FSSA provides update on growing waitlist, hears about provider issues under managed care

Two committees tasked with studying and addressing issues related to aging met Thursday, concluding that Medicaid waitlist progress was "barely treading water" and dissecting ongoing provider issues with the transition to managed care.

Membership and content of the two committees overlap, though each spent significant time discussing topics unique to their statutory mission. The Commission on Aging reviewed efforts to better integrate mental health and behavioral health services into programming for senior Hoosiers. On the other hand, CHOICE — or Community and Home Options to Institutional Care for the Elderly and Disabled — heard about several efforts to expand housing options through the Indiana House and Community Development Authority.

But the two topics taking the most time was the state's transition to managed care, overseen by Managed Care Entities (MCEs) or insurers, and an update on the waitlist for Medicaid services for both the PathWays for Aging Waiver as well as the Health and Wellness Waiver. The latter is designed to provide services for disabled Hoosiers while the former serves Hoosiers aged 60 and older.

WAITLIST UPDATE

Leslie Huckleberry, the director of the Division of Aging within FSSA, reported that a total of 13,679 Hoosiers were on waitlists for Medicaid waiver services as of late August — or 9,248 Hoosiers waiting for aging services under PathWays and another 4,431 Hoosiers on the waiting list for the Health and Wellness waiver.

Though the agency has committed to inviting 925 Hoosiers off the waitlists each month — 800 for PathWays, 125 for Health and Wellness — Huckleberry says the number invited off each month has been higher due to adjustments in who needs services.

People might leave the waitlist because they no longer need services, may move out of the state or die. Others might qualify as a "priority" based on certain factors and be bumped to the front of the line — which delays services for those further behind.

A little over 3,000 people have been invited off of the waiting list so far, Huckleberry said.

However, the waitlist continues to grow even as FSSA invites people off to enroll in services.

"We've got a sizable waitlist and I don't see it going away anytime too soon," said JoAnn Burke, chair of the Commission on Aging.

Rep. Ed Clere, R-New Albany, said progress was "barely treading water" when he heard the numbers during the CHOICE Board. He noted that, if no one else joined the waitlists, PathWays members could wait one year while those waiting for Health and Wellness services would wait nearly three years.

Last month, the state's Medicaid director said the agency was looking at spending federal funds on waitlisted Hoosiers who were placed at assisted living facilities.

Huckleberry said that FSSA had identified that population because "it's intricately tied to their housing" and some Hoosiers might be "stuck" in those facilities and can't leave until they access services. The move would also specifically address those who applied for Medicaid waiver services before waitlists were implemented in April.

"We're working to finalize that … by the end of this month, hopefully, so we can provide some targeted relief for those folks," Huckleberry said.

Huckleberry noted that the funds need to be spent by the end of the calendar year. Another FSSA representative clarified that, as of April 2024, 84% of the $2.1 billion of federal funds was invested, with other pots of money for home- and community-based services as well as PathWays for Aging.

"… it's certainly not to say that folks in other community settings don't have a need. It's just that we understand that these folks are at particular risk for eviction and so (we're) really trying to do what we can with the resources that we have."

Both Clere and Burke wondered if the federal funding could be expanded and should prioritize based on severity of need, rather than housing status.

"I understand the concern around assisted living — and I certainly share the concern — but I have just as much concern for people who are trying to remain at home and need waiver services to remain at home," Clere said. "I mean, some of those folks may end up in a skilled nursing facility for lack of waiver services at home, right?"

Huckleberry said FSSA would look more into spending the funds but shared logistical concerns about setting up a program to quickly spend the dollars before the end of the year.

"… we're doing what we can to bridge the gap for who we can," Huckleberry said. "If we had the funding, we would just have the normal waiver. So some of it's doing what we can with what we have."

Ranking someone based on acuity would be more difficult to define and could pose a hurdle for getting dollars out the door, Huckleberry said. Clere said that ranking based on severity of need would be a task for case management.

MANAGED CARE TRANSITION

Huckleberry continued to highlight high call answer rates and speedy bill payments but some Commission on Aging members, some of whom are providers under PathWays, reported problems in both areas.

Deb Lambert, the CEO of Byron Wellness in Fort Wayne, said she'd been on the phone for 90 minutes to answer "one simple question."

"I'm concerned that we're not really getting feedback from the people who are supposed to be getting the services," Lambert said. "… I consider myself relatively cognitively intact and I can't imagine how difficult this has to be for people that are having some cognitive struggles as an individual person trying to get services."

Though Huckleberry said the agency would respond to specific cases, Judith Schoon — a certified senior advisor based out of Griffith — said enrollees were reluctant to escalate problems out of a concern that they'd lose their services.

"I've called in to try to get help and I'm telling you right now it is a nightmare," Schoon said. "… It's hard to bring you specific ones because the fact that they're just terrified. They don't want to come forward."

Huckleberry assured committee members that "retaliatory action" wasn't the intention and emphasized that reporting wasn't meant to be punitive.

"I very much understand … but as much as you can encourage folks to be willing to come to us with those issues, that would be helpful for us," Huckleberry said.

Additionally, committee members reported that some enrollees hadn't been assigned service coordinators and existing service coordinators had large caseloads as the insurers continue hiring.

"If you have situations where you've reached out to the MCE and you're told this person doesn't have a service coordinator or care coordinator yet, we do want to hear about that," Huckleberry said. "Because that should not be happening."

Kristen LaEace, the CEO of the Indiana Association of Area Agencies on Aging, told committee members that her organization had heard from consumers who'd lost services during the transition and detailed delayed billing concerns from her members.

Attention turned to getting legislator buy-in before the 2025 legislative session, when lawmakers will write the state's two-year budget and direct spending priorities. At least one organization, AARP of Indiana, was collecting stories from Hoosiers impacted by the state's waiting lists for Medicaid services to present before the General Assembly.

As costs for Medicaid increase, lawmakers have vowed to closely examine the program's spending. The 2025 budget-writing session will be the first time lawmakers meet since the implementation of managed care and the Medicaid waiver waitlists.