Area 10 — which serves Monroe and Owen Counties — has 184 people on its waitlist.
(WTIU News, Bente Bouthier)
It's the night before the fourth of July. Matthew and Jason Harding stand in their dad's kitchen in Bedford, making him dinner.
Their dad, John, has dementia.
For the past couple of years, one of them has come over everyday to check on him and help around the house. At first it was just the evenings. But now one of them comes over every morning before work, too.
“We get here in the morning, get him his pills, get him something to eat, get him cleaned up," Matthew said. "As of right now he's got a home health care worker through a rehab process that comes over."
John is just above the limit to qualify for Medicaid. Matthew and Jason have hired legal aid to help with the paperwork to qualify.
Matthew said his dad needs help but isn’t ready to be in a facility. Currently, that’s the only option John has for long-term care services through Medicaid.
“You're kind of in that middle range, which really, when you apply for Medicaid works against you,” Matthew said.
They can’t afford the out-of-pocket cost for assisted living, which runs about $3,500 a month. Twenty hours a week of a home health aide costs about $2,700 monthly.
Matthew and Jason want their dad to receive home-based care. They’ve been in touch with their Area Agency on Aging, which previously was who they went through for help.
In April, the Family and Social Services administration created a waitlist for The Aged And Disabled Waiver to reconcile a billion dollar budget shortfall in Medicaid.
Indiana is introducing Medicaid managed care for people 60 and up. The state launched the Pathways for Aging program this month, which includes transitioning supports and services to managed care companies that charge a flat rate, instead of the previous process of fees being settled individually.
Jana Beth Trace, Elder Law and Medicaid Paralegal with Jones, McGlasson & Siefers said a lot of her clients, including the Hardings, are left hanging until the state provides more information.
"The state just stopped without any advance notice, approving waiver cases" she said. "And that included home health care and assisted living. We had some cases that were already started that got stopped and denied."
The FSSA said it will start to process the more than 9,000 people on the waitlist, which will take nearly a year. But Trace said there are many people who can’t wait that long and might be forced to use nursing homes sooner than they’re ready.
The Pathways program replaced the state’s fee-for-service Medicaid model. The state will instead pay a flat rate to managed care entities to handle long-term care and support services.
Most of this was managed by area agencies on aging. Kari Nowlin, Area 10 Aging and Disability Resource Team Leader,said her agency will still help with intakes for Medicaid programs but communication from the state and Managed Care Entities is minimal.
"With any transition, you're going to have those moments where you realize we overlooked this, we overlooked that," Nowlin said. "But it really feels like there's a lot of gaps that were overlooked. I wish the boots on the ground, folks from the AAA's had been more involved in the planning process."
She wants to know how area agencies are meant to notify a person’s managed care entity that an evaluation for the Medicaid waiver is complete.
"How specifically does it get transmitted? And will we have any further contact from the MCE? Or was or is it just that we put in that placeholder and we're done? What paperwork do they need? There's just a lot of questions in our intake process that haven't been addressed."
Nowlin recommended anyone who anticipates they or a loved one over 60 will need care get on the waitlist as soon as possible. She adds for people who need to take steps to protect assets, moving through the waiver process could take months.
For Area 10 — which serves Monroe and Owen Counties — there are 184 people on the waitlist.
Matthew said figuring out care and the recently changed Medicaid system for his dad has been extremely stressful for the family. But, his dad raised him and his brother, and it's the least he can do.
Matthew and Jason Harding sit with their dad at his home in Bedford. They both live locally with their own families. (WTIU News, Bente Bouthier)
He said he's worried about people in his dad's position who don't have friends are family nearby.
The FSSA has not moved people off the waitlist yet. The agency said in its July announcement that families should watch for a letter in the coming months for a notification that they’ve qualified for the waiver.
