As Indiana transitions its senior and long-term care Medicaid beneficiaries into plans run by several managed care organizations, a snag in the rollout is giving skilled nursing providers another reason to be wary.
One of four companies initially selected to administer a long-term Medicaid contract in Indiana was cut from the program in late September because it could not get its Dual-eligible Special Needs Plan ready in time for launch in early 2024.
“Molina reports that the state deemed Molina not to have met the readiness review requirements,” noted a filing posted last week by Molina Healthcare, which added the delay was due to an administrative requirement from the Centers for Medicare & Medicaid Services.
In March, the state’s Family and Social Services Administration announced it had recommended Molina, UnitedHealthcare, Anthem Blue Cross, and Humana Healthy Horizons for contracts to administer the Pathways for Aging program that is scheduled to launch July 2024. The readiness reviews are still underway, and the state has yet to award the contracts, which are worth an estimated $15 billion.
In 2020, KFF reported more than two-thirds of all Medicaid beneficiaries nationally received most or all of their care from risk-based MCOs, with 49 states awarding MCO contracts for at least part of their programs. In Indiana, nursing homes and senior advocates previously had pushed back against the conversion of care for long-term care patients and those 65 and over.
‘Fraught with pitfalls’
Much like with Medicare Advantage plans, providers have expressed concerns about denied coverage and delayed approvals and payments under MCOs. Earlier this month, Sen. Bob Casey Jr. (D-PA) wrote to CMS regarding its oversight of major MCO insurers and asking how the agency is ensuring “MCOs are not putting their bottom line ahead of the interests of patients seeking care.”
Indiana’s new Pathways for Aging program is intended to help seniors remain in their homes, and the state expects it to cover approximately 100,000 beneficiaries. With the program’s launch less than a year away, long-term care advocates in the state are worried about how the complicated program will work.
“This development is both a positive indication of how seriously Indiana’s Medicaid Agency is taking this overall transition, but also a window into just how complex and fraught with pitfalls this expansive change will be for providers and residents,” Eric J. Essley, president and CEO of LeadingAge Indiana told McKnight’s Long-Term Care News on Friday.
Essley said he hopes there will be “meaningful and ongoing oversight” for enrollment challenges, inadequate staffing fears, prior authorization concerns, and worries about sufficient rates of reimbursement as the state proceeds with awarding contracts.
The Indiana Health Care Association, which has lobbied against managed care, said in a statement to the Indiana Capital Chronicle that it worries about “additional layers between our health care providers and the care they provide to their residents.”
In a statement to McKnight’s on Friday, the group said it appreciates the state’s commitment to a thorough readiness review.
“It is critically important that with this significant transition to managed care that MCEs are fully prepared and equipped to support timely and appropriate care delivery for our residents,” association President Paul Peaper said.
