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FSSA launches navigation resource for Pathways for Aging, companies meet 'readiness requirements'

By Abigail Ruhman

Posted June 10, 2024

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The Pathways for Aging program will shift care to managed health plans from the fee-for-service structure the state has been using for home and community-based services. Lawmakers and senior care organizations have raised concerns about the readiness of the program for months. (iira116, Pixabay)

Despite concerns about the implementation of a new Indiana Medicaid waiver program, state officials said the insurance companies in charge of the transition have met the readiness requirements.

Medicaid members 60 years or older on the Aged and Disabled waiver will transition to a new service structure on July 1. The agency also announced a resource to help navigate the new program.

The Pathways for Aging program will shift care to managed health plans from the fee-for-service structure the state has been using for home- and community-based services. Lawmakers and senior care organizations have raised concerns about the readiness of the program for months.

Holly Cunningham Piggott, the director of care programs for the Family and Social Services Administration's Office of Medicaid Policy and Planning, said the insurance companies achieved “100 percent” compliance with the contract and all readiness requirements.

“We go through a readiness process with our managed care entities to make sure that they are ready day one to take the new enrollment of the Medicaid population that they are now going to serve,” she said.

Cunningham Piggott said the readiness review process took about a year and included measuring more than 250 requirements, such as policy reviews and on-site evaluations of their systems.

FSSA is also introducing a resource to help navigate the new program starting on July 1.

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The Pathways for Aging program will shift care to health plans run by managed care entities rather than the fee-for-service structure the state has been using. Medicaid officials said the state already has a long-term care ombudsman, but this new resource will provide direct assistance to people navigating Pathways coverage and address issues members may experience.

Shawna Frazier, the enrollment vendor manager for FSSA’s Office of Medicaid Policy and Planning, said if members have issues after the program has officially launched, they can reach out to the member support services vendor.

“This does not replace the support members will receive from their MCE, but it adds another layer of support when members need it,” Frazier said.

Frazier said members should try reaching out to the MCE in charge of their plan first, but they can contact the vendor either by phone or email starting on July 1.

Once the program launches, the vendor will be available via phone at (877) 738-3511, Monday through Friday from 8 a.m. to 8 p.m. ET. More information and additional ways to contact the vendor can be found at in.gov/pathways.

Abigail is our health reporter. Contact them at aruhman@wboi.org.