In Indiana, nursing homes or assisted living residents who receive Medicaid benefits must go through an annual redetermination process to confirm continued eligibility. This process—sometimes called “renewal” or “recertification”—ensures that Medicaid resources are directed to those who still meet the program’s financial and medical requirements. As part of the legal representation for our clients, we handle these.
Why Redeterminations Matter
Medicaid is a joint federal-state program that helps cover the cost of long-term care for individuals with limited income and assets. For nursing home residents, Medicaid can pay for room, board, medical care, and personal services. Because a resident’s income, assets, or living situation may change over time, Indiana law requires a yearly review of eligibility.
How the Process Works
The Indiana Family and Social Services Administration (FSSA) sends a redetermination notice to the resident—or their legal representative, before the renewal date. This notice lists the documents needed to be submitted, such as:
- Proof of income (Social Security statements, pension records)
- Bank statements and asset records
- Insurance policies and premium statements
The Medicaid recipient or authorized representative, which may be a law firm, must submit the requested information by the deadline stated. Failure to respond can result in suspension or termination of Medicaid coverage, which could leave the resident responsible for the full nursing home cost.
Role of Nursing Facilities if no legal representation
Nursing home staff often assist residents and families with gathering documents and communicating with the local Division of Family Resources (DFR) office. While the facility cannot complete every step; staff can help track deadlines and ensure that information is sent promptly.
Common Challenges
Redetermination can be complicated when residents have no family nearby, or legal representation, when records are missing. In some cases, assets like life insurance policies or property ownership may require clarification before eligibility is approved. Acting early and maintaining updated records throughout the year can make the process smoother.
What Happens After DFR Review
Once the DFR reviews all submitted materials, it will send a decision letter confirming continued eligibility or explaining any changes. If benefits are denied, residents have the right to request an appeal within a specified time frame.
Bottom Line
Annual redetermination is a standard part of maintaining Medicaid coverage for nursing home residents in Indiana. By staying organized, responding to notices promptly, and seeking assistance when needed, residents and their families can help ensure uninterrupted coverage.