State seeks to make it easier for Hoosiers to age at home rather than nursing homes

Indiana officials say they want to make it possible for more Hoosiers to age at home rather than at nursing homes, especially as the pandemic continues to sweep across America.

The Indiana Family and Social Services Administration said Thursday it plans to overhaul its rules to ensure that elderly residents have access to home- and community-based services, and let them know within 72 hours of inquiring if they are eligible for Medicaid home health support.

“This effort has been galvanized by COVID, with a demand by Hoosiers for a choice on where and how they should age,” said Dr. Jennifer Sullivan, FSSA’s secretary, or top official, in a press conference. “This is the right time and the right place for collaboration and meaningful change.”

Indiana has more than 500 nursing homes and standalone residential facilities that house about 65,000 people. But fewer than half of elderly Hoosiers—45%—now qualify for Medicaid funding to get care in their homes, even though about 75% of them would rather get long-term care at home as they age, according to recent surveys.

The program overhaul comes a week after Gov. Eric Holcomb announced in his State of the State address that too many Hoosiers are unable to stay at home and get care through state programs as they age.

“Now is the time to put this effort in place, including a managed care system similar to the ones 25 other states are using to integrate care across the entire spectrum to make it easier for families to navigate and drive outcomes in a transparent and accountable way,” Holcomb said Tuesday.

Indiana has about 1.9 million members in Medicaid, the federal program that pays for medical care, hospitalization, drugs, skilled nursing and other services for low-income and disabled people. But only 19% of the state’s spending on long-term care goes to home-based and community-based services, while the bulk of it goes to nursing homes.

Indiana officials say their goal is to get up to 60% of the state’s elderly who need long-term health care the ability to get it in their homes, rather than in nursing homes. Currently fewer than half of the elderly Hoosiers get home care.

But there are significant challenges. The state’s new efforts will require an expanded workforce to conduct home health visits and community health programs. And, several years ago, the legislature instituted a moratorium for additional spending through managed care entities, which are private partners that oversee and provide the care, including insurers, hospitals, doctors and home health nurses. That moratorium is set to expire at the end of this year.

The nature of congregant settings at nursing homes—or living together in large groups—has put the elderly at increased risk of contracting COVID-19, said Dr. Dan Rusyniak, FSSA’s chief medical officer. And many of them have other illnesses, from diabetes to heart disease, that increase the risk of hospitalization and death.

As part of the public health emergency, Indiana was given approval from the Centers for Medicare & Medicaid Services to run a pilot program to increase eligibility for home and community-based services. The program is designed to allow health providers to make faster determinations on whether someone is eligible to receive those services.

“So what used to take four to six weeks can now be done in 72 hours or less,” Rusyniak said.

State officials said its new comprehensive program is designed to correct deficiencies, especially lack of coordination among numerous long-term care programs.

Rusyniak said the reform effort includes four main parts: getting information about eligibility quickly to people who inquire; helping them navigate the system with the help of managed-care entities that will make sure they are getting proper care; linking provider payments to medical outcomes; and connecting numerous state databases to make sure the Indiana has up-to-date information on patients and providers.

He said the state has been able to rapidly approve hundreds of applications for services in recent months. The state also has instituted a “family caregiver program,” which gives eligible families financial support to take on caregiving roles for family members.