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 below and on the initial FSSA website, and updated Pathways website which contains 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 

Anthem 

Humana 

UnitedHealthcare 

Important Materials and Documents:

• Claims Testing Program: see BT2024110 - Updated Temporary Emergency Fund Assistance guidance doc - with application instructions and form. 
• LAIN Pathways FAQs (draft - updated 6-6-24).docx
• Forvis – Medicaid, Medicare, UPL and MDS Presentation
• FSSA Presentation
• Eric Essley – PathWays Managed Care Presentation
• Pathways Probari PPT on Care and Service Coordinator Roles 
• MCE Joint Claim-Billing Presentation
• LAIN Resident Enrollment / MCE Selection Tutorial
• MLTSS Occupancy Penalty Change Memo for Members
• mLTSS 101 an overview presented by Advancing States November 3 2021
• LAIN MLTSS Summary

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.  

LeadingAge Indiana, along with and other stakeholder groups in Indiana senior care, met with FSSA over the course of three years to advocate for certain operational, financial, and administrative guardrails to help ensure the Pathways transition is as smooth as is possible.  We continue to work to expand protections, but some of the safeguards we 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;
• Fair and timely claims payment requirements;
• Adequate and Adequate appeals processes for providers;
• Uniform Appropriate and efficient PA processes;
• Uniform credentialing process;
• Any Willing Provider contracting for at least three years;
• Clear efforts to reduce administrative burdens on providers;
• Dedicated and qualified care and case managers for this vulnerable population.  

Assisted Living Medicaid Waiver Specific Materials

• LAIN Pathways FAQs (draft - updated 6-6-24).docx
• FSSA has also 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
• IHCP has issued instructions for the Waiver provider certifications portal - BT202456 and BT202460. 
• IHCP has issued guidance for claims paid incorrectly for CIH waiver community transition services- BT202453
• 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.
• See other relevant Bulletins below. 

Bulletins

BT2024119 - IHCP reminds providers that NEMT services for NH residents are carved out and not brokered through Verida or MCE brokers

BT2024123 - IHCP reminds providers of Indiana PathWays for Aging open network

BT2024110 - Updated Temporary Emergency Fund Assistance guidance doc - with application instructions and form. 

BT2024113- IHCP clarifies Type of Bill code usage for managed care claims submitted by certain providers

Update For Aged And Disabled Waiver Recipients And Their Families

Update for Waiver Providers and Care Management Organizations

Waiting List Implemented for Aged and Disabled Waiver

LeadingAge Association Meeting - Pathways for Aging