It is located outside the community of Elizabeth, Indiana at the Harrison County line, across the Ohio River from Louisville, Kentucky.

The complex includes over 100,000 square feet (9,300 m2) of gaming space, a sports betting lounge, and several restaurants.

In January 1995 five different proposals were given to the Indiana Gaming Commission in order to begin a riverboat gambling organization in Harrison County.

They chose a site near Bridgeport, Indiana, an unincorporated town located immediately on the Harrison County side of the Harrison County/Floyd County border; the site is 15 miles (24 km) southwest of Louisville, Kentucky (Kentucky's largest metropolis), and was selected after performing a study to determine the nearest accessible location (to the city) that would permit a riverboat casino to operate legally.

Louisville officials attempted to delay the construction of Caesars Indiana, to protect the gambling revenue of Churchill Downs and other Kentucky horse racing interests.

Environmental groups lodged similar complaints due to concerns regarding the potential negative impact of the proposed development on local air quality, waterways, and wildlife.

However, the United States Army Corps of Engineers did caution the Caesars/RDI partnership to carefully consider the number of trees to be cleared and the impact on runoff water.

It has been estimated that Horseshoe Southern Indiana has diverted $12 million in lottery revenue annually from the state of Kentucky.

Notably, a resolution proposed in the Kentucky House in 2002 called for "the purchase of a submarine to patrol the waters of the Commonwealth and search and destroy all casino riverboats.

As part of its continual existence, the State of Indiana requires the casino to give money to two different charitable foundations in Harrison and Floyd Counties.

[9] From 2002 to 2019, the riverboat never left the dock, except for once per year to prove to the United States Coast Guard that the vessel was seaworthy and could move under its own power.

[3][19] In September 2022 it was announced that a Gordon Ramsay Steak restaurant will be opened at Caesars Southern Indiana before the end of the year.

Although it is located directly across the river from Southwest Louisville, due to the lack of a bridge, Louisvillians must drive north first through New Albany to reach Caesars.