Frequently Asked Questions

The Indiana Family and Social Services Administration will launch a new program in July 2024 for Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits. Research shows that most older adults - 75% or more - want to age at home and in their communities.

Health coverage in PathWays starts July 1, 2024.

You will get an enrollment letter in the mail, which will include a health plan comparison chart so that you can make a choice about which health plan is best for you.

To help you with the changes coming, FSSA will send you another letter 60 days before the start of the program to tell you which health plan will serve you. Your Medicaid health plan (Anthem, Humana or UnitedHealthcare) may also reach out to you 30 days before the start of the program with more information.

Call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to select your PathWays Medicaid health plan. You can also call this number if you need help with choosing a Medicaid health plan. You will need to choose from Anthem, Humana or UnitedHealthcare.

When calling to select your PathWays health plan please have the following information on hand:

1. Medicaid ID or SSN ( can use case #)
2. The correct phone #, address and DOB on file with FSSA
3. Primary medical provider
4. HCBS & Waiver Services Providers (i.e. Adult Day Services)

The PathWays health plans will have an open network until dictated by the state.  Thus, the member can continue to use their providers as long as the provider remains an IHCP approved provider no matter the health plan selected.

You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

Your service plans will stay in place for 90 days from program implementation with no reductions in services; changes can only be made if you need additional services.

Your Medicaid services that have already been authorized, will stay authorized for up to 120 days.

You will get a letter 90 days before your 60th birthday.  This letter will tell you that you are eligible for the PathWays program.  It will also include information on your health plan or how to select a health plan.

Indiana PathWays for Aging is a Medicaid managed care program for Hoosiers aged 60 and over who receive Medicaid (or Medicaid and Medicare) benefits. Research shows that most older adults - 75% or more - want to age at home and in their communities.

A health plan is a health insurance company. Physicians, hospitals, and other healthcare providers, including waiver providers, enroll with a health plan to provide care for members. Indiana partners with health plan for its Indiana PathWays for Aging, Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect programs.

A health plan provides members with health care coverage. After a member chooses a health plan for their Medicaid program, they can get medical care from a variety of health care providers and in some cases, waiver providers. Health plans provide enhanced care coordination to help members navigate the variety of services for which they are eligible. Health plans also provide service coordination.

The PathWays health plans are Anthem, Humana, and UnitedHealthcare.

A care coordinator is a person who may contact you to create a personalized care plan based on your preferences and needs. They can also help answer questions about your health care and help you with your providers.

A Service Coordinator is a person who will work with you to create a personalized Service Plan to help coordinate your Home and Community-Based Services. The Service Plan will help develop a plan of care of services and supports that best meet your needs and goals.

A health assessment is a set of questions that ask about your personal behaviors, life-changing events, health goals and priorities, service coordination and overall health. Your health plan will use these assessments to create a personalized care plan based on your preferences and needs.

A service plan is a support plan, developed by a service coordinator, for assisting you in gaining access to long-term care services, as well as medical, social, housing, educational, and other supports. Not everyone in PathWays will need a service plan.

You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294).

Yes, individuals can change health plans within 90 days of initial PathWays enrollment, during the annual health plan selection period, or at any time for just cause. Contact the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to talk about options.

Care coordination services are available to every PathWays member.  Members who meet the functional eligibility requirements have access to service coordination and the additional services:

• Adult day services
• Adult family care
• Assisted living
• Attendant care
• Home modifications
• Health care coordination
• Home-delivered meals
• Nutritional supplements
• Personal emergency response systems
• Respite
• Specialized medical equipment
• Structured family care
• Transportation
• Vehicle modifications

All of the PathWays health plans are currently working to contract with providers so their directories may not be up to date, but the state is working to ensure members will still be able to see their current providers regardless of which health plan they choose.

Caregivers can call the member’s PathWays health plan.  The health plan can provide resources to support you and the PathWays member.

After the initial enrollment into a health plan in early 2024, your health plan selection period for Pathways is mid-October to mid-December annually. This is also open enrollment for Medicare.

You can also call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) during the open enrollment to change your health plan. The health plan selection period for Pathways is mid-October to mid-December annually.

The Member Support Services program is available to all PathWays members to help them, their caregivers, and families resolve questions or problems and serve as a source of assistance, advice, and advocacy.

PathWays is for individuals who are 60 years of age and older and are eligible for Medicaid based on age, blindness, or disability. Individuals can also be those in a nursing facility, and those who are receiving long-term services and supports in a home or community-based setting. Individuals in PathWays may also have Medicare at the same time.

If you are enrolled into the PathWays program, you will receive a letter from the Division of Family Resources or the Enrollment Broker.

You must renew your coverage every year.  You can do this by visiting your local Division of Family Resources office or through your portal account at https://fssabenefits.in.gov/bp/#/.  Your health plan (Anthem, Humana or UnitedHealthcare) can also assist you in renewing your coverage.

Every 12 months members are required to complete the eligibility redetermination process. This includes financial and medical eligibility. If something changes with your information, FSSA may send a request that requires a response to continue eligibility before the 12-month period ends. FSSA may ask again for you to verify your income and your assets.

You can first apply for Medicaid online, print an application, or have an application mailed to you via the FSSA Benefits Portal https://fssabenefits.in.gov/bp/#/, or contact an Indiana Navigator https://in.accessgov.com/idoi/Forms/Page/idoi/find-a-navigator/1.

Yes, there is a standard program income and asset limit.

If applying for HCBS or Nursing Facility waiver there are special income and asset limits.

https://www.in.gov/medicaid/members/apply-for-medicaid/eligibility-guide/#Aged__Blind__and_Disabled

Functional Eligibility means that you require assistance with at least three activities of daily living such as help with eating, dressing, toileting, etc. or that you are unable to care for yourself medically.

Enrollment into the PathWays program is automatic for those who meet the Medicaid eligibility requirements and are 60 years of age or older.  However, if you are a member of a recognized tribe or currently receiving hospice services, you will have the option to opt-in to the program.

Health plans offer the same basic benefits but can vary in their added benefits. Depending on your situation and health needs, one plan may suit you better than another. It’s important to review your options and select the plan that’s right for you.

You can choose a health plan by calling 87-PATHWAY-4 (1-877-284-9294).  You will be provided counseling on which health plan would best meet your needs.

Yes! Having the same health plan for Medicare and Medicaid will better coordinate your care and supports.

You can change your health plan by calling 87-PATHWAY-4 (877-284-9294). You can change your health plan for the following reasons:

• within 90 days of starting PathWays
• any time your Medicare and Medicaid plans are not the same
• once per calendar year for any reason at any time
• using the just cause process
• during the health plan selection period (mid-October to mid-December)

You will want to make sure that you choose a health plan that includes your doctor.  You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

If you are an enrolled PathWays member, you should call your health plan (Anthem, Humana or UnitedHealthcare) or go online to their website to research which providers are in that health plan's network. Members can also call 87-PATHWAY-4 (877-284-9294) and ask.

If you are just joining PathWays and want to make sure you choose a health plan that includes your doctor, call 87-PATHWAY-4 (877-284-9294) to discuss your options.

You will want to make sure that you choose a health plan that includes your doctor. You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

You can call the Indiana PathWays for Aging Helpline at 87-PATHWAY-4 (877-284-9294) to discuss your options.

You must call your health plan’s transportation broker (similar to a dispatching service) or call your health plan directly at least 48 hours in advance. The transportation broker arranges rides to and from the medical appointment. There are no mileage or frequency limits (such as annual limits), however prior authorization may be required for longer trips or more than 20 one-way trips per member per year.

PathWays provides the standard Medicaid benefits including coverage for medical expenses such as doctor visits, hospital care, therapies, medications, prescriptions, and medical equipment. The benefits also include preventive care, such as regular check-ups, and mental health and substance abuse treatment.

You will continue to receive the same Medicaid benefits in the PathWays program.

Each of the PathWays health plans offer additional services to their members. Call your health plan directly to see what additional benefits are available to you.

Home and community-based services are services for eligible individuals who choose to remain in their home as an alternative to residing in a long-term care institution, such as a nursing facility. These services assist a person to be as independent as possible and live in the least restrictive environment possible while maintaining safety in the community.

You will want to contact your health plan (Anthem, Humana or UnitedHealthcare) to discuss your options.  Your health plan will do health assessments and refer you to a service coordinator to determine your functional eligibility to receive the supports your need to stay at home.

You will want to contact your health plan (Anthem, Humana or UnitedHealthcare) to discuss your options.  Your health plan will conduct health assessments and refer you to determine your functional eligibility to receive the supports you need in a nursing home.

No, you will not have any copayments in PathWays. However, you may have copayments as part of your Medicare plan.

Yes, you will have transportation in PathWays to any covered non-emergency medical service, as well as pharmacy and durable medical supply pick-ups and transport related to hospital discharges.  If you are an enrolled PathWays member, you should call your health plan (Anthem, Humana or UnitedHealthcare) to schedule a ride. Your health plan and service coordinator can also work with your attendant care provider to schedule rides.

Care coordination services are available to every PathWays member.  Members who meet the functional eligibility requirements have access to service coordination and the additional services:

• Adult day services
• Adult family care
• Assisted living
• Attendant care
• Home modifications
• Health care coordination
• Home-delivered meals
• Nutritional supplements
• Personal emergency response systems
• Respite
• Specialized medical equipment
• Structured family care
• Transportation
• Vehicle modifications

Your PathWays Medicaid health plan will work with your Medicare health plan to coordinate your care.  This can include connecting your medical and community supports that you need. Your PathWays health plan can also help you get access to services not covered by Medicare.

• PathWays dual eligible enrollment options

Yes. A person can be eligible for both Medicaid and Medicare and receive benefits from both programs at the same time.

A Dual Eligible Special Needs Plan is a type of health insurance plan. It’s for people who have both Medicaid and Medicare. If that’s you, you’re “dual-eligible.”

You can get information on D-SNPs by contacting the State Health Insurance Assistance Program (SHIP) at (800) 452-4800 to speak to a counselor.  SHIP is a free counseling program for people with Medicare. You can get one-on-one assistance in person, on the phone, or virtual.

Individuals who qualify for both Medicare and Medicaid at the same time, are “Dual Eligible.”

A Dual Eligible Special Needs Plan (D-SNP) is a type of health insurance plan. It’s for individuals who have both Medicaid and Medicare at the same time. D-SNP is a type of Medicare Advantage plan.

Medicare is a national health insurance program run by the federal government. It's for individuals aged 65 years and older.

Some individuals with certain disabilities or conditions who are under the age of 65 may be eligible for Medicare.

There are different parts of Medicare which help cover specific services:

• Medicare Part A (Hospital Insurance) – Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
• Medicare Part B (Medical Insurance) – Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
• Medicare Part D (Prescription Drug Coverage) - Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Medicaid is a federal and state program that gives health coverage to qualifying individuals with limited resources and income.

Medicare Advantage (also known as “Part C”) is a type of Medicare health plan offered by a private company that contracts with Medicare. These plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t cover. There are different types of Medicare Advantage plans.

D-SNP is a type of Medicare Advantage plan. There are also other Medicare Advantage plans such as:

• Health Maintenance Organization (HMO) Plan
• Preferred Provider Organization (PPO) Plan
• Private Fee-for-Service (PFFS) Plan
• Medical Savings Account (MSA) Plan

Also known as Original Medicare, this is coverage managed by the federal government and not managed by a private insurance company.

Medicare and Medicaid are two different programs.  Both are managed by separate entities and have different eligibility requirements.

Medicare eligibility requirements:

• Individuals need to be a U.S. citizen or a legal resident age 65 or older. Individuals may also be able to get Medicare earlier if there is a certain disability or condition.

Medicaid eligibility requirements:

• Individuals are under age 65 and meet the requirements for low-income families, pregnant women and children, receiving Supplemental Security Income (SSI), disability or another special situation.
• Individuals are at least 65 years old, are blind or disabled, meet the income and asset limits.

A coordinated benefit is a benefit that both Medicare and Medicaid cover. Coordination of benefits ensures the correct insurance plan has the primary payment responsibility and the extent to which other plans will contribute when an individual is covered by more than one plan.

Individuals can get information on D-SNPs by contacting the State Health Insurance Assistance Program (SHIP) at (800) 452-4800 to speak to a counselor.  SHIP is a free counseling program for people with Medicare. Individuals can get one-on-one assistance in person, on the phone, or virtual.

D-SNPs are available in most states in the U.S., but not all states. Indiana D-SNP enrollment is based on verification that an individual is eligible for both Medicare and full Medicaid health coverage.

D-SNP health plans offer care coordination and provide supplemental benefits to their beneficiaries. They are designed to meet the specific needs of dually eligible individuals.

Individuals can enroll in a D-SNP during the annual enrollment period, during open enrollment and one time per quarter.

D-SNPs typically allow their members a 6-month grace period after losing Medicaid eligibility during which the individual may remain in the D-SNP.

Individuals can change D-SNP plans quarterly through a Special Election Period (SEP) and during the annual enrollment period (AEP) and during open enrollment.  They may also change plans if they have a change in status. For example, if they lose Medicaid eligibility or move out of the service area of the D-SNP, they can change their plan.

Yes! Having the same health plan for Medicare and Medicaid will better coordinate care and supports.

After the initial enrollment into a health plan in 2024, the health plan selection period for Pathways is mid-October to mid-December annually. This is also open enrollment for Medicare.

No, you can either join a regular Medicare Advantage plan or enroll in original Medicare.

Members can change health plans:

• Anytime during their first 90 days in PathWays
• Anytime their Medicare and Medicaid health plans are not the same
• Annually during the PathWays health plan selection period (mid-October-mid December)
• Once per calendar year for any reason
• Anytime using the just cause process

Exclusively aligned enrollment refers to a dually eligible individual who enrolls with the same Indiana PathWays for Aging Medicaid health plan as their Medicare D-SNP.  For example, if an individual is currently enrolled in Anthem’s D-SNP plan, the individual will be auto enrolled with Anthem for their Indiana PathWays for Aging Medicaid benefits. The result is increased coordination of Medicare and Medicaid benefits which provides enrollees an optimal member experience

If an individual is enrolled in PathWays and becomes eligible for Medicare, they will be default enrolled in the D-SNP plan that is the same as their Indiana PathWays for Aging Medicaid health plan. For example, if an individual is enrolled with Anthem to receive their Medicaid benefits through the Indiana PathWays for Aging program, they will be default enrolled in Anthem’s D-SNP when they become eligible for Medicare.

PathWays members will not be automatically enrolled into a D-SNP. However, if they are enrolled in a D-SNP, the member will be automatically assigned to the Pathways health plan that is sponsored by the same health plan as their D-SNP.

If an individual is enrolled with a PathWays for Aging Medicaid health plan and they become eligible for Medicare, the individual will be default enrolled in the D-SNP plan that is the same as their Indiana PathWays for Aging Medicaid health plan.

Yes, D-SNPs in Indiana will be statewide and able to enroll individuals throughout the state

D-SNPs are a health plan for individuals who are eligible for both Medicare and Medicaid.  It’s an all-in-one plan that combines your Medicare Part A, and Part B, Medicare Part D and your Medicaid.

No, if a member becomes ineligible for Medicaid they will be allowed to continue in their D-SNP plan for up to 6 months. During the 6 month period, the member may contact SHIP for assistance in choosing a new Medicare plan that works best for them.

As protected by federal statute, all dual eligible individuals will have freedom of choice to enroll in their preferred Medicare plan, which include Special Needs Plans (D-SNP, C-SNP, I-SNP); conventional Medicare Advantage plans (non-SNP); and Original Medicare (fee-for-service).

Members who become eligible for Medicare after enrolling in Pathways, will be default-enrolled into the D-SNP with the same company as their selected Pathways health plan; however, in such instances, a member will be notified about how to opt-out of default enrollment and enroll in a different Medicare service delivery system of their choice.

No matter what Medicare plan the member selects, the Pathways program requires coordination of benefits to the greatest extent possible between the Pathways Medicaid health plan and the member's Medicare health plan.

Alignment specifically refers to aligning membership for Pathways in a Medicare Advantage D-SNP but is only applicable when the member chooses to enroll in a D-SNP instead of traditional Medicare (also known as original Medicare) or a non-D-SNP Medicare Advantage Plan.

If a member is enrolled in a D-SNP then they will be automatically assigned to the aligned PathWays Medicaid health plan.

The PathWays Medicaid health plan will coordinate benefits and work with the Medicare health plan to coordinate care. This can include connecting medical and community supports. The PathWays health plan can also help get access to services not covered by Medicare.

Pathways enrollment is not impacted by the member's choice of Medicare.  Individuals who are 60 years or older and receive Medicaid benefits will be enrolled in PathWays.

D-SNP members who turn 60 years old are allowed to stay with that plan until the end of the year. At the end of the year , the D-SNP plan will crosswalk the member over to the appropriate plan.

If the member wants to move to the appropriate plan before the end of the year after they turn 60, they can work with that D-SNP to transition.

The PathWays Medicaid health plan will work with a member’s Medicare health plan to coordinate care.  This can include connecting medical and community supports a member’s needs. The PathWays health plan can also help a member get access to services not covered by Medicare.

Yes, the D-SNP and PathWays health plans will assign a care coordinator or a service coordinator to the member to assist in managing and coordinating the treatment plan.

If a member experiences issues with their home health provider, the member can reach out to their PathWays health plan and submit a grievance.

Most the member's medical care is coordinated through their Medicare Plan, which provides primary coverage for most medical services.

Most of the member's LTSS/HCBS needs will still be coordinated by their Pathways Service Coordinator.

The member's Pathways health plan will also designate one single point of coordination on the member’s ICT for members who are enrolled in an aligned Dual Special Needs Plan (D-SNP) to coordinate member care across Medicare and Medicaid.

The only out-of-pocket costs that a member may have, are federally established co-pay for drugs under Part D.

Some individuals may have a monthly patient liability if they reside in a nursing facility or a monthly waiver liability if they receive home and community-based services through the PathWays waiver. The Division of Family Resources will notify the individual if there is a liability requirement.

Medical costs included in Medicare are covered by the D-SNP plan.