The purpose of this memorandum is to update the allowable room and board rates for calendar year 2025 that an assisted living facility may charge individuals who participate in Indiana’s Health and Wellness, Traumatic Brain Injury, or PathWays 1915(c) Home and Community- Based waiver or in the state’s Money Follows the Person Demonstration program. 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 (PNA) as established by the state of Indiana, found here.
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 2025 is $967 per month for an eligible individual based on a 2.5% cost of living increase. Providers may not charge Medicaid eligible individuals a room and board rate for a studio apartment that exceeds the maximum SSI amount for 2025. 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 here. Per Ind. Code §12-15-7-2, the State PNA is $52.
Example 1: Medicaid Waiver Participant Receiving only SSI Income
| Medicaid Waiver Participant Monthly Income | $967.00 |
| SSI for an Eligible Individual | $967.00 |
| PNA | $52.00 |
| Allowable Room and Board Rate | $915.00 |
Example 2: Medicaid Waiver Participant with Income in Excess of the SSI Rate
| Medicaid Waiver Participant Monthly Income | $985.00 |
| SSI for Eligible Individual | $967.00 |
| PNA | $52.00 |
| Allowable Room and Board Rate | $933.00 |
Example 3: Medicaid Waiver Participant with Income in Excess of the SSI Rate
| Medicaid Waiver Participant Monthly Income | $1,229.00 |
| SSI for Eligible Individual | $967.00 |
| PNA | $52.00 |
| Allowable Room and Board Rate | $967.00 |
In all these examples, the participant retains their PNA and the room and board rate is no greater than the maximum SSI.
