The top official at the Indiana Family and Social Services Administration said the state’s new long-term care program for Medicaid members over 60 hasn’t met expectations. The statement contradicts claims the agency made under the previous administration, but aligns with concerns providers have raised.
The Pathways for Aging program shifted Medicaid members over 60 into health plans managed by health insurance companies. FSSA Secretary Mitch Roob said the state will end up paying those companies more than $300 million over budget this year.
Roob said he never would have pursued a program like this because it doesn’t make sense for the population it serves.
“It's very difficult for managed care companies to manage the care of individuals who are in nursing homes,” Roob said. “What is the value—what is the value they can have?”
When he served as FSSA secretary in 2006, Roob said he looked into the possibility of managed care for vulnerable populations like those over the age of 60 or children with disabilities. However, he said when he tried to find a managed care program to see what it would look like, he couldn’t find a private insurance program that had a program for those populations.
“[Managed care] is the way most states have chosen to do care today,” Roob said. “It provides them a bit of fiscal—short-term fiscal surety. I could not find a popular, managed care program, in the private sector that dealt with fragile populations. I couldn't find that because the fragile populations are by definition going to be covered by Medicaid.”
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Roob said managed care works for pregnant people or people without disabilities because their care is more predictable. But Roob said the previous fee-for-service model used for traditional Medicaid populations, including older Hoosiers, accounts for the ways that their care can be more expensive and less predictable.
“There is a possibility that in the longer term, we will create a better system,” Roob said. “In the venture capital world, it's called the Valley of Death. Getting from here to here has been very difficult. It's been very painful for everybody involved so far. That pain shows signs of easing, but only signs.”
In addition to Roob’s concerns about the program, lawmakers raised additional concerns this year during the legislative session. FSSA was tasked with addressing provider claims processing concerns by the General Assembly before Pathways launched in July 2024. This year, the Indiana legislature also passed legislation targeting similar issues for the second year in a row.
Among other things, House Enrolled Act 1474 set standards for how quickly a managed care organization must pay, deny or suspend a claim from a provider and how much interest is owed if that deadline is not met.
Providers have criticized the claims processing time since the launch of the program.
Abigail is our health reporter. Contact them at aruhman@wfyi.org or on Signal at IPBHealthRuhman.65.