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How do I join Health and Wellness, Pathways Medicaid waiver waitlists? Here’s what you need to know

By Abigail Ruhman

Posted November 5, 2024

How do Hoosiers get onto the waitlist for home- and community-based health services through Medicaid waivers? A member of our audience inspired this question.

The process for the Pathways waiver, including for people who may not be enrolled in the Pathways Program, and the Health and Wellness waiver starts with one of Indiana’s 16 Area Agencies on Aging.

At the beginning of the process, a local Area Agency on Aging will complete a preliminary “level of care screening” by phone. The waivers provide services to people who qualify for care equivalent to nursing facilities, but want or need to remain at home. If the screening determines someone is eligible for that level of care, the agency will place them on a waitlist and confirm it by mail.

The agency will also discuss Medicaid eligibility and may assist people with that application.

Once someone is invited off the waitlist, they have 30 days to take action. The “options counselor” from the local Area Agency on Aging will make three attempts to reach the individual in that time.

Once that contact is made, the counselor will schedule an in-person appointment. This will include a full eligibility assessment to determine the level of care someone requires. This part of the process also includes establishing Medicaid eligibility, which is required to participate in the waivers.

The counselor will help develop a service plan. After Medicaid eligibility and waiver eligibility is approved, the state will begin providing those services.

The Family and Social Services Administration said it can’t estimate how long people will be waiting for services because that depends on how many people are part of a priority category each month. People are given “priority status” if they were discharged from a hospital or are transitioning from a nursing facility or the CHOICE program.

The waitlist began in April in response to last year’s Medicaid forecasting error. When new spots opened in July, FSSA said it would process about 900 people per month between both waivers.

FSSA announced in October it will increase that number to 1,700 — including 1,200 off the Pathways waiver waitlist and the rest from the Health and Wellness waitlist.

More than 13,500 people are waiting for services between both waivers as of October.

That means it will take some members almost seven and a half months to move off the Pathways waiver waitlist and more than nine months for the Health and Wellness waitlist. However, the number of people on the waitlist may grow as new people join.

In July, FSSA said there were about 10,500 open slots available for the Pathways waiver. It also said there were fewer than 3,000 open slots available for the Health and Wellness waiver. The agency’s waitlist dashboard lists how many invitations it has sent so far, but it does not explain how many slots are still open.

Anyone looking to access the Family Supports Waiver should contact their local Bureau of Disabilities Services office.

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