New process puts 18,000-plus seniors on waiting list for care

Families needing home-and-community-based services can cover costs with a Medicaid waiver. However, a recent change has delayed the process, placing more than 18,000 Hoosiers on a perilous waitlist. 

LifeStream helped families locally with the waiver assessments. But in July 2024, the Indiana Family and Social Services Administration (FSSA) introduced a new program, PathWays to Aging, that outsourced this role to insurance companies. 

Leland Legacy, an assisted living facility at 900 S. A St., Richmond, sits with vacant rooms. Executive Director Amanda Marquis has witnessed a three-to-four-week process extend to a year. 

Marquis called it an “absolute nightmare,” and mentioned seeing some clients die waiting for proper care. In one case, a nonverbal resident has waited since September for an assessment, which was finally scheduled this week. Without them advocating on his behalf, Marquis said he’d be without care and housing. 

At 2727 E. Main St., Richmond, Hand-in-Hand Adult Day Care is seeing similar issues. For 38 years, it’s offered daily care and transportation services. However, the waiver delay has become an obstacle for patrons.

“LifeStream worked. It was a good process,” said Mary Russell, Hand-in-Hand’s office manager. She says the insurance companies simply aren’t trained, recalling a video meeting where an insurance representative was only aware of their transportation service.

Hand-in-Hand’s Executive Director Johanna Smith recalls regular visits from case managers who became familiar with their operations and provided referrals. Within the two years of the new process, Smith counted two in-person visits and one referral.

According to reporting by Indiana Capital Chronicle, the new PathWays Waiver program was intended to streamline care and control Medicare spending. Indiana Medicaid Data/Long Term Care Cost Reports found assisted living is around 37% the cost of a nursing home, with home health and day care services even lower. The waivers saved $1.2 billion federally, with the state savings being $424 million in December 2024, via the FSSA.

Within the PathWay Program’s first year, state costs tallied an extra $300-plus million. And two of the three insurance companies were placed on probation for back reimbursement payments.

Marquis is thankful they were financially prepared despite $200,000 in owed payments. But she worries about other facilities and future impact.

“It’s not good for clients and not cost-efficient for the state,” Marquis said.

ICC reported that February’s House Enrolled Act 1277 removes nursing home residents from PathWays to a model not run by insurance companies. But it won’t go into effect until July 2027.

Smith encourages donations for nonprofits like Hand-in-Hand. In the past, they secured grant funding to offer scholarships. This year, that grant was not approved, and the absence of funding leaves potential clients in limbo. Smith said a two-year participant who came at the start of the new program is still on the waitlist for the waiver.

“And it’s not just our services that they’re waiting for. It’s any service that they need. They’re on hold, not getting the care that they need,”said Smith.

For more information on Hand-in-Hand’s services visit adcofrichmond.com.