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 they need the Indiana General Assembly to let them.
The GOP-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."
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 rapidly approved more than 600 such waiver applications.
Now the Family and Social Services Administration is looking to make that permanent and 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.
Sullivan said, for instance, a new system could help to 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 to that due to the changes during the pandemic.