INDIANAPOLIS – Indiana officials want to overhaul state rules to allow more elderly Hoosiers to access home- and community-based services so they can age at home, rather than at nursing homes.
The proposals announced last week by the Indiana Family and Social Services Administration come a week after Gov. Eric Holcomb said in his State of the State address that too many older Indiana residents are unable to stay at home and get care through state programs as they age.
FSSA officials want to revamp state rules to ensure that elderly residents have access to home- and community-based services – and let them know within 72 hours of inquiring if they are eligible for Medicaid home health support.
The proposed changes come as Indiana continues facing a COVID-19 pandemic that's killed many nursing home residents who live in group settings that put them at increased risk of contracting the coronavirus.
“This effort has been galvanized by COVID, with a demand by Hoosiers for a choice on where and how they should age,” FSSA Secretary Jennifer Sullivan said at a news conference. “This is the right time and the right place for collaboration and meaningful change.”
Under Indiana’s current system, many Hoosiers who wish to age at home are instead receiving care in nursing homes, in part due to a fragmented long-term care system that is difficult to navigate.
That’s why officials are pursuing a managed care system that would allow Hoosiers to access information about the different types of care that are available, including home care. Under a managed care system, an organization or company becomes the clearing house for directing residents and their families toward the care they need.
Indiana would join 25 other states that already administer long-term care through a managed care system.
“That will make sure that they’re getting the right care from the right provider in the right environment at the right time,” said Dan Rusyniak, the FSSA’s chief medical officer.
Indiana has more than 500 nursing homes and standalone residential facilities that house about 65,000 people. But fewer than half of elderly Hoosiers – 45% – now qualify for Medicaid funding to get care in their homes, even though recent surveys indicate that about 75% of them would rather get long-term care at home as they age.
About 1.9 million Indiana residents are on Medicaid, the federal program that pays for medical care, hospitalization, drugs, skilled nursing and other services for low-income and disabled people. But only 19% of Indiana's spending on long-term care goes to home-based and community-based services, while the bulk of it goes to nursing homes.
Indiana officials say their goal is to get up to 60% of the state’s elderly who need long-term health care the ability to get it in their homes, rather than in nursing homes.
But there are significant challenges. The state’s new efforts will require an expanded workforce to conduct home health visits and community health programs.
And a ban on managed care that state lawmakers passed several years ago has prevented the Holcomb administration from moving forward. That moratorium is set to expire at the end of the year, barring an extension by the General Assembly.
In October, state officials announced a pilot program for several Indiana counties that allowed them to expedite approvals for home or community-based care. Patients can now get approval within 48 to 72 hours, whereas before the process would take six weeks or more, Rusyniak said.
More than 600 Hoosiers have been approved through that pilot program.