. Nursing facility care runs several thousand dollars a month, and once someone moves into a facility, coming home again is far harder than never leaving. Families who arrange support early often keep a parent at home for years longer than anyone expected.
These are the offices you are most likely to deal with. It helps to have the numbers in one place.
REAL Services is the Area Agency on Aging and Aging and Disability Resource Center serving Elkhart County, along with St. Joseph, LaPorte, Kosciusko, and Marshall counties. It offers options counseling, helps with Medicaid applications, coordinates service planning, and can submit an assessment referral on your behalf. Located at 1151 S. Michigan Street, South Bend, IN 46601. Phone: (800) 552-7928 or (574) 284-2644. Its Aging and Disability Resource Center can be reached directly at (574) 233-8205 or toll-free at (800) 552-2916.
realservices.orgFor choosing or changing a PathWays health plan, or to confirm which plan a family member is enrolled in, call (877) 284-9294. The helpline is open Monday through Friday. Member Support Services, which helps members and caregivers resolve problems, is at (877) 738-3511.
Medicaid applications go through the FSSA Benefits Portal at fssabenefits.in.gov, where you can apply online, print an application, or request one by mail. General Indiana Medicaid information is at in.gov/medicaid, and the FSSA Division of Aging can be reached at (800) 713-9023. Program details are on the FSSA PathWays page and the DDRS page for the Health & Wellness Waiver.
fssabenefits.in.gov · in.gov/medicaid · FSSA PathWays page · DDRS pageMaximus conducts the nursing facility level of care assessment required for PathWays, the Health & Wellness Waiver, and the TBI Waiver. Request an assessment at (833) 597-2777 or inlcar.com.
inlcar.comStatewide overview of PathWays, the Health & Wellness Waiver, and structured family care with FreedomCare.
freedomcare.com/indianaFreedomCare works with families who are already providing care and want to understand what Indiana Medicaid covers. We help you identify which program fits, work through Medicaid enrollment, get paperwork filed correctly the first time, coordinate with the assessment process, and stay with you as the service plan comes together. You can read more about what we stand for and the families we have worked with.
What we do not do is decide eligibility. That authority sits with the Indiana Family and Social Services Administration and, for PathWays members, with the assigned managed care entity. What we can do is make sure you are applying to the right program with the right documentation, and that you know what happens next.
Yes. Indiana Medicaid covers care at home through home and community-based services waivers. The two main programs are PathWays for Aging for people 60 and older and the Health & Wellness Waiver for people 59 and younger. Covered services include personal care, homemaker help, respite, and structured family care, based on an assessment.
Indiana PathWays for Aging is a Medicaid managed care program for Hoosiers 60 and older who are eligible for Medicaid based on age, blindness, or disability. Members enroll with one of three health plans, Anthem, Humana, or UnitedHealthcare, which coordinate both medical care and long-term services and supports including home and community-based services.
The Health & Wellness Waiver is an Indiana Medicaid HCBS waiver for people aged 59 and younger who have a disability and meet a nursing facility level of care. It is administered by the Division of Disability and Rehabilitative Services. It replaced part of the former Aged and Disabled Waiver on July 1, 2024.
It ended on July 1, 2024 and split into two programs by age. People 60 and older moved to PathWays for Aging. People 59 and younger moved to the Health & Wellness Waiver. Any guidance describing the Aged and Disabled Waiver as a current option is out of date.
Three things must be met: financial eligibility under Indiana Medicaid rules for HCBS applicants, functional eligibility meaning help is needed with at least three activities of daily living or the person cannot care for themselves medically, and the specific program's criteria such as age. Eligibility is determined by FSSA.
Indiana allows family involvement in defined ways. Structured family care supports a caregiver who lives in the home with the person receiving care, through an approved provider agency, and is available under both PathWays and the Health & Wellness Waiver. Attendant care may be provided by some relatives, with limits: spouses as legally responsible individuals cannot provide it, and legal guardians of adults are capped at 40 hours per week. Whether a particular family member may take part is determined by the service coordinator or managed care entity based on the program and circumstances.
There are two tracks and they run in parallel. For the financial side, apply for Indiana Medicaid through the FSSA Benefits Portal at fssabenefits.in.gov. For the care side, request a level of care assessment from Maximus, the state's Level of Care Assessment Representative, at (833) 597-2777 or inlcar.com. You can also call REAL Services at (800) 552-7928, which can submit the assessment referral for you and help with the Medicaid application. For questions about an existing PathWays enrollment, call the PathWays Helpline at (877) 284-9294.
Expect to provide proof of identity and Indiana residency, Social Security and Medicare or Medicaid numbers, income documentation such as Social Security award letters and pension statements, bank and asset statements, insurance information, and medical records supporting the level of care. Gathering financial records early is usually the slowest part of the process.
It varies. Some families move through in weeks, others take several months, depending on how quickly documentation comes together and whether a disability determination is needed. Waiting lists have applied to both waivers, and people transitioning from a nursing facility or hospital receive priority by application date.
There are no copayments in PathWays, though a member may have copays through their Medicare plan. Some individuals have a monthly waiver liability if they receive home and community-based services, or a patient liability in a nursing facility. The Division of Family Resources notifies the individual if a liability applies.
PathWays does not change Medicare benefits. It is a Medicaid managed care program designed to coordinate with a person's Medicare coverage. Members who want to keep a specific doctor should confirm that provider participates with the health plan they select, and can call the PathWays Helpline to discuss options.
It does not hurt, and for one program it may help. Household composition does not by itself determine Medicaid eligibility, which is based on the applicant's own income and countable assets along with their assessed need for care. Structured family care specifically requires that the caregiver live in the home with the person receiving care, so a multigenerational household already meets that condition. Whether it applies in your case depends on the assessment and program approval, which the service coordinator determines.
If you are caring for someone in Elkhart County and want to understand whether Indiana Medicaid may cover that care, call FreedomCare at (866) 506-9284. We will talk through the situation, explain which program looks like the fit, and tell you what the next step involves. If a different program or agency is the better route for your family, we will say so.
Related pages
Talk to someone who knows Indiana Medicaid home care. We will walk you through what is available in Elkhart County and what your family may qualify for. Call (866) 506-9284 or check your eligibility online.
Important information about eligibility. Eligibility for Indiana Medicaid and its home and community-based services waivers is determined by the Indiana Family and Social Services Administration, not by FreedomCare. Qualifying depends on financial, functional, and program-specific criteria set by the state. Covered services and care plans are determined through assessment and approval by the appropriate state agency or managed care entity. Program rules, waiver availability, and benefits may change over time. FreedomCare provides education and enrollment support and cannot guarantee eligibility, enrollment, or any particular outcome.
We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Indiana every day.
We’ll help you find the right program for your family.
Why Families Choose FreedomCare
We help families across Indiana every day.
You’ve been caring for your loved one because it’s the right thing to do. FreedomCare can help you navigate Indiana’s FSSA program, understand your options, and take the first step toward care from someone you trust while they get paid for it.
