The Indiana Pathways for Aging waiver is an option for older adults seeking long-term care without having to enter a nursing facility. Ahead, we explore the range of services available through the waiver, eligibility criteria, the application process, and how this program coordinates care across Medicaid and Medicare.
The Indiana Pathways for Aging (PathWays) waiver is a Medicaid program that provides long-term services and supports (LTSS) to individuals aged 60 and older. It allows these people to access home and community-based services (HCBS) as an alternative to nursing home care.
Through the PathWays waiver, Indiana aims to achieve several key goals:
The program is managed through selected Managed Care Entities (MCEs) that work alongside Medicaid and Medicare to ensure participants get the physical and behavioral health services they need.
The Aged and Disabled (A&D) Waiver in Indiana split in July of 2024 into two separate waivers: the Health and Wellness Waiver and the PathWays to Aging Waiver. Pathways for Aging is a mandatory program for persons 60+ years old. Those who were enrolled in IN Medicaid, including Hoosier Care Connect (HCC), the Aged & Disabled Waiver, and Nursing Home Medicaid, were automatically transitioned to Pathways when the program became live on July, 1 2024.
The Indiana Pathways for Aging waiver offers services and supports to help people stay in their homes or transition back to community settings from nursing home care.
Pathways is a 1915(b) Managed Care Delivery System Waiver that operates along with a 1915(c) Home and Community Based Services (HCBS) Waiver. A waitlist forms for HCBS when all the slots have been filled. Note: that there is never a waiting list for regular Medicaid (medical care) provided via Pathways for Aging nor for nursing facility care.
Structured Family Caregiving (SFC) is offered through the Indiana Pathways for Aging waiver, allowing family members (excluding spouses) to be paid caregivers through "consumer-direction." SFC provides financial compensation, caregiver training, and ongoing support to ensure that caregivers can manage medical needs and provide high-quality, personalized care. Caregivers assist with activities of daily living like bathing, dressing, and mobility while offering companionship and emotional support. To help prevent burnout, the program also includes respite care, giving caregivers time to rest while ensuring continuity of care for the participant.
To qualify for the Indiana Pathways for Aging waiver, individuals must meet specific financial and medical criteria. These requirements ensure that participants are eligible for Medicaid and need the level of care provided through the waiver.
The individual's financial situation primarily determines eligibility for the Pathways for Aging waiver.
Financial criteria include:
In addition to meeting financial criteria, participants must have a medical need for long-term care services.
Medical eligibility criteria include:
Below is a step-by-step guide to the application process for the Indiana Pathways for Aging waiver
Contact your local Medicaid office or the Indiana Family and Social Services Administration (FSSA). They will help determine if you meet the basic financial and medical criteria for the waiver.
Based on your financial situation and health condition, you'll undergo a preliminary assessment to determine if you are a candidate for the Pathways for Aging waiver.
Applicants must provide proof of income, assets, and other financial details. Required documents may include recent bank statements, pay stubs, tax returns, and documentation of any other income sources.
You'll also want to gather medical records, reports from healthcare providers, and any other information demonstrating your need for long-term care.
Work with a case manager or Medicaid specialist to complete the Indiana Medicaid waiver application. As part of this process, you'll work with a case manager or care coordinator to develop a person-centered care plan outlining the services and supports you'll need under the waiver.
After submitting your application, a Medicaid-appointed evaluator will conduct an in-home or facility-based assessment to determine your functional limitations and medical needs.
Based on the assessment, the evaluator will decide if you meet the criteria for nursing facility-level care, which is required for the waiver.
Once the assessment is completed, the Medicaid office will notify you if you have been approved for the waiver. If approved, you will be enrolled in the program and assigned a Managed Care Entity (MCE) to help coordinate your care. Once enrolled, services outlined in your care plan will begin.
Care coordination is a central component of the Indiana Pathways for Aging waiver, coordinating care across various healthcare providers, systems, and funding sources to help improve outcomes and enhance the quality of life for participants.
Medicaid is the primary source of coverage for long-term services and supports offered under this waiver. These include personal care assistance, home health services, adult day services, and structured family caregiving.
Participants are enrolled in Medicaid through a single Medicaid health plan provided by a Managed Care Entity (MCE), which is effectively a private healthcare company responsible for managing and coordinating the participant's healthcare services through their network of care providers.
There are three MCEs from which to choose a Pathways for Aging health plan: Anthem, Humana, and United Healthcare.
In addition to medical care, Medicaid also covers non-medical services essential for the participant's daily living, such as homemaker services, transportation, and respite care for caregivers.
The MCE can work with the waiver participant's Medicare healthplan to coordinate care.
Medicare covers medical services that participants may require, especially those dually eligible for both Medicare and Medicaid. Medicare primarily covers hospital care, doctor visits, prescription drugs, and short-term skilled nursing or rehabilitation services.
Since many participants in the Pathways for Aging waiver are dual-eligible (meaning they qualify for both Medicaid and Medicare), care coordination must take into account the services provided by both programs.
Some waiver participants may also be enrolled in Medicare Advantage Plans, which can affect how their services are coordinated. Care managers work closely with Medicare plans to ensure that participants receive the benefits they are entitled to and that there is no duplication of services.
We empower families to provide the best possible care for their loved ones at home. The Indiana Pathways for Aging waiver offers essential support to help older adults age with dignity while allowing family to be part of the solution. You can use our free program matching tool to see if you qualify.
