Core Eligibility Requirements
To qualify for the Indiana PathWays for Aging program, individuals must meet several foundational criteria. The Indiana Family and Social Services Administration (FSSA) specifies that enrollment is primarily for residents 60 years of age or older. A key component is being eligible for full Medicaid benefits within the aged, blind, or disabled category. The program was launched in July 2024 to transition eligible seniors to a managed care system, coordinating their health and long-term services.
Age and Medicaid Status
The most fundamental requirements are straightforward:
- Age: Must be 60 years or older. A person who is 59 will be notified of their eligibility 90 days before their 60th birthday.
- Medicaid Eligibility: Must qualify for full Medicaid benefits based on age, blindness, or disability. This also includes individuals receiving Medicaid through specific pathways like M.E.D. Works. Enrollment is automatic for those who meet these requirements, with some specific exceptions.
Financial and Functional Criteria
Beyond age and basic Medicaid qualification, eligibility depends on financial and functional needs. The financial criteria for PathWays are consistent with standard Indiana Medicaid, focusing on limited income and resources. Functional eligibility is determined by a comprehensive health assessment, which evaluates a person's ability to perform activities of daily living (ADLs).
Who is Eligible for the Home and Community-Based Services (HCBS) Waiver?
For those needing long-term support at home, the PathWays program replaced the Aged and Disabled (A&D) Waiver for individuals 60 and older on July 1, 2024. To qualify for these services, a person must meet the nursing facility level of care (NFLOC). This means an individual is assessed as needing a level of care similar to that provided in a nursing facility but can safely receive those services in their home or a community setting.
For more details on specific qualifying situations, exclusions, how to apply, and a comparison of eligibility scenarios, please refer to the {Link: Indiana FSSA website https://www.in.gov/pathways/frequently-asked-questions/}.
How to Apply or Get More Information
For those who are not automatically enrolled, the process typically begins with contacting the local Area Agency on Aging (AAA).
- Contact your local Area Agency on Aging (AAA): The AAA conducts a preliminary Level of Care screening to assess functional eligibility. You can find your local agency on the FSSA website at https://www.in.gov/fssa/da/area-agencies-on-aging.
- Apply for Indiana Medicaid: If not already enrolled, the AAA can assist with the Medicaid application process.
- Choose a Managed Care Entity (MCE): Eligible individuals select one of three managed care health plans contracted with the state (Anthem, Humana, or UnitedHealthcare). If no choice is made, the state assigns one.
- Complete the Comprehensive Assessment: Once enrolled with an MCE, a comprehensive health assessment is completed to determine needed services.
Conclusion
Understanding who is eligible for the PathWays for aging program in Indiana is crucial for seniors and their families seeking coordinated healthcare and long-term services. The program serves full Medicaid recipients who are 60 or older and coordinates their care through a chosen managed care entity. By knowing the specific age, Medicaid, and potential functional criteria, Hoosiers can navigate the system effectively to access the services that allow them to age independently in their homes and communities. Individuals requiring home-based services will also need to meet nursing facility level of care requirements, which are assessed with the help of a local Area Agency on Aging. For those excluded or with questions, contacting the FSSA or an AAA is the best way to determine the right path forward.
