Understanding The Indiana Pathways for Aging Program

Navigating changes in healthcare can be overwhelming, especially when it comes to understanding new programs and policies that impact your coverage. With constant updates and complex information, it’s easy to feel lost and unsure about what steps to take next. At Brickyard Healthcare, we understand these challenges and are dedicated to being a reliable partner for our residents.

In mid-2024, Indiana residents aged 60 and over who utilize Medicaid will experience a significant transition as the state rolls out the Indiana Pathways for Aging Program.

What is the Indiana Pathways for Aging Program?

The Indiana Pathways for Aging Program is a new, managed long-term services and support initiative designed to enhance the quality of care for Indiana residents aged 60 and older who are Medicaid-eligible due to age, disability, or blindness. Scheduled to launch on July 1, 2024, this program aims to simplify the healthcare system, ensure equitable access to services, and provide comprehensive support to older adults.

Eligibility Criteria

To qualify for the Indiana Pathways for Aging Program, you must meet the following criteria:

• Be an Indiana resident aged 60 or older
• Be eligible for Medicaid based on age, disability, or blindness
• Be currently enrolled in programs such as Hoosier Care Connect, the Aged & Disabled Waiver, or Nursing Home Medicaid

Goals of the Program

The primary goals of the Pathways program include:

• Ensuring equitable access to healthcare services and support for all eligible seniors
• Reducing the complexity of the current healthcare system to make it more user friendly
• Breaking down silos between different service providers to enhance coordination of care
• Introducing new benefits to improve the quality of life for members and their families
• Increasing the availability of home-based services to help seniors live independently
• Enhancing the overall quality of care provided to program participants

By addressing these goals, the Pathways program aims to create a more integrated and efficient healthcare system for older adults in Indiana, ensuring they receive the support and services they need to maintain their health and independence.

Timeline of the Transition

Understanding the timeline of the Pathways program transition is crucial for staying informed and prepared. Here’s a detailed look at the key milestones and what to expect during this period.

February 2024: Introduction to Pathways

In February, eligible Indiana residents received a letter from the State of Indiana’s Family and Social Services Agency (FSSA) introducing the Pathways program. This letter, branded “Pathways,” provided an overview of the upcoming changes and initial steps for preparation.

March 2024: Calls from Maximus

In March, residents received phone calls from Maximus, a company hired by the State of Indiana to act as the enrollment broker for the Pathways program. Maximus provided unbiased counseling to help residents choose the best insurance plan to meet their needs.

April 2024: Brickyard Healthcare’s Check-In

In April, Brickyard Healthcare reached out to each resident to confirm their insurance choice. This step was crucial to ensure that everyone selected a plan that best suited their needs. For those who had not made a choice, Brickyard provided additional support to assist in making an informed decision.

July 2024: Official Start of the Pathways Program

The Pathways program will officially begin on July 1, 2024. At this point, all eligible residents will be enrolled in the program, either through their chosen plan or via automatic enrollment if no choice was made. Brickyard Healthcare will continue to provide ongoing support and communication to ensure a smooth transition and address any issues that may arise.

Choosing the Right Insurance Plan

Selecting the right insurance plan under the Indiana Pathways for Aging Program is a crucial step in ensuring you receive the best possible care and support. Here’s a guide to help you make an informed decision.

Available Plans

Under the Pathways program, you have the option to choose from three managed care entities (MCEs): Anthem, Humana, and United Healthcare. Each of these providers offers a network of healthcare services tailored to meet the needs of older adults.

Role of Maximus

Maximus, the enrollment broker hired by the State of Indiana, has been providing unbiased counseling to help you choose the best plan. Their goal is to ensure that you understand the benefits and services offered by each plan so you can make the best choice for your individual needs.

Key Factors to Consider

When selecting an insurance plan, consider the following factors:

• Network of Providers: Ensure that your preferred doctors and healthcare facilities are included in the plan’s network.
• Covered Services: Compare the services covered by each plan, including medical care, home-based services, and additional benefits like dental and vision care.
• Cost and Coverage: Evaluate the cost of premiums, co-pays, and out-of-pocket expenses associated with each plan.
• Additional Benefits: Some plans may offer extra benefits such as gym memberships, over-the-counter allowances, or transportation services.

Getting Your Questions Answered

It is essential to have all your questions answered before making a final decision. Contact Maximus or your Brickyard Healthcare representative to clarify any doubts or concerns. Making an informed choice now will help ensure that you receive the care and support you need in the future.

How Brickyard Healthcare Supports Residents Through the Transition

At Brickyard Healthcare, we are committed to supporting our residents through every step of the Indiana Pathways for Aging Program transition. Here’s how we help ensure a smooth and stress-free experience.

Proactive Communication

We understand the importance of keeping you informed. Our team has been communicating regularly with residents about the upcoming changes, providing updates and information through letters, phone calls, and in-person meetings.

Personalized Support

Each resident receives personalized support from our dedicated care coordinators and service coordinators. These professionals are available to answer your questions, assist with the selection of an insurance plan, and ensure that your healthcare needs are met during the transition.

Ensuring Smooth Transitions

Brickyard Healthcare takes a proactive approach to ensure that all residents are smoothly transitioned into the Pathways program. This includes verifying that each resident has selected an insurance plan that best suits their needs and providing additional assistance to those who need help making a choice.

Addressing Concerns

We are here to address any concerns you or your family may have. Whether it’s understanding the benefits of the new program or navigating the enrollment process, our team is available to provide the support and information you need.

Ongoing Support

Our commitment to your well-being doesn’t end once the Pathways program begins. We will continue to offer ongoing support and communication, ensuring that any issues are promptly addressed and that you receive the highest quality of care.

By offering comprehensive support and clear communication, Brickyard Healthcare aims to make the transition to the Indiana Pathways for Aging Program as seamless and stress-free as possible.

Benefits of the Pathways Program

The Indiana Pathways for Aging Program offers a wide range of benefits designed to improve the quality of care and support for older adults. Understanding these benefits can help you make the most of the program.

Comprehensive Healthcare Services

Pathways covers a broad spectrum of healthcare services, ensuring that you receive the medical care you need. These services include:

• Care Coordination: Dedicated care coordinators help manage your healthcare needs, ensuring that all services are well-coordinated.
• Medical Services: Routine doctor appointments, laboratory work, X-rays, hospital care, and surgical procedures are covered.
• Home Health Care: Services such as nursing care, physical therapy, occupational therapy, and durable medical equipment are included.
• Mental Health and Substance Abuse Treatment: Access to necessary mental health services and substance abuse treatment is provided.
• Vision and Dental Care: These essential services are part of the comprehensive coverage.

Long-Term Care Services and Supports

For those who need additional support, Pathways offers long-term care services, including:

• Adult Day Care: Supervision and personal care in a community-based setting during the day.
• Assisted Living Services: Assistance with daily living activities in an assisted living facility.
• Home and Community-Based Services (HCBS): Services such as personal care, homemaker services, meal delivery, and home modifications to help you live independently at home.
• Respite Care: Temporary relief for primary caregivers.
• Specialized Medical Equipment: Access to necessary medical equipment tailored to your needs.
• Transportation Services: Non-emergency transportation to medical appointments and other essential activities.

Additional Benefits

Managed care entities (MCEs) may offer additional benefits to enhance your quality of life. These can include:

• Over-the-Counter Allowances: Financial allowances for over-the-counter medications and supplies.
• Gym Memberships: Access to fitness centers to promote physical health.
• Gift Cards for Groceries and Household Items: Financial support for purchasing essential items.

MCE-Specific Benefits

Each MCE may offer unique benefits, so it’s important to review what each plan includes to find the best match for your needs. These additional perks can add significant value to your overall healthcare experience.

Quality and Coordinated Care

One of the key advantages of the Pathways program is the emphasis on quality and coordinated care. By integrating various services and breaking down silos between providers, the program ensures that you receive seamless and effective care tailored to your individual needs.

Understanding Medicaid Managed Care

To fully appreciate the benefits of the Pathways program, it’s important to understand how Medicaid managed care works compared to traditional fee-for-service models.

Fee-for-Service vs. Managed Care

• Fee-for-Service (FFS): In this traditional model, Medicaid pays providers directly for each service they provide. Beneficiaries can receive services from any Medicaid-certified provider, but this model often leads to fragmented care and higher costs.
• Managed Care: Under managed care, Medicaid contracts with Managed Care Organizations (MCOs) to provide a set amount per beneficiary, regardless of the services used. MCOs have networks of doctors, hospitals, and other providers. Beneficiaries must use providers within the network, leading to more coordinated and cost-effective care.

Advantages of Managed Care

Managed care offers several advantages over the fee-for-service model, including:

• Improved Care Coordination: MCOs work to ensure that all aspects of your healthcare are well-coordinated, reducing the risk of fragmented care.
• Cost Efficiency: By managing care more effectively, MCOs can control costs better, making the system more sustainable.
• Enhanced Quality of Care: With a focus on outcomes and patient satisfaction, MCOs strive to provide high-quality care that meets your needs.

Role of Managed Care Entities (MCEs)

In the Pathways program, MCEs like Anthem, Humana, and United Healthcare play a crucial role in delivering healthcare services. They manage the network of providers and ensure that you receive the benefits and services covered under the program. By choosing the right MCE, you can ensure that your healthcare needs are met efficiently and effectively.

Eligibility and Enrollment Process for Pathways

Understanding the eligibility criteria and enrollment process for the Indiana Pathways for Aging Program is essential to ensure you or your loved one can take full advantage of the available benefits.

Financial Criteria: Income and Assets

To qualify for the Pathways program, applicants must meet specific financial criteria, which include limits on income and assets:

• Income Limits:
  • Single applicants: The income limit is set at $1,255 per month.
  • Married couples: The combined income limit for couples, whether one or both are applying, is $1,704 per month.
  • For those requiring nursing home care or home and community-based services, the individual income limit is higher at $2,829 per month.
• Asset Limits:
  • Single applicants: The asset limit is $2,000.
  • Married couples: The asset limit is $3,000, regardless of whether one or both spouses are applying.
  • For married applicants where only one spouse is applying, the non-applicant spouse can keep a larger portion of the couple’s assets to prevent spousal impoverishment.

Exempt Assets

Certain assets are exempt from being counted towards the asset limit, including:

• The primary home, if the applicant lives in it or has the intent to return.
• Household furnishings, personal effects, and one vehicle.

Look-Back Period

It’s important to note that Medicaid has a 60-month look-back period. Any assets given away or sold below market value during this period may result in a penalty and affect eligibility.

Functional Need Criteria

For those needing home and community-based services or nursing home care, a functional need assessment is required. This assessment, typically conducted by the Area Agency on Aging (AAA) or Maximus, ensures that the applicant meets the Nursing Facility Level of Care (NFLOC) criteria, which usually involves needing assistance with daily living activities.

How to Apply for The Indiana Pathways for Aging Program

Before starting the application process, ensure that you meet the eligibility criteria. Gathering necessary documentation ahead of time can help avoid delays. Required documents typically include:

• Copies of Social Security and Medicare cards
• Recent bank statements
• Proof of income
• Copies of life insurance policies, property deeds, and pre-need burial contracts

Application Process

1. Online or Paper Application: You can apply for The Indiana Pathways for Aging Program online through the state’s Medicaid website or by submitting a paper application. You can also request that an application be mailed to you.
2. Assistance from Navigators: If you need help with the application, you can contact a navigator for guidance through the process.
3. Enrollment Broker Assistance: Maximus, the Pathways Enrollment Broker, can provide assistance in choosing a health plan and answering any questions about the process.

Current Medicaid Recipients

Current Medicaid recipients who are eligible for The Indiana Pathways for Aging Program should have received an enrollment letter by now. This letter includes a comparison of the three MCEs offering statewide health plans: Anthem, Humana, and United Healthcare. For assistance in selecting a plan, you can call The Indiana Pathways for Aging Program Helpline at 877-284-9294 (87-PATHWAY-4).

Automatic Enrollment

If you do not select a plan by the specified deadline, the state will automatically enroll you in one of the available plans. You will receive a welcome packet from your assigned MCE, and your new healthcare plan will begin on July 1, 2024.

Approval Process and Timing

The approval process for The Indiana Pathways for Aging Program can take up to three months or longer from the start of your application to receiving the determination letter. Here’s what you can expect.

Application Review

• The Medicaid office has up to 45 days to review and approve or deny your application. This period extends to 90 days for disability applications.
• Delays can occur if the application is incomplete or if required documentation is missing.

Waiting List for Services

• For home and community-based services, there may be a waiting list due to a limited number of participant slots. Approved applicants may need to wait several months to start receiving benefits.

Ongoing Communication

• Throughout the process, Brickyard Healthcare will maintain regular communication with you to provide updates and assist with any issues that may arise. Our goal is to ensure that your transition to the Pathways program is as smooth as possible.

By understanding the eligibility and enrollment process, you can better navigate the transition to the Indiana Pathways for Aging Program and take full advantage of the benefits it offers.

Common Questions and Concerns

Transitioning to a new healthcare program can raise many questions and concerns. Here, we address some of the most frequently asked questions about the Indiana Pathways for Aging Program to help you navigate this change with confidence.

What happens if I don’t choose a plan? If you do not choose a plan by the deadline, the state will automatically enroll you in one of the available managed care entities (MCEs). You will receive a welcome packet from the assigned MCE, and your new healthcare plan will start on July 1, 2024.

Can I keep my current doctor? Whether you can keep your current doctor depends on whether they are part of the network of the MCE you choose. It’s important to check the provider network of each plan to ensure your preferred doctors and healthcare providers are included.

What if I need help understanding my options? Maximus, the enrollment broker, provides unbiased counseling to help you understand your options and choose the best plan for your needs. Additionally, Brickyard Healthcare’s staff is available to answer any questions and provide guidance throughout the process.

How will this program affect my current benefits? The Pathways program is designed to enhance your current benefits, not reduce them. You will continue to receive comprehensive healthcare services, and additional benefits may be available through your chosen MCE. The goal is to provide better-coordinated and higher-quality care.

What are the financial criteria for eligibility? To be eligible, applicants must meet specific income and asset limits. For a single applicant, the income limit is $1,255 per month, and the asset limit is $2,000. For married couples, the combined income limit is $1,704 per month, and the asset limit is $3,000. Higher income limits apply for those requiring nursing home care or home and community-based services.

Will I lose my home if I qualify for Medicaid? Your primary home is generally exempt from being counted towards Medicaid’s asset limit, provided you live in it or intend to return. Other exempt assets include household furnishings, personal effects, and one vehicle.

What if I have assets over the limit? There are planning strategies available to help you qualify for Medicaid even if you have assets over the limit. These can include setting up trusts, spending down countable assets, and consulting with Medicaid planners for more complex situations.

How can I get help with the application process? You can apply online, submit a paper application, or request assistance from a navigator. Brickyard Healthcare staff are also available to help guide you through the application process and ensure you have all the necessary documentation.

Ensuring a Smooth Transition

The Indiana Pathways for Aging Program represents a significant step forward in improving healthcare for older adults in Indiana. By simplifying the system, enhancing care coordination, and providing comprehensive support, the program aims to ensure that you receive the highest quality of care and can live as independently as possible.

Brickyard Healthcare is committed to supporting you through this transition. Our team is here to provide clear communication, personalized assistance, and ongoing support to ensure that you navigate these changes smoothly and with confidence. We understand that healthcare transitions can be challenging, but we are dedicated to making this process as easy and stress free as possible for you and your family.

Take the Next Step with Brickyard Healthcare

For more information about the Indiana Pathways for Aging Program or to get assistance with the transition, please visit our contact page. Our team is ready to help you with any questions or concerns you may have.

Stay informed and prepared by visiting the Pathways FAQs and reaching out to your Brickyard Healthcare representative. Together, we can ensure that you receive the care and support you need to thrive under the new program.