By Indy Senior Advisor Care Team · August 12, 2026
Since July 1, 2025, a statewide contractor called the Level of Care Assessment Representative -- not your Area Agency on Aging -- conducts the assessment that gates Indiana's Medicaid waivers. Here is the new sequence, the timelines, and what CICOA still does.
The phone number changed, and nobody sent your family a letter
If you called an Area Agency on Aging in Indianapolis three years ago because your mother needed help at home, one organization handled almost everything. CICOA Aging & In-Home Solutions answered the phone, sent someone out to assess her, decided whether she met the state's care threshold, and helped build the plan. One call, one agency.
That is no longer how it works. On July 1, 2025, Indiana moved the assessment itself out of the Area Agencies on Aging and handed it to a single statewide contractor called the Level of Care Assessment Representative, or LCAR. The vendor is Maximus. The Family and Social Services Administration describes the change as creating one statewide point of entry, with the stated goal of more consistent determinations across Indiana's 92 counties.
Most families do not learn this from a mailing. They learn it the way they learn everything else about long-term care: mid-crisis, on the phone, after being transferred twice. So here is the sequence, in the order you will actually need it.
What the assessment actually decides, and what it does not
The thing being assessed is called nursing facility level of care, usually shortened to NFLOC. It is a functional test, not a financial one. An evaluator looks at what your parent can and cannot do on their own -- bathing, dressing, transferring, managing medications, cognition -- and determines whether their needs rise to the level the state associates with nursing facility care.
That determination is the gate for Indiana's home- and community-based waiver programs: PathWays for Aging for Hoosiers 60 and over, the Health and Wellness Waiver for people under 60 with disabilities, and the Traumatic Brain Injury Waiver. It is also the gate for Medicaid-paid nursing facility admission.
It is separate from the money question. Meeting nursing facility level of care does not make your parent financially eligible for Medicaid, and being financially eligible for Medicaid does not mean they meet the level of care. Both have to be true, and they are decided by different offices. Families routinely assume clearing one clears the other, and then lose weeks finding out otherwise.
FSSA has been explicit that the criteria themselves did not change on July 1, 2025. What changed is who applies them. Assessors use the age-appropriate interRAI assessment tool, a nationally used instrument, and the standards remain set in Indiana Administrative Code and the CMS-approved waiver documents.
Who you call now, and how long it takes
If your parent is not already enrolled in PathWays and you are seeking new home- and community-based services, you can request the assessment yourself. Maximus takes requests by phone at 1-833-597-2777 or online at inlcar.com. You do not need a referral from anyone to start it.
You can also ask CICOA to submit the referral for you, which is worth doing if you are not confident describing your parent's situation in the state's terms. Either route lands in the same queue.
FSSA's published timeline is specific and useful for planning. Maximus is responsible for completing the assessment within 7 calendar days and issuing the level of care recommendation within 11 calendar days of receiving the request, unless it receives a completed assessment from another qualified entity. The determination arrives by mail. Assessors meet people virtually or in person as the situation requires.
Eleven days is not fast when a hospital is discharging your father on Friday, and it is not slow by long-term care standards. Plan around it rather than waiting on it. If you are inside a 72-hour discharge window, the waiver assessment is not the thing that will get your parent placed this week.
CICOA did not disappear -- its job narrowed
The most common misreading of this change is that the Area Agency on Aging is now irrelevant. It is not. CICOA remains the Area Agency on Aging for Planning and Service Area 8, which covers Marion, Hamilton, Hendricks, Johnson, Boone and Hancock counties along with Morgan and Shelby. Every county this site covers sits inside that one agency, which is unusual -- many metros are split across two or three.
What CICOA still does: information and referral, options counseling through its Aging & Disability Resource Center, help submitting the referral to Maximus, help with the Medicaid application itself, service planning and case management for people on the Health and Wellness and Traumatic Brain Injury waivers, waitlist navigation, and advocacy. It also runs the local CHOICE program, home-delivered meals, transportation, home accessibility modifications and caregiver support -- none of which required a level of care determination in the first place.
The Resource Center number is 317-803-6131; the main office is 317-254-5465, at 8440 Woodfield Crossing Blvd., Suite 175, Indianapolis, IN 46240, open 8 a.m. to 5 p.m. weekdays. Options counseling is free.
When Maximus makes a determination, CICOA is notified through the assessment system. If your parent meets the level of care, the agency picks the thread back up on service planning.
Intake counseling: two doors, and you only have to walk through one
Alongside the assessment, Indiana added something called intake counseling for the 60-and-over population. It is available to people within one month of their 60th birthday month and older who qualify for long-term nursing facility level of care, and it exists to walk through the actual choice in front of the family: a nursing facility, home- and community-based services through PathWays, or the Program of All-Inclusive Care for the Elderly.
Maximus delivers this counseling by phone, with in-person available on request. But it is not the only door. FSSA's own guidance is that intake counseling may be provided either by the Aging & Disability Resource Center or by Maximus -- and if a family has already gone through options counseling with CICOA, they are not required to repeat it with the LCAR.
That matters practically. A Maximus counselor works from a statewide script. A CICOA options counselor knows which Carmel communities have a track record of taking waiver residents and which Greenwood provider has a six-month wait. Both conversations are legitimate. Only one of them knows the local market.
If your parent is already enrolled, the process runs differently
For someone already on PathWays for Aging, the family does not call Maximus for a reassessment. The managed care entity conducts the assessment, and the LCAR issues a determination recommendation based on those results. Indiana deliberately structured it that way to avoid assessing the same person twice.
PathWays is run through three health plans -- Anthem, Humana and UnitedHealthcare -- and members choose one at enrollment. The plan assigns a care coordinator and a service coordinator. The state's PathWays helpline is 877-284-9294.
For people on the Health and Wellness Waiver, the case manager coordinates with the LCAR for annual reassessments and for any reassessment triggered by a change in condition. Level of care is reassessed annually for a long-term determination, when someone moves between programs, and when their condition changes materially -- and it has to keep being met to stay eligible.
One thing families should verify at enrollment rather than assume: whether the home care agency, adult day program or community they want is in network with the specific plan they picked. Plan networks are not identical.
If the answer is no, or if the answer is 'wait'
A determination that your parent does not meet nursing facility level of care is appealable. The official outcome letter includes notice of appeal rights and the process for exercising them, and FSSA has stated the appeals process itself did not change with the LCAR transition. Read the letter rather than relying on what someone said on the phone -- the deadline is in it.
The other answer is the waiting list, which is a different problem. Meeting level of care does not mean a waiver slot exists. Indiana has run waiting lists for both the PathWays and Health and Wellness waivers, inviting people off in monthly groups as capacity allows. The LCAR change did not affect anyone's waiting list status.
Be aware of what nobody can tell you: the list is not a static line. People are added daily with different level of care criteria that affect how invitations go out, so neither CICOA nor FSSA can tell you your parent's place in line. What CICOA can give you is the original level of care date and priority category -- ask for those specifically, because they are the only concrete facts available. FSSA's general inbox for waiver questions is [email protected].
While waiting, the useful move is to look at what does not require a slot: the CHOICE program, Older Americans Act services, and private-pay arrangements that bridge the gap.
What none of this pays for
It is worth being blunt about the limit of the whole exercise, because the level of care determination is often treated as the finish line when it is closer to the starting gun.
PathWays covers care services. It does not cover room and board in an assisted living community. Indiana's room-and-board assistance for residents of licensed Residential Care Facilities is a separate program, the Residential Care Assistance Program, with its own agreements. A community can hold a PathWays agreement, an RCAP agreement, both, or neither -- and the only way to know is to ask that community directly, in those words.
We also cannot tell you what any of this will cost in Indianapolis specifically. CareScout publishes Indiana state medians, not metro figures, and there is no published memory care median anywhere in the country because it is not surveyed as a category. Any Indianapolis-specific number you see quoted online is someone's estimate wearing the clothes of a statistic.
Start with the assessment, because nothing else moves without it. Then treat the money as a second, separate project.
