The document outlines the 'Pathways for Aging' program in Indiana, designed to provide managed long-term services and supports (LTSS) for Medicaid recipients aged 60 and over, starting in July 2024. It discusses eligibility requirements, including the need to meet Medicaid income/resource limits, and lists additional services available to participants. The document also addresses the transition of individuals from the aged and disabled waiver program to this new managed care model while outlining the importance of improving care coordination and community engagement.

1. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Part 3
Pathways for Aging
Long Term Services and Supports
Pathways for Aging
Health and Wellness Waiver
Structured Family Caregiving
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2. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
What are Long-Term Services and Supports (LTSS)?
Long-term services and supports refers to both institutional and home and community-
based services.
Medicaid beneficiaries who receive LTSS often have complex conditions and high needs. In
2019, LTSS beneficiaries accounted for approximately 32.8% of Medicaid spending but
represented only 5.4% of Medicaid enrollees.
These services are not covered by Medicare, so states shoulder the weight of these
services.
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3. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
What factors are driving the switch to Managed Care?
• Baby Boomers are retiring – almost 10,000 Baby Boomers are turning 65 every day
• Improvements in health determinants mean people are living longer.
• People with chronic conditions such as diabetes, mental illness, and COPD are living
longer and accessing more expensive health care treatments.
• The COVID-19 crisis revealed and exacerbated ongoing challenges for those in need of
LTSS – worker shortages and needs outpacing available resources.
• Current LTSS program has programs that are disconnected and siloed.
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4. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Aged and Disabled Waiver
The shift to MLTSS has created the need to change the current Aged and Disabled Waiver.
FSSA submitted waiver amendments to the Aged and Disabled waiver to create:
• Pathways for Aging
• Health and Wellness Waiver
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5. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
What is Pathways for Aging?
It is a managed care-based model for Hoosiers aged 60 and over who received Medicaid or
who are dually eligible for Medicare and Medicaid.
The goal is to increase person-centered planning, improve coordination of care, increase
community engagement, enhance member experience, maintain qualified providers,
promote efficiency and comply with HCBS waiver rule.
Choice, Quality, Cost and Sustainability
In 2021, 24 states had adopted a managed care approach for their LTSS (MLTSS). In July
2024, Indiana will roll out its own MLTSS called Pathways for Aging.
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6. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Who is eligible for Pathways for Aging?
Medicaid recipients* who are
• Age 60 or over
• May be in a nursing facility
• May be approved for LTSS through Home and Community Based Services (HCBS)
• May have Medicare
• May be on the Behavioral and Primary Health Coordination Program (BPHC)
Currently 28,000 of the Aged and Disabled waiver program will transition to Pathways for
Aging.
*Must meet Medicaid income/resource limits
or Nursing home or HCBS income/resource limits
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7. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Who is NOT eligible for Pathways for Aging?
• Those under 60
• Those enrolled in Healthy Indiana Plan
• Those enrolled in Hoosier Healthwise
• Those eligible for Emergency Services Only
• Traumatic Brain Injury Waiver
• Family Support or Community Integration and Habilitation Waiver
• End Stage Renal Disease Waiver
• Breast and Cervical Cancer Program (BCCP)
• Those in intermediate care facilities with intellectual/developmental delays
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8. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Managed Care
Entities
• Anthem Blue Cross and
Blue Shield
• Humana Healthy Horizons
in Indiana
• United Healthcare
Community Plan
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9. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Dual-Eligible Special
Needs Plan
For participants that have both
Medicare and Medicaid, the MLTSS will
be operating a Medicare Dual-Eligible
Special Needs Plan (D-SNP).
Special Needs Plans (SNP) provide
benefits and services including care
coordination to members. It operates
under either an HMO or PPO model.
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10. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Plan Selection
Individuals will be allowed to
change plans:
• Within 90 day of initial
enrollment
• During annual plan selection
period – mid-October – mid-
December (in alignment with
Medicare Open Enrollment)
• Anytime for just cause
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11. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
What additional service and supports are available to all
Pathways members?
• Adult Day Services
• Adult Family Day Care
• Assisted Living
• Attendant Care
• Home modifications
• Healthcare Coordination
• Home-delivered meals
• Nutritional supplements
• Personal emergency response systems
• Respite
• Specialized medical equipment
• Structured Family Care
• Transportation
• Vehicle modifications
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12. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
What will PathWays cost?
Medicaid only members will
not have copays. Medicare
members may have the
copays associated with the
Medicare plan
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13. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways Timeline
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Pathways for Aging

14. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
PathWays Communication
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FSSA is sharing information
about the PathWays
program
• FSSA Website
• TV and Radio spots
• YouTube
• Specialty publications
• Other tools
Pathways for Aging

15. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
Health and Wellness Waiver
Some 11,000 Hoosiers aged 59
and younger who qualify for
waiver services will be under
the Health and Wellness waiver
effective July 1, 2024. This
waiver will be administered by
the Indiana Bureau of Disability
Services, not the Division of
Aging.
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16. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
IHCP Updates
Structured Family Caregiving
Structured Family Caregiving (SFC) provides financial and
supportive services for family and non-family caregivers. It
empowers caregivers to give care to seniors and those with
disabilities who qualify for a waiver so they may remain in the
home. The caregiver provides supervision, personal care
assistance and homemaker services.
As of 2023, Indiana was one of only 8 states to have this
program.
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17. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
IHCP Updates
Structured Family Caregiving
How does it work?
The caregiver living with the care recipient is employed
through a home health agency or in-home provider agency.
The agency provides access to a social worker, nurse or care
coordinator to provide emotional support, answer health
related questions, and training to meet the needs of the care
recipient. The caregiver also is responsible for providing
written notes to be reviewed by the agency.
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18. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
IHCP Updates
Structured Family Caregiving
SFC caregivers must be:
• 18+ years old
• Committed to being the primary caregiver
• Able to provide the needed care
• Able to pass a background check
SFC caregivers are paid a daily stipend, not an hourly wage,
which is usually a percentage of the stipend the agency
receives from Medicaid.
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19. This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Pathways for Aging
IHCP Updates
For IHCP purposes, income received from the SFC program is
exempt for all MAGI and Non-MAGI programs.
Documentation of the type of payment received may be
requested by FSSA.
Difficulty of Care payments, for services such as attendant
care will be exempt for MAGI categories only. This income is
considered tax exempt by the IRS and so is exempt for MAGI
categories. Difficulty of Care payments are still countable for
Non-MAGI categories.
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