Indiana’s Continuing Medicaid Crisis

This image depicts a managed-care entity making a business decision to prevent a disabled older man and a wheelchair from entering a nursing home.

Changes in Indiana’s Medicaid system, which is supposed to help low-income seniors and disabled people, are creating serious problems. The changes are making life harder for people needing nursing home care or needing help staying at home. So, what’s behind Indiana’s continuing Medicaid crisis?

How Indiana’s Medicaid System Works

The average Indiana nursing home resident pays more than $90,000 per year for care. When people needing nursing home care or home health care run out of money, they often need Medicaid to help pay for their care. Applying for Medicaid is a complicated process. To qualify, seniors must provide a lot of information about their finances. This includes details about their income, any assets they own, and if they’ve given away any money or property in the past few years. Many people hire elder law attorneys to help them get the Medicaid benefits they need to pay nursing home bills and home health care costs.

Privatizing Indiana’s Medicaid System

Earlier this year, we wrote about Indiana’s big Medicaid changes (https://www.hawkinselderlaw.com/indianas-home-healthcare-crisis/). Instead of the state managing everything, they handed over the job to private companies known as managed-care entities (MCEs). Indiana hired Anthem Blue Cross and Blue Shield, Humana Healthy Horizons, and United Healthcare Community Plan of Indiana to manage the Medicaid system as Indiana’s MCEs.

The MCEs manage Medicaid applications for people in nursing homes through a program called PathWays.

Problems with Privatization

Unfortunately, Indiana has created a “perfect storm” of problems by turning over the Medicaid system to these private companies. Instead of improving the situation, Indiana’s continuing Medicaid crisis has gotten worse.

Incentives to Deny Applications

One of the big issues is that the state pays these MCEs to save money. This gives them a financial incentive to find reasons to deny Medicaid applications. It also encourages them to push people out of nursing homes if they can. The fewer people they have to cover, the more money they make.

Red Tape and Delays

By law, the state must process Medicaid applications within 45 days. However, the MCEs often make mistakes, and fixing these mistakes requires approval from state employees. This slow process is slow often leads to delays. As a result, MCE employees often deny Medicaid applicants for “failure to cooperate” to meet processing deadlines.

Long Waiting Lists

People applying for Medicaid to receive home and community-based services (HCBC) face even bigger problems. On July 1, the Director of Indiana’s Division on Aging said that the Division would take a year to process all the applications that were already on the waiting list before July 1, 2024. For those applying for the newly named Health & Wellness Waiver, the Division could take up to 2 ½ years for their applications to be processed.

What Elder Law Attorneys Are Doing About Indiana’s Continuing Medicaid Crisis

Indiana’s Elder law attorneys in Indiana are monitoring the issues and sharing updates with each other daily. Our Indiana Chapter of the National Academy of Elder Law Attorneys (NAELA) advocates for elderly and disabled Hoosiers.

We are pushing for new laws requiring the Division of Aging to fix the system. We want to ensure that seniors and disabled people get the help they need without facing unnecessary delays or denials.

Conclusion

The Medicaid system’s purpose is helping some of the state’s most vulnerable residents. But right now, the system is broken. With private companies running a poorly planned system, seniors and disabled people face more hurdles than ever before to get the care they need. Fortunately, elder law attorneys are working to address these issues and push for changes that will make the system better for everyone.

Where to Get More Information

If you want to learn more about this issue or need help with Medicaid, visit the Hawkins Elder Law Facebook page at https://www.facebook.com/HawkinsElderLawPC/ or our website at www.hawkinselderlaw.com. You can also call us at 812-268-8777 for more assistance.