The purpose of this memorandum is to clarify the allowable room and board rates an assisted living facility may charge individuals who participate in the Indiana Medicaid Waiver and Money Follows the Person Aged and Disabled and Traumatic Brain Injury programs. This memorandum supersedes all previous communications regarding allowable room and board rates.
Under 455 IAC 3-1-12, participants living in assisted living facilities are entitled to retain at least their personal needs allowance as established by the state of Indiana.
A provider, after assuring that the participants retain their PNA, may bill participants up to the current maximum Federal Supplemental Security Income. The monthly maximum Federal SSI amount for 2023 is $914 per month for an eligible individual based on an 8.7% cost of living increase. Providers may not charge Medicaid eligible individuals a room and board rate that exceeds the maximum SSI amount for a studio apartment. A participant who wishes to select a larger room may pay extra for any unit exceeding the size of a studio based on the monthly amount determined by the facility.
Please see the three illustrations below for further clarification. The amounts included in the examples below are for illustrative purposes only. Providers are responsible for determining the current maximum SSI and the State PNA when calculating room and board rates. The current SSI may be found by clicking here.  Per Ind. Code §12-15-7-2, the State PNA is $52.
Example 1:Â Medicaid Waiver Participant Receiving only SSI Income
- Medicaid Waiver Participant Monthly Income                         $914
- SSI for an Eligible Individual                           $914
- PNAÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $52
- Allowable Room and Board Rate                       $862
Example 2:Â Medicaid Waiver Participant with Income in Excess of the SSI Rate
- Medicaid Waiver Participant Monthly Income              $925
- SSI for Eligible Individual                             $914
- PNAÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $52
- Allowable Room and Board Rate                        $873
Example3:Â Medicaid Waiver Participant with Income in Excess of the SSI Rate
- Medicaid Waiver Participant Monthly Income            $1,200
- SSI for Eligible Individual                             $914
- PNAÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $52
- Allowable Room and Board Rate                       $914
In all these examples, the participant retains their PNA and the room and board rate is no greater than the maximum SSI.
