Steinmetz
Getting older can bring about a wealth of uncertainties and complex decisions
But research shows that among older adults, one subject is abundantly clear: 75% of them want to age in their own homes and communities, not in an outside care facility.
A new program through Indiana’s Medicaid offering will help them achieve that.
“Some people choose to, or because of the level of care they need, will opt into nursing facility care or assisted care. But we want to create a system within Medicaid that for those who want to stay in their homes, they have the supports needed to do so,” said Cora Steinmetz, Indiana Medicaid director.
Health care coverage through state’s PathWays for Aging starts on Monday, ushering in new potential and options for Indiana residents aged 60 and older who receive Medicaid (or Medicaid and Medicare) benefits.
Through the new program, people will receive managed care through one of three existing insurance carriers: Anthem, Humana and UnitedHealthcare. They’ll have access to a care coordinator and services coordinator to help them get the benefits of living as independently as possible.
“It provides additional supports for these individuals to really navigate a complex space in health care, especially as people are aging. It coordinates those Medicare benefits with Medicaid benefits, letting people know which plan covers what, and ensuring the quality of the services they receive are very high,” Steinmetz said. “They have a dedicated individual to help them, to really be their advocate, have someone to talk to and figure out what they need to live their healthiest and best life.”
PathWays for Aging has been in development by the state for years. Up until that point, Medicaid patients received their care directly through the state of Indiana by way of the Indiana Family and Social Services Administration.
But FSSA leaders wanted to pivot to a system that expanded the individualized, person-centered care that Medicaid offers, Steinmetz said.
The state’s managed care partners Anthem, Humana and UnitedHealthcare have a wealth of experience in this field, and have the staff and resources to work more directly with Medicaid members.
“It allows us to manage cost growth in the Medicaid program moving forward, and it really allows us to focus on the quality of services,” she said.
A majority of Indiana’s Medicaid population already is served by a managed care plan. PathWays for Aging brings about 120,000 Hoosiers into those care programs. The plans from Anthem, Humana and UnitedHealthcare are all required to provide the same Medicaid benefits the state currently had offered before, Steinmetz said. Added benefits from the plans include items such as gym memberships and home-delivered meals.
The managed care model of PathWays for Aging provides people with added benefits, such as having a dedicated care coordinator to help navigate the maze that the health care system can be.
“If they’re having trouble accessing a provider or need help connecting to a primary care doctor, or they can’t get their prescription filled when they need to. This care coordinator will act as a care manager to help them with any of their health care complexities,” Steinmetz said.
A portion of the Medicaid population in Indiana will also qualify for waiver services based on their needs, receiving a service coordinator to help arrange services such as home-delivered meals and specialized medical equipment.
FSSA staff have been working for months with organizations serving older adults to spread information about PathWays for Aging. In February, eligible participants were given notice about the change, explanations about what it means and options to pick from one of the three carriers. If people didn’t pick one of the carriers, they were automatically assigned to one of those plans.
They still have the ability to call to change their plan for 90 days after the launch on July 1, Steinmetz said.
People who have questions — or if they did not receive a welcome packet, are confused about coverage or have other questions — can call a helpline at 87-PATHWAY-4 (or 877-284-9294). Information can also be found at the PathWays for Aging website, in.gov/PathWays.
“The managed care plans have now reached out with welcome packets, so that’s really why we’re trying to get the word out about this — you should have received some information from the new plan that you’re part of now,” Steinmetz said.
AT A GLANCE
PathWays for Aging
What: Indiana’s new, managed long-term services and supports initiative for Medicaid enrollees, as well as those dually eligible for Medicare and Medicaid, who are 60 years or older and meet age, blindness or disability criteria.
When: Began July 1
How does it work: Enrollment for PathWays for eligible residents started in February; if people did not make a health care provider choice, they were automatically enrolled in a plan. Three managed care entities have partnered with the state to provide Medicaid health care coverage: Anthem, Humana and UnitedHealthcare. Patients can change their provider within 90 days of starting PathWays.
How to get help: People with questions can call 87-PATHWAY-4 (877-284-9294) or go to the website in.gov/pathways.
