INDIANAPOLIS — A state plan to better care for aging Hoosiers is getting push back from families and nursing homes who are concerned it will put too much power in the hands of insurance companies.
The Indiana Family and Social Services Administration (FSSA) managed care initiative will allow more Hoosiers to age in the setting of their choice and create a single point of contact for care coordination, according to FSSA.
The plan is expected to launch in 2024.
The initiative is not sitting well with some families and long-term care providers who say it will result in patients being denied services and delays in insurance claim payments.
The Indiana Health Care Association, which represents nursing homes, says FSSA’s plan will reallocate approximately $330 million from health care providers to insurance companies, giving insurers control of the health care decisions of more than 50,000 Hoosiers who rely on long-term services and supports.
Kristine Putt, of Fort Wayne, says her mother Gayle uses both Medicare and Medicaid to pay for her care in an Indiana nursing home, where she has lived for four years.
“We don't know the number of days we all have left on this earth and it's not about prolonging life it's about quality of life as long as our loved ones are still alive,” Putt said. “That's our responsibility."
Kristine is concerned the state’s plan would put insurance companies in the driver’s seat when it comes to her mother’s care.
"Having a third party that has no idea about our elderly's needs, making the decisions, would cause a lot of stress,” Kristine said. “I don’t understand why the state would want to do something like this. I don’t understand the concept of taking away healthcare decisions from loved ones, from care takers.”
A recent national survey that shows nearly 90% of people want to remain in their homes with caregiver assistance.
However, in Indiana only about half of those who qualify for Medicaid long-term services and supports receive these services in their homes, according to FSSA.
“This is because the current system incentivizes institutional care, such as nursing facilities,” said Jim Gavin, FSSA’s director of communications and media, in an email to WRTV. “This care is costly and will be unsustainable as Indiana’s population ages over the next two decades. Contributing to the overreliance on institutional care is that our current system is complicated and requires individuals and their families to navigate fragmented services provided by Medicare, Medicaid, and through Medicaid’s Aged and Disabled waiver.”
This approach has been adopted by 24 other states and Gavin says it will build upon Indiana’s already successful managed care programs, like the Healthy Indiana Plan and Hoosier Healthwise, that currently serve more than 80% of Hoosiers on Medicaid.
FSSA says its proposal simplifies the current system through a number of improvements:
- Single point of contact for care coordination
- Alignment of Medicare and Medicaid for Hoosiers covered by both programs
- Protections for members and providers
- Single point of accountability for achieving outcomes
- Predictable costs and incentives
FSSA declined an on-camera interview about the initiative.
Ron Nunziato, CEO of Extended Care Clinical Consulting, a nursing home and assisted living operator with three facilities in Indiana, is concerned about the state’s plan.
“Is this really good public policy?” Nunziato asked. “We're in a pandemic. These facilities are having a hard time managing day to day operations let alone worrying about what it's going to cost to the facility's operation and our residents.”
Currently, a nursing home’s medical team develops the patient’s plan for care and treatment, which can often include speech therapy, occupational therapy, physical therapy and other services.
Under the state’s proposed managed care model, insurance companies would be the ultimate decision makers for which services a patient receives and for how long, Nunziato said.
“We don’t want our most vulnerable Hoosiers who rely on us for Medicaid-covered services to be beholden to insurance companies that don’t know their specific health care needs,” Nunziato said. “These are going to be Medicaid recipients, the most vulnerable and usually the sickest in our population and we are going to be handing their care over to an insurance company. It's very concerning.”
Nursing homes say they may need to hire extra staff to handle the additional insurance issues.
“These facilities can’t afford to bring on more staff for the billing process,” Nunziato said.
The Indiana Health Care Association, which represents nursing homes, created a website to educate people about the state’s plan.
They’re also turning to state lawmakers for help.
“At this point we are now working with the legislature on what those alternatives could be to insurance only managed care,” said Zach Cattell, president of IHCA. “We have a significant concern about placing the decisions of that care in the hands of large insurance companies.”
Rep. Mike Karickhoff, R-Kokomo, filed House Bill 1194 that would halt the state’s plan from moving forward and would require FSSA to use a model he says would keep the decisions in the hands of patients and their health care providers.
“It's about quality of care,” Karickhoff said. “It's about patients having the ability to stick with their same doctor and elderly people being able to have care close to their home.”
FSSA points out their plan is the result of more than 200 meetings with stakeholders across the state and has been in the works for two years.
“This program will help level the playing field for all Hoosiers, regardless of race, ethnicity or geography,” Gavin said. “A managed system establishes accountability and ties payment to health outcomes and service delivery across the various settings in which Hoosiers may receive services — both within institutions and at home.”
This program will be funded the same way long-term services and supports are today, through state and federal Medicaid funding.
“Over time administrative costs will be fully offset by the savings incurred by having more Hoosiers cared for in a home and community setting,” Gavin said.
AARP Indiana, which represents older Hoosiers in our state, released the following statement to WRTV regarding the state’s plan.
AARP Indiana Statement:
Everyone helping to provide long-term care in our state, from the administration to facilities, agrees that changes need to be made. AARP Indiana has been involved in these discussions to ensure that Indiana’s long-term services and supports program is centered on the individual in its design, service planning, and service delivery.
We also want any future program to support caregivers, holistically address the full array of participants’ needs including those related to social determinants of health, and increase access to care at home. Indiana’s long-term care system has overwhelmingly favored facility-based care and Hoosiers should have more home and community-based care options and more individual choice.
Ultimately, what Hoosiers deserve is access to high-quality, affordable care and we’re looking forward to continue working with the administration, the Indiana General Assembly, and community partners to build a system that works for older Hoosiers and their families.