In accordance with public notice requirements established at 42 CFR 441.301, the Indiana Family and Social Service Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) intends to submit a 1915(b) and 1915(c) waiver to the Centers for Medicare and Medicaid Services (CMS) for consideration regarding the implementation of the new Medicaid managed care program, Indiana PathWays for Aging (PathWays). The program will serve individuals 60 years and older who qualify for Medicaid on the basis of age, blindness, or disability. Enrollees include members who have a full Medicare benefit, those in a nursing facility, and those who are receiving long term services and supports (LTSS) in a home or community-based setting. The anticipated effective date is July 1, 2024.

From 2010 to 2030, the proportion of Hoosiers over 65 will grow from 13% to 20%. Indiana aims to reform the current system with the PathWays program to meet the growing demand and to create a program that will ensure member choice, drive quality, and manage cost. PathWays will ensure Hoosiers over 60 can choose to age in an environment that best suits them, be it at home or in the comforts of a quality long term care facility. Surveys show 75% of people over 50 prefer to age in their own homes, yet only 45% of Hoosiers who qualify for Medicaid do, and must navigate a complex system of care to do so. PathWays will be a managed care program used to integrate care to make it easier for Hoosiers and their families to navigate the health care system in order to drive outcomes in a transparent and accountable way.

PathWays builds on Indiana's long standing, statewide partnership with managed care plans that offer comprehensive benefits to Hoosiers. As of 2022, 85% of current Indiana Medicaid members (2.0 M) receive services through managed care plans.

The OMPP has proposed the waiver to be effective July 1, 2024.

A previous public comment period for this waiver was held from November 8, 2023, through December 14, 2023. Comments submitted during the initial public comment period were reviewed by the state. Additional changes are now being proposed to the waiver. Therefore, a second public comment period is being held to allow stakeholders an opportunity to provide input on the following modifications to this waiver.

Newly Proposed Amendments to the PathWays Waiver

• Adjusts time frame for continuity of care for existing service plans by managed care entities.

• Clarifies the policies surrounding the allowance of services provided by legally responsible individuals.

• Revises the unduplicated participant counts.

• Revises provisions for annual rate.

• Edits language for service definition clarification.

Previously Proposed Language Included in the Initial Public Comment Period

• Implements the new managed care program, Indiana PathWays for Aging, that will serve individuals 60 years and older who qualify for Medicaid on the basis of age, blindness, or disability. Eligible enrollees include members who have a full Medicare benefit, those in a nursing facility, and those who are receiving LTSS in a home or community-based setting.

The 30 day public comment period will run January 17, 2024, through February 16, 2024. Comments may be emailed to backhome.indiana@fssa.in.gov or mailed to the address below:

The Indiana PathWays for Aging implementation waiver drafts are available for review and public comment on the FSSA public notice webpage (https://www.in.gov/fssa/public-notices/). Copies of the waivers are also available at local Division of Family Resources offices, as well as local Area Agencies on Aging. In-person consultations or phone calls are available upon request.

Dan Rusyniak, MD

Secretary

Family and Social Services Administration