FSSA says it may not have Medicaid waiver slots for everyone on waitlists, shares more on dashboard

Thousands of Hoosiers are stuck on a waitlist for home- and community-based services through Medicaid — often with no information about when they might get to the front of the line. The Family and Social Services Administration says it’s added new information to its dashboard that could help people understand where they are on the list.

To get on the Health and Wellness and Pathways Waiver waitlist requires an evaluation called a “level of care” determination, or screening. The date someone completes this evaluation determines where they are on the waitlist. Now, each month, FSSA will publish the latest determination date it will process that month on its waitlist dashboard.

In November, the last people processed for the Pathways Waiver were evaluated on April 1. The last people processed in November for the Health and Wellness waiver had an original “level of care” determination date of Feb. 13.

Indiana Medicaid Director Cora Steinmetz said people can use that information to see if FSSA is close to their own determination date.

“If an individual is not sure of their last level of care date, that information is something that they can obtain from their Area Agency on Aging, who does that level of care determination for them,” Steinmetz said.

Steinmetz said they cannot give people an estimated wait time because it depends on how many people are part of a priority category each month. Those who get “priority status” are individuals who are discharged from the hospital, transition from a nursing facility or transition from the CHOICE program.

READ MORE: FSSA launches Medicaid waiver waitlist dashboard, lawmakers want more information from the agency
 

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More than 13,000 people are on a waitlist for those services. In July, FSSA said it would process about 900 people per month between the two waivers. In October, the agency said it would increase that number to 1,700 — including 1,200 off the Pathways Waiver waitlist and the rest from the Health and Wellness waitlist.

For November, FSSA invited 1,500 people onto the Pathways Waiver and 500 people onto the Health and Wellness Waiver.

However, Steinmetz said there may not be enough slots open to accommodate everyone on the waitlist.

She said the number of slots can change by the hour as the agency processes more people.

At a Medicaid Advisory Committee meeting Wednesday, Steinmetz estimated there were about 5,000 open slots left for the Pathways Waiver — with almost 9,000 people on the waitlist.

“We do anticipate within this waiver year that there will be a point where, depending again on the uptake of those slots, we could run out of actual slots to even invite individuals until we get to July 1st of next year and it’s the new waiver year,” Steinmetz said.

Steinmetz did not say how many slots were still open on the Health and Wellness Waiver. However, there are about 5,000 on the waitlist and there were less than 3,000 open slots available in July.

If the program fills up completely, FSSA says it would not be able to invite people off the waitlist until July 2025.

The total number of slots available for both programs combined is 55,000 as of July 2024. Once a slot is used, it is considered used for the entire fiscal year — meaning those who don’t receive a spot this year will likely have to wait until July 2025 or later.

During the Medicaid Advisory Committee meeting, lawmakers reiterated their concerns about the lack of information FSSA has provided.

In August, Rep. Ed Clere (R-New Albany) requested FSSA to provide the number of people who were invited onto the waiver who did not end up receiving services. He also wanted the agency to include the reasons why those people did not receive services.

At the Wednesday meeting, Clere requested that information again.

“I'd like to know how many people were on the waiting list who didn't receive a waiver when they were invited — they no longer needed the waiver, were no longer eligible for a waiver,” Clere said. “Then break that down into categories. How many of those people had gone into skilled nursing? How many of those people had died? How many of those people had moved out of state?”

Clere asked if FSSA would be able to provide lawmakers that information before the end of the year and the 2025 legislative session.

“We're a little over a month away from the budget session,” Clere said. “I think that's critical information for the legislature and other stakeholders.”

Steinmetz said gathering that information could be complicated and said she wasn’t able to provide a possible timeline.

Sen. Fady Qaddoura (D-Indianapolis) questioned Steinmetz on FSSA’s projection model ahead of the budget session.

“One of the problems that contributed to the billion-dollar issue was the projections of demographics of people who might need the services versus the actual number that was approved,” Qaddoura said.

FSSA said that nearly half of last year’s $1 billion forecasting error was a result of the growth of the Aged and Disabled Waiver, which originally housed the services provided by the Health and Wellness and Pathways Waivers.

Steinmetz said the state has been improving the model it uses to create its forecasts as it looks into the forecasting error.

“It's given us a chance to really look at the modeling as well as looking at the aging population and what we know about the home and community based services space as well,” Steinmetz said. “That's allowed us to have better data to really inform what we think the demand might be in this space and then be prepared to during the budget session if there are requests for that.”

Steinmetz said FSSA has confidence in future fiscal estimates.

Clere also asked for an update on FSSA’s proposal to use federal funding still available from the COVID-19 public health emergency for assisted living grants.

Many people in assisted living waiting to get on the Pathways Waiver are now in a rough financial situation. In August, FSSA proposed using ARPA funding to support those people while the state processes the waitlist.

Steinmetz said FSSA has allocated funding for that.

“Approximately $5 to $10 million is earmarked for that assisted living fund that you described around individuals who are residing in assisted living at the time that the waitlist was announced,” Steinmetz said.

Clere said he was interested in expanding who that funding could support. Stienmetz said after the assisted living fund, there wasn’t much ARPA funding left.

Abigail is our health reporter. Contact them at aruhman@wboi.org.