The Indiana Family and Social Services Administration said the new long-term care program is on track to launch in July. However, the major insurance companies overseeing the transition and a group representing senior care organizations didn’t reach a consensus on care management — leaving the future of the program unclear.
Currently, case management for Medicaid members older than 60 is handled by Indiana’s Area Agencies for Aging. The Pathways for Aging program will shift care to health plans managed by one of three major insurance companies or managed care entities: Anthem Blue Cross and Blue Shield, Humana Healthy Horizons and United Healthcare Community Plan of Indiana.
Connie Wolfe is the president and CEO of one of Indiana’s Area Agencies for Aging, and serves as a board member for Community Care Hub Indiana. CCHI was created to manage a contract between the insurance companies and Area Agencies for Aging. However, Wolfe said CCHI couldn’t reach an agreement due to the low rate proposed by FSSA for case management.
While Area Agencies for Aging can enter into individual contracts with the companies, many can’t afford the lower rate because it isn't enough to cover the cost of the work.
“Our business was going to be cut no matter what,” Wolfe said. “We knew that. We've been planning for that. But we hadn't been planning for the rate to be reduced from $189 to $112, and that the work would not be – the scope of work – would not be adjusted in any way to be in line with that reduction in pay point.”
The area agencies have been a significant part of the broader long-term care structure within the state. They are community-focused nonprofits that support older Hoosiers with programs aimed at allowing them to age within the community. Wolfe said case management is not the only thing they do, but it is an important revenue stream for most Area Agencies for Aging.
“It's kind of unfathomable to me, quite frankly, that community agencies are now being asked to subsidize the work that needs to happen,” Wolfe said.
Wolfe said many Area Agencies for Aging have already said they can’t afford to subsidize case management and have turned down the individual contracts due to the “untenable circumstances” created by the transition.
Even for Area Agencies for Aging that can afford to take on the contracts, the transition will shift how area agencies operate, which Wolfe said might lead to more spending in the long run.
Not everyone over the age of 60 qualifies for the Pathways for Aging program. The home and community-based services waiver behind Pathways for Aging requires an evaluation, and if that shows that someone needs a “nursing home level of care” then they qualify for the program. Wolfe said if they don’t get onto the Medicaid waiver then they might have to go to a nursing home.
“There's a lot of concern about too much spending in Medicaid,” Wolfe said. “The best lever to pull, and, quite frankly, the most effective one, and we have a lot of data to support this is to get to people early to help them early.”
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Wolfe said Area Agencies for Aging help to delay the need for the more expensive types of care through other programs and care coordination that supports people earlier in the process.
“By working closely with an individual and their family caregiver, if they have one to craft a support system that's appropriate, kind of the right touch at the right point with those clients,” Wolfe said. “And so your agencies on aging are that infrastructure that allows that to happen.”
Lawmakers have also raised concerns about the potential impact the transition could have on Area Agencies for Aging and older Hoosiers.
In November, Rep. Ed Clere (R-New Albany) said he wants the transition to be successful, but is worried it will be a “train wreck.” He said that with the loss of case management, Area Agencies for Aging are losing the revenue that often subsidized other functions of the agencies.
Earlier this month, Rep. Greg Porter (D-Indianapolis) released a statement urging the Holcomb administration and FSSA to reconsider the approach to shifting to the MCEs. He wrote Area Agencies on Aging will not have the financial capacity to help FSSA with the transition.
This week, Sen. David Niezgodski (D-South Bend) said in a statement that REAL Services in northwest Indiana announced it plans to layoff 65 employees due to the Pathways for Aging transition.
“Due to FSSA's proposed new rates, providers like REAL Services are put in the position of laying off workers and not able to help everyone who relies on their assistance,” Niezgodski said. “FSSA needs to continue to fully serve the Hoosier people under their new PathWays and ensure nobody falls through the cracks.”
Despite their frustrations and concerns, Wolfe said Area Agencies on Aging still want to support their clients through the transition because they want what’s best for the people they support.
“If we were all just businesses, we'd all say no,” Wolfe said. “Because it would make no sense to keep this, but we're not. We're part of a nonprofit sector that is mission driven and all of the decisions we make are both financial decisions, and, and decisions about how we best serve.”
Wolfe said she doesn’t know what’s going on behind the scenes, but it’s hard to imagine that the program is ready for its July 1 start date. She said if the program isn’t ready, she hopes the state pauses the transition until it is.
Abigail is our health reporter. Contact them at aruhman@wboi.org.