PathWays History
The Indiana PathWays for Aging Program will be a managed long-term services and supports program. Having a managed long-term services and supports program means FSSA will partner with experienced health plans to coordinate LTSS benefits and an individual’s other benefits such as Medicare. Twenty-five other states already have a managed LTSS program—the first established in 1989—and continue to innovate and refine the concept. FSSA is evaluating the experiences of these states and harnessing best practices from around the nation to achieve shared goals:
- A cornerstone will be robust care coordination with an emphasis on ensuring that all older Hoosiers have access to quality care and can achieve similar health outcomes regardless of race, ethnicity, geography, etc.
- LTSS are complex to navigate for older adults and their caregivers, especially for those who are also enrolled in Medicare. These programs are currently disconnected and siloed. Our managed LTSS system will feature seamless coordination of benefits regardless of program or setting and significantly reduce the confusion created by navigating multiple plans. Increased coordination between these programs will make accessing and navigating the entirety of the care/support continuum easier.
- mLTSS plans can offer enhanced benefits—such as caregiver supports—to help care recipients and their families.
- Through mLTSS, many states have increased access to services at home, with careful coordination and a responsive approach to helping each individual receive services in the setting of their choosing. Across the nation, now, more than 60% of long-term services and supports are delivered at home and in the community.
- mLTSS establishes accountability and can tie payment to health outcomes and service delivery across the various settings in which Hoosiers may receive services. This will allow Indiana to better invest in quality care for older Hoosiers and leverage data to ensure our system performs at a high level.
Additional update on MCE award recommendation
Oct. 3, 2023
Central to the Indiana Family and Social Services Administration’s priority of alignment for Indiana PathWays for Aging members, many of whom will be dually-eligible for Medicare and Medicaid, all managed care entities in the program must operate a Medicare Dual-Eligible Special Needs Plan.
FSSA has learned that Molina Healthcare, one of four managed care entities recommended for award in the PathWays program, has been unable to secure a D-SNP contract with Centers for Medicare and Medicaid Services to operate a Dual-Eligible Special Needs Plan by Jan. 1, 2024.
As a result, FSSA notified Molina Healthcare that the state is not continuing readiness review activities with it and will not offer Molina a contract for the Indiana PathWays for Aging program.
FSSA continues readiness review activities with the other three managed care entities who have been recommended for award.
Update on MCE Award Recommendation
On March 1, 2023, following a competitive procurement process, the Indiana Family and Social Services Administration and the Indiana Department of Administration announced the following vendors have been recommended for award for the Indiana PathWays for Aging Program. These Managed Care Entities have the opportunity to begin negotiations and implementation:
- Anthem Blue Cross and Blue Shield
- Humana Healthy Horizons in Indiana
- Molina Healthcare of Indiana
- United Healthcare Community Plan
The award comes after years of collaborative efforts across FSSA and with all our stakeholders to design a strong program that will bring the best managed care partners to the table. Each of the recommended MCEs has demonstrated experience and success in Medicaid managed care and long-term services and supports and brings resources and expertise to ensure Hoosiers get high-quality care. Through a person-centered approach, these MCEs will be integral to achieving our goals to make it easier for individuals to get home services, to create seamless coordination between Medicaid and Medicare, to align quality with payment, and to bend the cost curve related to caring for a growing aging population.
In terms of next steps, the State team will be working directly to coordinate with the MCEs in the contracting and readiness review process so they are prepared for the program to go-live in the summer of 2024 and are aligned in their support and partnership with our Indiana providers. FSSA is planning robust meet-and-greet sessions to bring together HCBS providers and MCEs.
To learn more about the program and view the award recommendation, please visit: https://www.in.gov/idoa/procurement/award-recommendations/.
Click below to access key MLTSS RFP documents which are identical to those posted by the Indiana Department of Administration on June 30, 2022.
