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Frequently Asked Questions

Program Go-Live

  • What is Indiana PathWays for Aging?

    The Indiana Family and Social Services Administration will launch a new program in July 2024 for Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits. Research shows that most older adults - 75% or more - want to age at home and in their communities.

  • When does PathWays start?

    Health coverage in PathWays starts July 1, 2024.

  • Will I get something in the mail?

    You will get an enrollment letter in the mail, which will include a health plan comparison chart so that you can make a choice about which health plan is best for you.

    To help you with the changes coming, FSSA will send you another letter 60 days before the start of the program to tell you which health plan will serve you. Your Medicaid health plan (Anthem, Humana or UnitedHealthcare) may also reach out to you 30 days before the start of the program with more information.

  • What do I need to do now?

    Call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to select your PathWays Medicaid health plan. You can also call this number if you need help with choosing a Medicaid health plan. You will need to choose from Anthem, Humana or UnitedHealthcare.

    When calling to select your PathWays health plan please have the following information on hand:

    1. Medicaid ID or SSN ( can use case #)
    2. The correct phone #, address and DOB on file with FSSA
    3. Primary medical provider
    4. HCBS & Waiver Services Providers (i.e. Adult Day Services)
  • My doctor isn’t in my health plan; can I still use them?

    The PathWays health plans will have an open network until dictated by the state.  Thus, the member can continue to use their providers as long as the provider remains an IHCP approved provider no matter the health plan selected.

  • My case manager isn’t in my health plan; can I still use them?

    You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

  • What if I already have a service plan? Will a new service plan be made for me?

    Your service plans will stay in place for 90 days from program implementation with no reductions in services; changes can only be made if you need additional services.

  • What if I already have Medicaid services that have already been authorized?

    Your Medicaid services that have already been authorized, will stay authorized for up to 90 days.

  • I am 59 years old, what should I expect?

    You will get a letter 90 days before your 60th birthday.  This letter will tell you that you are eligible for the PathWays program.  It will also include information on your health plan or how to select a health plan.

General Program

  • What is Indiana PathWays for Aging?

    Indiana PathWays for Aging is a Medicaid managed care program for Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits. Research shows that most older adults - 75% or more - want to age at home and in their communities.

  • What is health plan?

    A health plan is a health insurance company. Physicians, hospitals, and other healthcare providers, including waiver providers, enroll with a health plan to provide care for members. Indiana partners with health plan for its Indiana PathWays for Aging, Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect programs.

  • What does a health plan do?

    A health plan provides members with health care coverage. After a member chooses a health plan for their Medicaid program, they can get medical care from a variety of health care providers and in some cases, waiver providers. Health plans provide enhanced care coordination to help members navigate the variety of services for which they are eligible. Health plans also provide service coordination.

  • Who are the PathWays health plans?

    The PathWays health plans are Anthem, Humana, and UnitedHealthcare.

  • What is a Care Coordinator?

    A care coordinator is a person who may contact you to create a personalized care plan based on your preferences and needs. They can also help answer questions about your health care and help you with your providers.

  • What is a Service Coordinator?

    A Service Coordinator is a person who will work with you to create a personalized Service Plan to help coordinate your Home and Community-Based Services. The Service Plan will help develop a plan of care of services and supports that best meet your needs and goals.

  • What is a health assessment?

    A health assessment is a set of questions that ask about your personal behaviors, life-changing events, health goals and priorities, service coordination and overall health. Your health plan will use these assessments to create a personalized care plan based on your preferences and needs.

  • What is a service plan?

    A service plan is a support plan, developed by a service coordinator, for assisting you in gaining access to long-term care services, as well as medical, social, housing, educational, and other supports. Not everyone in PathWays will need a service plan.

  • I received mail that I do not understand. Who can help me with this?

    You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294).

  • Will I be able to switch my health plan if I am not satisfied?

    Yes, individuals can change health plans within 90 days of initial PathWays enrollment, during the annual health plan selection period, or at any time for just cause. Contact the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to talk about options.

  • What additional services and supports are available in the PathWays program?

    Care coordination services are available to every PathWays member.  Members who meet the functional eligibility requirements have access to service coordination and the additional services:

    • Adult day services
    • Adult family care
    • Assisted living
    • Attendant care
    • Home modifications
    • Health care coordination
    • Home-delivered meals
    • Nutritional supplements
    • Personal emergency response systems
    • Respite
    • Specialized medical equipment
    • Structured family care
    • Transportation
    • Vehicle modifications
  • How do I find a PathWays provider?

    All of the PathWays health plans are currently working to contract with providers so their directories may not be up to date, but the state is working to ensure members will still be able to see their current providers regardless of which health plan they choose.

  • I am a caregiver for a PathWays member, how can I get assistance finding resources?

    Caregivers can call the member’s PathWays health plan.  The health plan can provide resources to support you and the PathWays member.

  • When is the health plan selection period for PathWays?

    After the initial enrollment into a health plan in early 2024, your health plan selection period for Pathways is mid-October to mid-December annually. This is also open enrollment for Medicare.

  • Who do I call during open enrollment to change my PathWays health plan?

    You can also call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) during the open enrollment to change your health plan. The health plan selection period for Pathways is mid-October to mid-December annually.

  • What is the Member Support Services program?

    The Member Support Services program is available to all PathWays members to help them, their caregivers, and families resolve questions or problems and serve as a source of assistance, advice, and advocacy.

  • What is the difference between the PACE and PathWays program?

    The Program of All-Inclusive Care to the Elderly (PACE) was implemented by the state of Indiana to provide quality community-based care for Indiana Health Coverage Programs (IHCP) members who:

    • Are 55 years old or older
    • Are certified by the state to qualify for nursing home level of care
    • Are able to live safely in the community at the time of enrollment
    • Live in a PACE service area

    The PACE program is operated by PACE organizations who manage the care delivery system.

    PathWays is a managed care program for Indiana Medicaid members that are:

    • 60 years of age and older
    • Are eligible for a full-coverage aged, blind or disabled category (with or without Medicare)
    • Can be receiving long-term support services including:
    • Resides in a nursing or long-term care facility
    • Are approved for an Aged and Disabled waiver
    • Can be on the Behavioral and Primary Health Coordination program

    The PathWays program is operated within the managed care delivery system by health insurance companies. The MCEs for the PathWays program are Anthem, Humana, and UnitedHealthcare. PathWays members can receive home and community-based services as well as medical services.

  • What will happen to PACE members when PathWays launches?

    PACE will continue to operate independently from the PathWays program. When PathWays enrollment begins, individuals already participating in PACE can stay in PACE and should experience no disruption in service. PACE members are also excluded from PathWays enrollment marketing, so they shouldn't receive any direct notices about switching programs.

    After PathWays begins operating, individuals who newly meet the eligibility requirements for both PACE and PathWays will be able to choose which program to enroll with. Further, the entity responsible for conducting Nursing Facility Level of Care (NFLOC) assessments and determinations will provide "intake counseling" to help individuals navigate options such as PACE and PathWays if they have a NFLOC or ensure they are referred to the appropriate place if they don't meet NFLOC.

  • Is it possible for someone to enroll in PACE during the interim period between February 2024 (when enrollment for PathWays begins) and July 2024 (when services start)?

    It is possible. Once the individual is disenrolled with PACE they would be eligible for PathWays.

  • If a person enrolls in PACE during the interim period but chooses to remain with PACE instead of moving to PathWays, how will this be facilitated?

    If they are enrolled in PACE and wish to continue in PACE then they will show up as excluded from PathWays.

  • Apart from age groups, what distinguishes PathWays from PACE?

    There are payer specific business rules and limitation indicators on the state enrollment file. The PACE program participants have a specific enrollment indicator that distinguishes them from other Medicaid programs.

  • When will members get their service plans reassessed?

    Service plans are reviewed at least every 90 days and on an annual basis. Members are assessed upon enrollment with an MCE and are reassessed when there is a change in status and annually based on their NFLOC redetermination date. Changes and updates to an individual’s service plan are determined on the results of the individual’s assessment and reassessment.

  • Which days of the week and timeframes will Maximum make outreach phone calls?

    The helpline is open M-F 8am-7pm. Outbound calls can be made any time the helpline is open, and will be dependent on their inbound call volume.

  • How does this affect, if at all, their primary Medicare insurance, either Traditional Medicare or Managed Care?

    It does not affect the individual’s Medicare benefits. PathWays is a Medicaid managed care program designed to better coordinate care with an individual’s Medicare plan.

  • Can they have two separate insurances between their primary and secondary, or do they need to be the same? For example, can they have UHC Managed Medicare and Anthem Medicaid?

    From July 1, 2024-December 31, 2024 individuals may be with one managed care entity, such as UHC for Medicaid, and also receiving their Medicare Advantage D-SNP benefits from Anthem. Beginning January 1, 2025, individuals can either be in an aligned managed Medicaid and Medicare Advantage D-SNP, such as Anthem for PathWays and Anthem for Medicare. Or individuals can be unaligned and choose a managed Medicaid health plan such as Anthem and be enrolled in traditional Medicare.

  • Will the member see a change in how their Part B is being paid and co-pays/deductibles that are being paid by Medicaid?

    No, the MCEs will continue to pay at least what FFS pays and members are protected from being billed for any remaining balance.

Eligibility

Health Plans

  • Why are there different health plans?

    Health plans offer the same basic benefits but can vary in their added benefits. Depending on your situation and health needs, one plan may suit you better than another. It’s important to review your options and select the plan that’s right for you.

  • How do I choose a health plan?

    You can choose a health plan by calling 87-PATHWAY-4 (1-877-284-9294).  You will be provided counseling on which health plan would best meet your needs.

  • Can I have the same health plan for Medicare and Medicaid?

    Yes! Having the same health plan for Medicare and Medicaid will better coordinate your care and supports.

  • When can I change my health plan?

    You can change your health plan by calling 87-PATHWAY-4 (877-284-9294). You can change your health plan for the following reasons:

    • within 90 days of starting PathWays
    • any time your Medicare and Medicaid plans are not the same
    • once per calendar year for any reason at any time
    • using the just cause process
    • during the health plan selection period (mid-October to mid-December)
  • What if my current provider does not work with my PathWays health plan?

    You will want to make sure that you choose a health plan that includes your doctor.  You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

  • How do I find out if a provider participates with my PathWays health plan?

    If you are an enrolled PathWays member, you should call your health plan (Anthem, Humana or UnitedHealthcare) or go online to their website to research which providers are in that health plan's network. Members can also call 87-PATHWAY-4 (877-284-9294) and ask.

    If you are just joining PathWays and want to make sure you choose a health plan that includes your doctor, call 87-PATHWAY-4 (877-284-9294) to discuss your options.

  • My doctor isn’t in my health plan; can I still use them?

    You will want to make sure that you choose a health plan that includes your doctor. You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

  • My service coordinator isn’t in my health plan; can I still use them?

    You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

  • How do I arrange transportation with my health plan?

    You must call your health plan’s transportation broker (similar to a dispatching service) or call your health plan directly at least 48 hours in advance. The transportation broker arranges rides to and from the medical appointment. There are no mileage or frequency limits (such as annual limits), however prior authorization may be required for longer trips or more than 20 one-way trips per member per year.

Coverage and Benefits

  • What is covered by the Indiana PathWays for Aging program?

    PathWays provides the standard Medicaid benefits including coverage for medical expenses such as doctor visits, hospital care, therapies, medications, prescriptions, and medical equipment. The benefits also include preventive care, such as regular check-ups, and mental health and substance abuse treatment.

  • Will my Medicaid benefits change in PathWays?

    You will continue to receive the same Medicaid benefits in the PathWays program.

  • What are added benefits?

    Each of the PathWays health plans offer additional services to their members. Call your health plan directly to see what additional benefits are available to you.

  • What are home and community-based services?

    Home and community-based services are services for eligible individuals who choose to remain in their home as an alternative to residing in a long-term care institution, such as a nursing facility. These services assist a person to be as independent as possible and live in the least restrictive environment possible while maintaining safety in the community.

  • I want to stay in my home, but I do need some help. What are my options?

    You will want to contact your health plan (Anthem, Humana or UnitedHealthcare) to discuss your options.  Your health plan will do health assessments and refer you to a service coordinator to determine your functional eligibility to receive the supports your need to stay at home.

  • I think I need to go to a nursing home, what do I do?

    You will want to contact your health plan (Anthem, Humana or UnitedHealthcare) to discuss your options.  Your health plan will conduct health assessments and refer you to determine your functional eligibility to receive the supports you need in a nursing home.

  • Are there copayments in PathWays?

    No, you will not have any copayments in PathWays. However, you may have copayments as part of your Medicare plan.

  • Will I have transportation in PathWays?

    Yes, you will have transportation in PathWays to any covered non-emergency medical service, as well as pharmacy and durable medical supply pick-ups and transport related to hospital discharges.  If you are an enrolled PathWays member, you should call your health plan (Anthem, Humana or UnitedHealthcare) to schedule a ride. Your health plan and service coordinator can also work with your attendant care provider to schedule rides.

  • What additional services and supports are available in the PathWays program?

    Care coordination services are available to every PathWays member.  Members who meet the functional eligibility requirements have access to service coordination and the additional services:

    • Adult day services
    • Adult family care
    • Assisted living
    • Attendant care
    • Home modifications
    • Health care coordination
    • Home-delivered meals
    • Nutritional supplements
    • Personal emergency response systems
    • Respite
    • Specialized medical equipment
    • Structured family care
    • Transportation
    • Vehicle modifications

Medicare/Duals/DSNP

General D-SNP Information

  • What does Dual Eligible mean?

    Individuals who qualify for both Medicare and Medicaid at the same time, are “Dual Eligible.”

  • What is a Dual Eligible Special Needs Plan or D-SNP?

    A Dual Eligible Special Needs Plan (D-SNP) is a type of health insurance plan. It’s for individuals who have both Medicaid and Medicare at the same time. D-SNP is a type of Medicare Advantage plan.

  • What is Medicare?

    Medicare is a national health insurance program run by the federal government. It's for individuals aged 65 years and older.

    Some individuals with certain disabilities or conditions who are under the age of 65 may be eligible for Medicare.

    There are different parts of Medicare which help cover specific services:

    • Medicare Part A (Hospital Insurance) – Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
    • Medicare Part B (Medical Insurance) – Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
    • Medicare Part D (Prescription Drug Coverage) - Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
  • What is Medicaid?

    Medicaid is a federal and state program that gives health coverage to qualifying individuals with limited resources and income.

  • What is Medicare Advantage?

    Medicare Advantage (also known as “Part C”) is a type of Medicare health plan offered by a private company that contracts with Medicare. These plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t cover. There are different types of Medicare Advantage plans.

    D-SNP is a type of Medicare Advantage plan. There are also other Medicare Advantage plans such as:

    • Health Maintenance Organization (HMO) Plan
    • Preferred Provider Organization (PPO) Plan
    • Private Fee-for-Service (PFFS) Plan
    • Medical Savings Account (MSA) Plan
  • What does Medicare Fee-For-Service (FFS) program mean?

    Also known as Original Medicare, this is coverage managed by the federal government and not managed by a private insurance company.

  • How does an individual qualify for both Medicare and Medicaid?

    Medicare and Medicaid are two different programs.  Both are managed by separate entities and have different eligibility requirements.

    Medicare eligibility requirements:

    • Individuals need to be a U.S. citizen or a legal resident age 65 or older. Individuals may also be able to get Medicare earlier if there is a certain disability or condition.

    Medicaid eligibility requirements:

    • Individuals are under age 65 and meet the requirements for low-income families, pregnant women and children, receiving Supplemental Security Income (SSI), disability or another special situation.
    • Individuals are at least 65 years old, are blind or disabled, meet the income and asset limits.
  • What is a coordinated benefit?

    A coordinated benefit is a benefit that both Medicare and Medicaid cover. Coordination of benefits ensures the correct insurance plan has the primary payment responsibility and the extent to which other plans will contribute when an individual is covered by more than one plan.

  • Where can I get more information on D-SNPs?

    Individuals can get information on D-SNPs by contacting the State Health Insurance Assistance Program (SHIP) at (800) 452-4800 to speak to a counselor.  SHIP is a free counseling program for people with Medicare. Individuals can get one-on-one assistance in person, on the phone, or virtual.

D-SNP Enrollment

Aligned Medicaid and Medicare Health Plan Enrollment

  • What is exclusively aligned enrollment?

    Exclusively aligned enrollment refers to a dually eligible individual who enrolls with the same Indiana PathWays for Aging Medicaid health plan as their Medicare D-SNP.  For example, if an individual is currently enrolled in Anthem’s D-SNP plan, the individual will be auto enrolled with Anthem for their Indiana PathWays for Aging Medicaid benefits. The result is increased coordination of Medicare and Medicaid benefits which provides enrollees an optimal member experience

    If an individual is enrolled in PathWays and becomes eligible for Medicare, they will be default enrolled in the D-SNP plan that is the same as their Indiana PathWays for Aging Medicaid health plan. For example, if an individual is enrolled with Anthem to receive their Medicaid benefits through the Indiana PathWays for Aging program, they will be default enrolled in Anthem’s D-SNP when they become eligible for Medicare.

  • Will a PathWays member be automatically enrolled into an exclusively aligned enrollment D-SNP?

    PathWays members will not be automatically enrolled into a D-SNP. However, if they are enrolled in a D-SNP, the member will be automatically assigned to the Pathways health plan that is sponsored by the same health plan as their D-SNP.

    If an individual is enrolled with a PathWays for Aging Medicaid health plan and they become eligible for Medicare, the individual will be default enrolled in the D-SNP plan that is the same as their Indiana PathWays for Aging Medicaid health plan.

  • Will individuals who live in an unincorporated or rural area be able to enroll in an exclusively aligned D-SNP?

    Yes, D-SNPs in Indiana will be statewide and able to enroll individuals throughout the state

  • Is there a Medicare Advantage plan that is specialized for dually eligible members?

    D-SNPs are a health plan for individuals who are eligible for both Medicare and Medicaid.  It’s an all-in-one plan that combines your Medicare Part A, and Part B, Medicare Part D and your Medicaid.

  • Can a member be disenrolled from their D-SNP if they become ineligible for full Medicaid or QMB?

    No, if a member becomes ineligible for Medicaid they will be allowed to continue in their D-SNP plan for up to 6 months. During the 6 month period, the member may contact SHIP for assistance in choosing a new Medicare plan that works best for them.

  • Will Dual members be forced to take a Medicare Advantage Plan, instead of just original Medicare and Medicaid?

    As protected by federal statute, all dual eligible individuals will have freedom of choice to enroll in their preferred Medicare plan, which include Special Needs Plans (D-SNP, C-SNP, I-SNP); conventional Medicare Advantage plans (non-SNP); and Original Medicare (fee-for-service).

    Members who become eligible for Medicare after enrolling in Pathways, will be default-enrolled into the D-SNP with the same company as their selected Pathways health plan; however, in such instances, a member will be notified about how to opt-out of default enrollment and enroll in a different Medicare service delivery system of their choice.

    No matter what Medicare plan the member selects, the Pathways program requires coordination of benefits to the greatest extent possible between the Pathways Medicaid health plan and the member's Medicare health plan.

  • When aligning the Medicaid health plan, will that also affect the Medicare health plan? Can a member remain traditional Medicare?

    Alignment specifically refers to aligning membership for Pathways in a Medicare Advantage D-SNP but is only applicable when the member chooses to enroll in a D-SNP instead of traditional Medicare (also known as original Medicare) or a non-D-SNP Medicare Advantage Plan.

    If a member is enrolled in a D-SNP then they will be automatically assigned to the aligned PathWays Medicaid health plan.

  • How does PathWays work with the Medicare health plan?

    The PathWays Medicaid health plan will coordinate benefits and work with the Medicare health plan to coordinate care. This can include connecting medical and community supports. The PathWays health plan can also help get access to services not covered by Medicare.

  • How will members who are enrolled in a Medicare Advantage plan be enrolled in PathWays?

    Pathways enrollment is not impacted by the member's choice of Medicare.  Individuals who are 60 years or older and receive Medicaid benefits will be enrolled in PathWays.

  • When an individual under 60 is on the appropriate D-SNP health plan from their company, what happens when they turn 60 years old?

    D-SNP members who turn 60 years old are allowed to stay with that plan until the end of the year. At the end of the year , the D-SNP plan will crosswalk the member over to the appropriate plan.

    If the member wants to move to the appropriate plan before the end of the year after they turn 60, they can work with that D-SNP to transition.

Medicaid and Medicare Care Coordination

Member Costs