By Niki Kelly
Indiana Capital Chronicle
The Indiana Family and Social Services Administration on Monday announced its PathWays for Aging program launched for more than 123,000 eligible Hoosiers aged 60 and over.
“This is an exciting day for Indiana as we go live with this transformative program,” Indiana Medicaid Director Cora Steinmetz said. “We thank our partners across the state who have been instrumental in helping us design a program that will make a difference for this population, and the state.”
FSSA said PathWays for Aging is a Medicaid managed care program designed to improve the health and wellbeing of the Hoosiers it serves, provide choice for those members who want to age in their homes or communities, and better manage the rising costs of providing Medicaid coverage to the aging population.
This becomes the state’s fourth managed care program in addition to the Healthy Indiana Plan, Hoosier Healthwise and Hoosier Care Connect.
Before PathWays, the aging individuals on Medicaid had to navigate a complicated healthcare and supports system on their own,” FSSA Secretary Dr. Dan Rusyniak said. “Now, individuals need only one point of contact for assistance, making it easier for more Hoosiers to stay in their homes, surrounded by family and friends.”
Managed Care Entities (MCE’s) will now administer long-term supports and services, meaning the state will pay a flat rate to cover member health benefits rather than individually paying for claims. On PathWays, individuals contact a care coordinator who can help them access services or find other resources to meet their needs.
“I am glad to hear that FSSA has heard from people who are having success and no issues with the transition taking place today with the new waivers,” said Kim Dodson, CEO at Arc of Indiana. “However, we know there are some individuals and families in our state who are not having success and remain concerned about how they or their loved one will continue to get important services.”
She said some families have yet to hear from their care manager, don’t have a transition plan approved, or didn’t hear from their provider on how to log in to start structured family caregiving.
“The crisis of a workforce shortage has plagued our state for several years and we should be looking for ways to resolve this conference – allowing legally responsible individuals to provide necessary and appropriate care should be allowed under guidelines and restrictions,” Dodson said.
Waiver services also change
July 1 also marks the end of the Aged and Disabled Waiver. Two new waivers, the PathWays Waiver for individuals aged 60 and older and the Health and Wellness Waiver for individuals 59 and younger, will provide home and community-based services to eligible Hoosiers who need nursing facility level of care.
Per the federal approvals, both waivers have a designated number of slots available:
PathWays for Aging Waiver: 39,842 slots, of which 29,268 are filled by Hoosiers already receiving services. 10,574 slots will remain for newly eligible individuals.
Health and Wellness Waiver: 16,127 slots, of which 13,190 are filled by Hoosiers already receiving services. 2,937 slots will remain for newly eligible individuals.
A slot can only be used by one person during the July 1, 2024 through June 30, 2025 waiver year. The slot cannot be re-used by a different person if a member no longer needs services, like if the member moves out of state.
In April, FSSA established a waiting list for the former Aged and Disabled Waiver. Beginning this month, the agency will begin inviting eligible individuals on the waiting list to continue the process to access either the PathWays Waiver or Health and Wellness Waiver.
At this time, 9,015 people are on the waiting list for the PathWays Waiver, and 3,762 are on the waiting list for the Health and Wellness Waiver.
Dodson said there are real concerns with the health and wellness waiver waiting an estimated 30 months for services. She said this is because only 125 people will be targeted to transition per month.
“The state used to target 300 people per month on the Family Support Waiver … This is concerning as people who are in need of services will not have access for nearly 3 years. We do not want to see moved into nursing homes or group homes because HCBS waiver services are not available,” she said.
No waitlist will exist for the overall PathWays program; only individuals eligible for waiver services under PathWays may be placed on a waitlist.
Structured care move
Also starting Monday, legally responsible individuals are no longer permitted to provide attendant care. Two options were offered: Structured Family Caregiving or Attendant Care from a caregiver who is not a legally responsible individual.
This change saves the state money but has been opposed by parents of medically complex disabled children who can’t find nurses or home health aides to provide all the needed care.
More than 1,700 members, or the vast majority of those affected, had completed a newly approved service plan and can begin their new services. After July 1, all Health and Wellness waiver members 17 and younger who select Structured Family Caregiving for the first time will be assessed by care managers to determine the appropriate tier of service. Families who transitioned to Structured Family Caregiving before the July 1 start were placed in a tier based on the Attendant Care hours they were already utilizing.
In mid-2025, a new Structured Family Caregiving Level of Service Assessment will be in place.
Rusyniak acknowledged some families will be paid less than they were under the previous attendant care program but said the state has to balance state fiscal constraints with members’ needs.