Reimbursement Roundtable 10 23 25 Handout Medicaid Managed Care
Medicaid Managed Care
The Indiana Family and Social Services Administration (FSSA) has moved the delivery of long term services and supports (LTSS) for most older Medicaid-eligible Hoosiers Seniors (60+) to a managed care model. FSSA launched this program on July 1, 2024 and it is known as Indiana Pathways for Aging.
See recent FSSA Power Point Presentations below and on these websites: the FSSA website, the updated Pathways website, the Medicaid Strategies website, and the AL Waiver Waitlist website, all of which contain presentations and other notable information.
PathWays and MCE Resources
Enrollment Broker and General Questions
87-PATHWAY-4 (877-284-9294)
Member Support Services – available on and after July 1
[indianapathwaysmss.com]indianapathwaysmss.com
877-738-3511
indianapathwaysmss@maximus.com
MCE Member Services
Anthem: 833-412-4405 or by registering at www.anthem.com/register
Humana: 866-274-5888 or INHealthyHorizons@humana.com
UnitedHealthcare: 800-832-4643 or IN_HPops@uhc.com
MCE Websites
Anthem: https://mss.anthem.com/in/insurance-plans/pathways-for-aging.html
Humana: https://www.humana.com/medicaid/indiana
UnitedHealthcare: https://www.uhc.com/communityplan/indiana/plans/medicaid/pathways
PathWays Provider Resources
For Stakeholder Engagement information, webinar recordings, and presentations, please visit:
https://www.in.gov/pathways/stakeholder-engagement/
MCE Provider Helpline
Anthem: 833-569-4739
Humana: 866-274-5888
UnitedHealthcare: 877-610-9785
MCE Provider Contracting Contacts
Anthem: INmltssproviderrelations@anthem.com
Humana: InMedicaidProviderRelations@humana.com
UnitedHealthcare: in_providerservices@uhc.com
MCE Provider Manuals
Important Materials and Documents:
- LAIN Pathways FAQs (draft - updated 6-6-24).docx
- 2024 Forvis Mazars – Medicaid, Medicare, UPL and MDS Presentation
- Mds 3.0 Update Handout
- Eric Essley – PathWays Managed Care Presentation
- Updated - New Pathways Probari PPT on Care and Service Coordinator Roles
- MLTSS Occupancy Penalty Change Memo for Members
- LAIN MLTSS Summary – 2023 document
Looking for something? Click here for archived resources and documents.
FSSA has transitioned the member experience (eligibility, care management, etc.) and claims-payment responsibilities relative to 60 and over Medicaid recipients to a managed care (insurance company) system; see the Pathways website . In other words, senior Hoosiers will be attached to one of the various insurance companies who won the procurement bid. Those three (3) are: Anthem, United Health Care, and Humana.
Assisted Living Medicaid Waiver Specific Materials
- General AL Waiver information can be found here, and here.
- Current AL waiver stats (for both the PathWays and Health & Wellness waivers) can be found here.
- Providers are encouraged to routinely check the IHCP Bulletins page ... for PathWays and other Medicaid activity;
- Here, you will find quite a few AL Waiver specific Bulletins.
- On Feb. 12, 2025, FSSA updated its waiver invitation process for individuals on a waiting list for HCBS services. See here.
- LAIN Pathways FAQs (updated 6-6-24).docx
- In May 2024, FSSA issued this Aged & Disabled Waiver & Traumatic Brain Injury Legally Responsible Individuals Transition Update, and has released:
- Individual and Family Bi-Weekly Webinar for Aged and Disabled or TBI Waiver, slide deck from May 1, 2024
- Structured Family Caregiving Frequently Asked Questions for Waiver Individuals and Families
- Structured Family Caregiving Frequently Asked Questions for Care Managers and HCBS Providers
- FSSA shared responses to requests made by Indiana Families United for Care. We have posted these responses here, so that the information is available to all A&D and TBI Waiver members.
- IHCP has issued instructions for the Waiver provider certifications portal - BT202456 and BT202460.
Historical documents:
Update For Aged And Disabled Waiver Recipients And Their Families
Update for Waiver Providers and Care Management Organizations
