Medicaid Managed Care
The Indiana Family and Social Services Administration (FSSA) is planning to significantly rebalance the delivery of long term services and supports (LTSS) for most older Medicaid-eligible Hoosiers in favor of more home and community based care services (HCBS). FSSA is targeting Summer to Fall of 2024 for this project; known as Indiana Pathways for Aging.
See recent FSSA Power Point Presentations and the FSSA website, which contains presentations and many other important materials.
- FSSA Report to Legislators 2021
- FSSA's Feb. 22 mLTSS Report to Legislators February 2022
- mLTSS 101 an overview presented by Advancing States November 3 2021
FSSA intends to transition the member experience (eligibility, care management, etc.) and and claims-payment responsibilities to a managed care (insurance company) system. In other words, senior Hoosiers will be attached to one of the various insurance companies who won the procurement bid. Those four are: Anthem, United Health Care, Molina, and Humana.
The projected timeline for the request for information (RFI), Request for Proposals (RFP) from the prospective managed care entities (MCE - insurance companies), and the implementation of mLTSS is projected as follows:
- RFI Co-Design and Finance Workgroups: January 2021 through the present;
- RFI Release: July 2021;
- RFP Release: June 2022;
- RFP Award: March 2023;
- Contracting/Readiness/Implementation: Throughout 2023 - July 2024;
- Tentative Implementation Date: No earlier than July 1, 2024
LeadingAge Indiana, and other stakeholder groups in Indiana senior care, have met together and with FSSA to advocate for certain structural, financial, and administrative guardrails to help ensure that this move to the managed LTSS will be as smooth as is possible. We continue to work to expand this list, but some of the safeguards we have tentatively secured include:
- Preservation of the IGT/UPL system;
- changes will include a value-based incentive system, but IGT/UPL payment will continue - and might increase upon hitting certain metrics;
- Adequate appeals processes for providers;
- Appropriate and efficient PA processes;
- Uniform credentialing process;
- Clear efforts to reduce administrative burdens on providers;
- Dedicated and qualified care and case managers for this vulnerable population.
Here is a summary mLTSS one-pager to review and to use when discussing relevant issues with residents and their families, and also with legislators.
Please refer to this enrollment summary for questions about resident enrollment during and after the transition to managed care. Additional material will be put out by LeadingAge Indiana as it becomes available.