Paul Peaper: Medicaid should work for aging Hoosiers, not big insurance

Nearly 100 people a day in Indiana celebrate their 65th birthday. The number of Hoosiers who will be 65 years old and older will increase to 1.4 million by 2030. But if structural improvements are not made to the Medicaid program that serves as the health care support for many in this aging population, there will unfortunately be fewer long-term-care providers available to treat them than there are today.

A handful of core Medicaid programs ensure that children, pregnant women, the elderly and the disabled all receive care. For providers and patients in the long-term-care continuum, Indiana Medicaid launched the PathWays for Aging program in 2024 to coordinate care for those at least 60 years old. Historically, these services had been administered and directly overseen by the Indiana Family and Social Services Administration, but with the launch of Pathways, FSSA ceded management of this population to three Fortune 50 insurance companies: United Health Care, Elevance Health and Humana.

Now eight months into the program, despite being paved with good intentions, the PathWays program has become littered with more potholes and road closures than downtown Indianapolis in the springtime.

More than 20 service providers are covered in PathWays, including nursing homes, assisted-living communities, adult day care, home health services, home-delivered meals, home modifications and more. Despite the variety of service types, one constant for providers has been a lack of timely payments from the contracted insurance companies.

Dating back to claims filed in July, skilled nursing providers alone are owed more than $100 million. Providers waiting nine months and counting for payment puts a significant strain on operations, payroll and the ability to care for the needs of their residents.

Access to care for the PathWays population has also been constrained and will likely be further constrained in the future. A core tenant of the program was to support eligible Hoosiers in getting the appropriate level of care for their medical needs and allowing them to choose where they will receive that care. Yet Hoosiers face a road closure for the first time in their ability to access assisted living and other home and community-based services due to the implementation of a waitlist. In 2027, insurance companies will also be able to restrict provider access and participation in the PathWays program, which will limit consumer choice in where Hoosiers receive long-term care and home and community-based services.

Opening the closed road to assisted living and other home and community-based services and allowing patient choice in health care decisions are vital to the future health of impacted Hoosiers and the long-term viability of the PathWays program. The entire continuum of care is needed to responsibly manage Medicaid spending and appropriately care for a record number of aging Hoosiers over the coming years.

Leading up to and since the launch of PathWays, the General Assembly has been engaged with constituents, residents and providers on these issues. We appreciate the legislators who have visited with residents in long-term-care communities to learn about these challenges firsthand and the willingness of Gov. Mike Braun to collaborate with all stakeholders to find solutions that will repave the “PathWays” for aging and disabled Hoosiers.

The solutions are clear. Hoosiers need access to affordable and cost-effective services, providers need timely payment for services rendered, consumers should have a choice in their health care, and Fortune 50 insurance companies should be held accountable for their significant shortcomings.

Every day, more Hoosiers need long-term services and supports on Medicaid. It is imperative that we address the systemic problems of PathWays before it is too late.•

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Peaper is president of the Indiana Health Care Association and Indiana Center for Assisted Living.