The Journal Gazette
Friday, January 22, 2021 1:00 am

State eyes shift in elderly health

Goal is managed care at home, not facilities

NIKI KELLY | The Journal Gazette

INDIANAPOLIS – Gov. Eric Holcomb's administration is laying the groundwork for a managed care system for elderly Hoosiers on Medicaid – with a goal of shifting more toward home-based settings rather than facilities.

But the administration needs the Indiana General Assembly to let it.

The Republican-led legislature imposed a moratorium on managed care in 2017 and has extended it several times. It is set to expire in June. A bill has already been filed to extend it for another year.

“Our hope is by presenting an option to the General Assembly to do all of these items is that moratorium will sunset and not be renewed,” said Dr. Jennifer Sullivan, secretary of the Family and Social Services Administration. “This is the right time for meaningful change.”

But Sen. Vaneta Becker, R-Evansville, thinks the state is moving too fast and needs to take another year to create a strong foundation – including increasing the number of providers. She is carrying the bill to extend the moratorium.

She said providers haven't received an increase in rates in years and if the state does this “there will be people on the streets.”

Becker said the “only way managed care makes money is by denying care and that's all their interested in – saving a buck.”

Dr. Dan Rusyniak, chief medical officer for the agency, said under the public health emergency the state has participated in an expedited eligibility pilot for home and community-based settings. Instead of taking the usual four-to-six weeks to get approval for home and community supports it takes only a few days. The state has approved more than 600 such waiver applications.

Now the Family and Social Services Administration is looking to reform the system for long-term services and supports that allow a person to avoid going to a nursing home.

Rusyniak said under a managed care system, one company will coordinate the care with the state incentivizing that company to get to the goal that both grandma and the state wants.

He said there will be supports for a family caregiver, from education to emotional and financial help.

Sullivan said, for instance, a new system could help finance the redesign of a bathroom or installation of a ramp – inexpensive projects in the grand scheme of the cost of nursing homes.

She said the gold standard is to get to a 60-40 split of the dollars being spent – with more going to home care than institutional settings. Indiana's immediate goal is 50-50, and the state has inched slowly toward that due to the changes during the pandemic.

Sullivan said 25 states have managed care programs and have seen lower costs and improved outcomes. Tennessee and Arizona are two states Indiana has looked at, but the design of any program is wide open.

Sullivan hopes to put out a Request for Information to stakeholders in the spring. She added that most of the Medicaid system already uses managed care except for this carveout.

Rep. Tim Brown, R-Crawfordsville, authored the bill with the original moratorium and said Thursday the instability in the system was a problem back then.

He acknowledged the idea of managed care for elderly Medicaid population “is working its way forward” largely because of the amount of money the state is spending on Medicaid for that age population. They account for about 15% of the recipients but 35% of the cost.

“We are trying to get a handle on that,” Brown said.

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