News for Indiana Medicare and Medicaid Beneficiaries

A new program for eligible Hoosiers called Indiana Pathways for Aging will begin July 1, 2024. Medicare and Full Medicaid recipients will begin to receive their Medicaid benefits from this new program. This program was designed to better align the care you receive from your Medicare Advantage Plan and Medicaid.

Who is eligible?

For enrollment into Indiana PathWays for Aging, a member must:

• Be 60 years of age or older

• Be eligible for Medicaid based on age, blindness, or disability

• Have limited income or resources

In addition to the above, individuals are also eligible if they:

• Are receiving full Medicare benefits (dually eligible)

• Reside in a nursing facility

• Receive hospice services

• Are receiving long-term services and supports (LTSS) in a home or community-based setting-including those on the Aged and Disabled Waiver

Who is not eligible?

All individuals who are 60 years of age or older in the target eligibility categories will be included unless they meet one of the following exclusions:

• Individuals who are only partial benefit dually eligible (Qualified Medicare beneficiary (QMB)-only, specified low-income Medicare beneficiary (SLMB)-only, Qualifying Individual (QI), or Qualified disabled working individual (QDWI)

• Individuals who are Department of Disability and Rehabilitative Services (DDRS) waiver recipients 

• Program of All-Inclusive Care for the Elderly (PACE) members

• Resident care assisted program (RCAP) members

• End stage renal disease (ESRD) 1115 members

• Breast and cervical cancer (MA-12) eligible members

• Individuals who are Traumatic brain injury (TBI) waiver recipients

• TBI out-of-state placements

• Intellectual or developmental disability (IDD) residents of intermediate care facilities (ICF) (in other words, group homes)

• Emergency services only (ESO) members

• Family planning only members

• Members with modified adjusted gross income (MAGI) eligibility in Healthy Indiana Plan (HIP) or Hoosier Healthwise

• Individuals who are registered members of a federally recognized tribe that are eligible for HIP but have opted out into non-HIP, Fee for Service (FFS) coverage; in other words, Medicaid for Native Americans (MANA)

• Anyone 59 years of age or younger (including those on the Aged and Disabled Waiver)

 What do I need to do?

You will be automatically assigned the same provider for your Medicaid as your Medicare Advantage Dual Special Needs Plan (DSNP). For example, if you are enrolled in a Humana DSNP plan you will have Humana-DSNP as your Medicaid Health Plan under Indiana PathWays for Aging. If you are satisfied with same provider you don’t have to do anything.

What if I want to change my Medicaid health plan provider?

You can change your assigned Medicaid health plan by calling 87-PATHWAY-4 (1-877-284-9294). You will have the choice to choose between the 3 approved providers which are Anthem, Humana or UnitedHealthcare (UHC).

Can I use my current Medicaid card?

You can continue to use your current Medicaid card. The changes take effect July 1, 2024.

I have questions, who can I contact?

Perfiniti Agents would be happy to answer your questions. Please call us at 888.885.8361 or e-mail us at Contact@PerfinitiInsurance.com

You can also call Indiana PathWays for Aging at 87-PATHWAY-4 (1-877-284-9294)

Will I get more information on this?

Yes, the Indiana Family and Social Services Administration (FSSA) will be sending notices and more information about 30 days before this becomes effective July 1, 2024. Look for a letter in your mailbox and please review this important information.