Indiana launches PathWays for Aging Medicaid managed care program

Submitted by Applegate & Dillman Elder Law

The Indiana Family and Social Services Administration (FSSA) has officially launched the Indiana PathWays for Aging program, aiming to enhance Medicaid services for over 123,000 eligible Hoosiers aged 60 and older. This new initiative marks a significant step in streamlining and improving the support system for Indiana’s aging population.

PathWays for Aging is a Medicaid-managed care program designed to improve health outcomes, provide greater choice for aging Hoosiers to remain in their homes or communities, and better manage the rising costs of Medicaid coverage. It is the state’s fourth managed care program, alongside the Healthy Indiana Plan, Hoosier Healthwise, and Hoosier Care Connect.

What is PathWays for Aging?

PathWays for Aging offers several key features to simplify and improve the support system for elderly Medicaid recipients:

• Single Point of Contact: PathWays participants will have access to a care coordinator who can help them access services or find resources to meet their needs, simplifying their interaction with the healthcare system.
• Waivers and Slots: The program introduces two new waivers: (1) The PathWays Waiver for individuals aged 60 and older has 39,842 slots, with 29,268 already filled by Hoosiers receiving services, leaving 10,574 slots for newly eligible individuals; and (2) The Health and Wellness Waiver for individuals 59 and younger has 16,127 slots, 13,190 of which have already been filled, leaving 2,937 slots for newly eligible individuals.
• Elimination of the Aged and Disabled Waiver: The previous Aged and Disabled Waiver has ended, and eligible individuals will transition to the new waiver. In April, FSSA established a waitlist for the former Aged and Disabled Waiver. Starting this month, the agency will begin inviting eligible individuals on the waiting list to continue the process to access either the PathWays Waiver or the Health and Wellness Waiver.
• No Overall PathWays Waitlist: No waitlist will exist for the overall PathWays program; however, individuals eligible for waiver services under PathWays may be placed on a waitlist. As of early July, there are currently 9,015 people on the waiting list for the PathWays Waiver, and 3,762 are on the Health and Wellness Waiver list.

Transition & next steps

FSSA will invite a group of individuals to continue the process of receiving services each month as long as capacity remains. Based on the number of slots, the number of people on the waiting list, and the necessary steps, FSSA plans to invite:

• 125 individuals per month to the Health and Wellness HCBS Waiver
• 800 individuals per month to the PathWays HCBS Waiver

These estimates are based on the required steps following invitation, such as face-to-face level of care assessments and determining functional and Medicaid eligibility. Individuals invited to proceed will receive a letter with further details.

How do I begin this process?

To access services through the PathWays for Aging or Health and Wellness Waivers, follow these steps:

• Check your eligibility to ensure you meet the age and Medicaid criteria for either the PathWays or Health and Wellness Waiver.
• If you are not already enrolled in Medicaid, consider consulting with a Medicaid specialist to understand your options and receive guidance on navigating the process.
• If you are on the waitlist, wait for an invitation from FSSA to proceed with the next steps, including the level of care assessments and eligibility determinations.
• Participate in required assessments and submit necessary documentation to determine your functional and Medicaid eligibility.