Medicaid members, providers continue to face challenges with FSSA’s Pathways implementation

Medicaid members and providers continue to encounter problems with the implementation of the state’s new long-term care program for people over 60. One lawmaker said the dedicated support line isn’t able to provide basic information.

The Family and Social Services Administration created the Member Support Services phone line for the Pathways for Aging program in June before the program officially launched.

There are three insurers or managed care companies that facilitate the health plans: Anthem, Humana and United Healthcare. Each company has their own support line for Pathways, but FSSA partnered with another company, Maximus, for an independent service line.

The agency said the goal was for members to have a third-party support line that could respond to questions about the program.

Rep. Robin Shackleford (D-Indianapolis) said she’s been trying to help seniors navigate the program, but the people answering the calls aren’t able to provide simple but important information.

“I’ve noticed that those representatives really don't understand Medicaid,” Shackleford said. “They don't understand the partial. They don't understand the full.”

Shackleford said they aren’t able to tell members which insurer is in charge of their plan, which is usually the information she’s helping people find. Because of this, she and the Medicaid members have to call each managed care company and ask if that insurer is in charge of their plan.

The Indiana Medicaid Director said FSSA will be looking into the issue.

READ MORE: Providers flag communication, reimbursement concerns for Pathways program implementation
 

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Medicaid providers also continue to see problems with the implementation of the Pathways program. Medicaid officials said one of the biggest challenges with the program so far has been with provider claims.

One concern is the timeliness of insurers processing those claims. One of the insurers, Anthem, failed to pay about 22 percent of their claims within three weeks, resulting in the company paying nearly $11,000 in interest to providers.

Holly Cunningham Piggott, with the Family and Social Services Administration, oversees the implementation of the program. She said there are still parts of the claims process that need work.

“We definitely aren't where we need to be,” Cunningham Piggott said. “We know this. They’re really working tirelessly to get these things corrected.”

Because of other claims issues, FSSA will continue to waive the timely filing requirement for providers until the end of this year. Cunningham Piggot said that date may be extended if problems continue beyond December 31.

FSSA said the insurers managing the Pathways for Aging health plans are required to submit weekly claims reports. FSSA also has multiple meetings that allow provider associations and insurance companies to share concerns.

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