The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) announced on May 23 that the Indiana PathWays for Aging (PathWays) managed care Medicaid program will launch on July 1, 2024.

PathWays is an Indiana Health Coverage Programs (IHCP) initiative for Hoosiers 60 and older who are eligible for Medicaid benefits based on age, blindness or disability, including individuals residing in a nursing facility, individuals receiving home- and community-based services, and patients who are dually eligible beneficiaries for both Medicaid and Medicare. The income criteria for PathWays are the same as for traditional Medicaid.

Enrollment into PathWays is automatic for currently enrolled Medicaid members unless they fall into an excluded category.  In March, patients targeted for PathWays enrollment were sent a letter with directions on selecting a PathWays managed care entity (MCE). Three MCEs are contracted to provide Medicaid healthcare coverage for PathWays: Anthem, Humana and UnitedHealthcare. Patients can change their MCE until July 1 and within 90 days of starting PathWays.

The PathWays MCEs are responsible for developing a provider network to serve their enrolled members. However, for the program's first two years, the MCEs must have an open network until provider network adequacy is demonstrated and approved to allow members to access out-of-network providers that are enrolled in the IHCP during the transition to PathWays. 

IHCP is encouraging providers to consider joining all three MCE networks. Providers may participate in multiple networks but must apply directly with each MCE. In the PathWays program, provider referrals will come from the MCE’s provider directory listing.

During this transition period, all prior authorizations and service authorizations for members will remain active, and providers should plan to continue to serve them. The MCE shall provide continuity of care for the authorization of services and choice of providers for 90 days. The FSSA expects providers to continue rendering services to all members under the existing authorizations.

Providers must also give written notice to each member who has chosen or is authorized to receive long-term services and support services from that provider no less than 30 calendar days before the effective date of the termination of services. 

IHCP emphasized that providers must verify member eligibility and assigned MCE on the date of service every time they provide services. This eligibility verification can be performed using the IHCP Provider Healthcare Portal, a phone-based interactive assistant (GABBY) or 270/271 Eligibility Benefit Inquiry and Response electronic transactions—batch or interactive.

More information can be found in IHCP Bulletin 202470.