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In 2024, the legal landscape surrounding elder law is undergoing significant transformation, with legislative changes reshaping the framework within which lawyers and their clients operate in this field.
These alterations, spanning various aspects of elder law, reflect a concerted effort to adapt to the evolving needs of an aging population and address emerging challenges. From changes to Medicaid benefits to reforms around family caregiving, the legal community finds itself navigating a web of new regulations and statutes, and understanding these legislative shifts is essential for those working with older adults.
Lasting effects of COVID-19
Following the conclusion of the COVID-19 federal public health emergency, Indiana Medicaid Members faced a transition period back to standard operations, commencing April 2023.
During the pandemic, Medicaid members were automatically re-enrolled, and were not required to complete redetermination packets and submission of income and asset documentation to maintain benefits. With this shift to pre-pandemic procedures, some members are experiencing interruptions in coverage, including losing benefits, delays in redetermination approvals, and the need for rectifying premature or incorrect suspensions.
To ensure continued coverage, it is imperative for members to respond promptly to mailer notifications from the Family and Social Services Administration (FSSA) and update information through the FSSA portal or by phone.
Moreover, it is essential to provide updates on various aspects such as income, assets, address changes, gifts received or given, and vehicle ownership.
PathWays for Aging and Managed Long-Term Services and Supports
The Indiana PathWays for Aging Program, which launched on July 1, 2024, introduces a Managed Long-Term Services and Supports (MLTSS) delivery system, engaging managed care entities (MCEs) to oversee medical care and long-term services and supports for Medicaid beneficiaries over the age of 60.
With the overarching goal of enhancing the quality and accessibility of care, PathWays aims to streamline benefits coordination, facilitate access to long-term services and supports, and provide guidance on navigating the complexities of Medicaid and Medicare.
By empowering members to choose their preferred care settings and ensuring accountability for service quality, Pathways endeavors to improve overall care outcomes.
What is a Managed Care Entity?
A Managed Care Entity is an organization contracted by the government or insurers to manage healthcare services for specific populations, often through a managed care model. These entities work to coordinate and oversee medical care, ensuring that patients receive the necessary services in a cost-effective and efficient manner.
In the context of the Indiana PathWays for Aging Program, several MCEs have been designated to administer MLTSS for enrolled Medicaid beneficiaries. Notable among these MCEs are Anthem Blue Cross and Blue Shield, Humana Healthy Horizons in Indiana, and United Healthcare Community Plan.
Each MCE offers its own array of benefits and services tailored to meet the needs of Medicaid beneficiaries.
Individuals considering enrollment in Pathways can compare the benefits offered by these MCEs through the provided link to make informed decisions about their healthcare coverage.
Who will qualify for PathWays?
The PathWays program extends eligibility to a diverse range of individuals with specific healthcare needs and circumstances. Qualified participants include:
• Hoosiers 60 and above who are already enrolled in Medicaid or the Hoosier Care Connect program (HCC).
• Those approved for the Aged and Disabled Waiver.
• Residents of long-term care facilities.
• Individuals enrolled in Medicare Part A & B, whether residing at home or in an assisted-living facility.
• Those enrolled in the Behavioral and Primary Health Coordination program.
Notably, eligible members already enrolled in one of the three MCE’s Medicare Advantage plans will be seamlessly enrolled into the aligned Medicaid Plan, ensuring continuity of care and coverage.
What is the Timeline for PathWays?
As of July 1, 2024, PathWays coverage is effective, marking the transition from the previous Fee-for-Service (FFS) or Hoosier Care Connect (HCC) arrangements to the new managed care model. (Government, PathWays, 2024)
Helpful Tips on PathWays
For those enrolling in the PathWays program, navigating the complexities of managed care can be simplified with a few helpful tips.
Firstly, members should be aware of their rights to switch PathWays MCE plans under certain circumstances, such as within the first 90 days of initial enrollment, upon disparities between Medicare and Medicaid plans, once per calendar year, or during the annual health plan selection period from mid-October to mid-December.
Additionally, should any issues arise regarding an MCE or services received, members are encouraged to voice their concerns to their local Member Support Services Vendor.
Furthermore, it is essential to ensure that the chosen MCE is licensed to cover the service providers currently utilized or anticipated for future care needs, guaranteeing seamless access to necessary healthcare resources. By adhering to these tips, individuals can navigate the PathWays enrollment process with greater ease and confidence, ensuring optimal coverage and care coordination.
Paid Family Caregivers-Attendant Care and Structured Family Caregiving
As of February 2024, significant legislative changes have been set to transform the landscape of caregiving in Indiana, particularly for paid family caregivers providing Attendant Care and Structured Family Caregiving.
These amendments, aimed at enhancing support for individuals requiring assistance with daily activities, redefine the roles and eligibility criteria for those providing such care.
Under the revised regulations, individuals holding specific relationships with the adult in need may now provide approved hours of Attendant Care.
These eligible relationships encompass a wide range, including biological or adoptive parents, stepparents, non-parent or stepparent Power of Attorney (POA) holders, authorized Medicaid representatives, authorized representatives for Social Security, health care representatives and other relatives.
This expansion of caregiver eligibility seeks to ensure that individuals with familial ties can contribute to the care and well-being of their loved ones.
Moreover, the legislation introduces limitations and provisions regarding the provision of care. Legal guardians, including parents who serve as designated guardians, are now permitted to offer up to 40 hours of Attendant Care per week per guardian.
However, the legislation specifies that as of July 2024, spouses will no longer be eligible to provide Attendant Care, marking a notable shift in caregiver dynamics.
In addition to Attendant Care, the legislation also addresses Structured Family Caregiving under the PathWays and Health & Wellness Waiver programs. This provision allows specific individuals, including spouses of waiver recipients, guardians of adult children, biological or adoptive parents, stepparents, POA holders, authorized Medicaid representatives, authorized representatives for Social Security, health care representatives and other relatives, to provide structured family care. However, it is essential to note that the definition of a legal guardian will adhere to Indiana Code 29-3-1-6.
The legislation delineates that POA holders will be permitted to engage in structured family caregiving only if they reside with the care recipient. It also emphasizes that no Legal Responsible Individual (LRI) will be authorized to provide ongoing Attendant Care. (Government, Paid Family Caregivers – Attendant Care and Structured Family Care on the Aged & Disabled Waiver Beginning July 1, 2024, 2024)
Overall, these legislative changes represent a significant step forward in recognizing and supporting the vital role of family caregivers in providing essential care and support to loved ones in need.•
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Lisa Dillman is the Managing Partner at Applegate & Dillman Elder Law. Opinions expressed are those of the author.
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