LifeSpan Resources CEO Lora Clark and LifeSpan Chief Business Development Officer Lucy Koesters are preparing for the state’s upcoming transition to a managed care model for Medicaid patients in long-term care. The Pathways for Aging program will roll out in July.
Brooke McAfee | News and Tribune
Indiana’s transition to the PathWays for Aging program will involve many adjustments for the state’s Area Agencies on Aging (AAAs), but organizations still have questions about the potential effects of the rollout.
When the Family and Social Services Administration’s new program begins in July, the state will switch from a fee-for-service model to a managed care model for Medicaid enrollees over age 60.
The move will affect Medicaid beneficiaries receiving long-term care in nursing homes or through home and community-based services.
Eligible Hoosiers will be notified in February to choose between three Managed Care Entities (MCEs), including Anthem Blue Cross and Blue Shield, Humana Healthy Horizons and United Healthcare Community Plan.
These MCEs will be responsible for care management under the new model, taking over responsibilities currently held by AAAs in Indiana. The new model will involve a flat, up-front fee per person.
LifeSpan Resources, a New Albany-based AAA serving Southern Indiana, is among the agencies preparing for the transition. Lora Clark, the agency’s CEO, said the transition will only affect their clients who are ages 60 and older on the Medicaid Aged and Disabled (A& D) Waiver.
LifeSpan offers care management, nutrition/wellness and transportation services for elderly and disabled clients in Clark, Floyd, Harrison and Scott counties.
“We’re concerned because it’s less than six months from implementation and we are still lacking information,” Clark said. “We don’t know what our rates are going to be [or] what rates they are going to give us. We don’t know our case assignments. We don’t know how many clients we’re going to be able to keep.”
Jenny Hamilton, president and CEO of LifeStream Services, Inc., said the transition comes with uncertainty for the Yorktown-based organization, which serves as the AAA for Blackford, Delaware, Grant, Henry, Jay, Madison and Randolph counties in East Central Indiana.
“It could possibly have a huge impact,” she said. “On a scale of 1 to 10, this could possibly be an 11 for us.”
State Rep. Ed Clere, R-New Albany, said he has “ongoing concerns and a lot of unanswered questions” about the rollout of the Pathways program.
“Now the AAAs are being told that they will do service coordination rather than case management,” he said. “So the MCEs...apparently will be doing the case management and subcontracting service coordination to the AAAs, and we don’t know what that’s going to look like, including how the cases will be assigned.”
The state stipulates that MCEs work with existing AAAs for at least 50% of the service coordination for the first two years of the managed care contract.
Clere worries about the effects the changes will have on the revenue of organizations such as LifeSpan. He serves as a member of the agency’s advisory council.
“The revenue LifeSpan earns from case management allows it to do a lot of other things in our community, including senior games and Angel Tree, to name a few activities that mean a lot to individuals in our community,” he said. Clark said LifeSpan has multiple funding streams that will not be affected by the managed care transition.
“It’s just the waiver clients who are over 60 years old,” she said. “It’s going to affect our operations... at least during the transition period.”
She is not sure what the exact effects on revenue will be. LifeSpan has 1,800 Medicaid clients over age 60 on the Medicaid A& D Waiver, representing about 15% or less of the agency’s current operating budget.
Although the changes could potentially lead to 900 clients transitioning out of the agency, Clark said that is only one scenario.
“However, we are confident the health care companies will find that our experience and expertise in service coordination will make it more cost-effective to let these clients remain with us,” she said.
She expressed confidence in LifeSpan’s “ability to ensure our clients and people in the community who need us will continue to get help and assistance from our staff,” and she noted the demand for the agency’s services with the growing aging population.
Hamilton also noted the uncertainty related to the effects on LifeStream’s revenue, saying the numbers are difficult to pinpoint.
“Even if you just go with a simple 50% of what we have now [for A& D waiver services], that could cut what we do and the people we serve in half and the revenue in half,” she said.
She expects that as the program begins, the agency will continue working “with a lot of the individuals that we serve now, but time will tell how that pans out.”
The changes could also affect LifeStream from a staffing perspective since many of the agency’s employees are case managers.
“I don’t know that it will be an actual reduction in staff, but it might be kind of a change in what they do,” Hamilton said.
LifeSpan leaders note that the 50-year-old organization has a history of accommodating changes from the state. LifeSpan Chief Business Development Officer Lucy Koesters referenced the challenges associated with the state’s centralization of non-emergency medical transportation several years ago.
“ There’s a lot of unknowns,” she said. “It’s going to be bumpy, but we’ve been there before. We take care of 3,000 clients in the community on an annual basis, and we don’t see that changing. We’ve been around 50 years, and we’ll be around 50 more.”
Despite the uncertainty associated with the changes, Hamilton also feels optimistic that the Pathways program will bring better coordination and reduced duplication of services.
“Right now [with] that fee-for-service model, you can have home-delivered meals, you can have an attendant care personal aide here and you can have a home health aide over here, and hopefully you all know what each other’s doing, but that coordination may not be so great,” she said. “So Pathways will turn that over to the Managed Care Entity so they can better manage the care and hopefully have better outcomes.”
LifeStream is focused on educating its providers and clients about the upcoming changes, Hamilton said.
“It’s going to be kind of figuring things out and helping these people that we serve — helping them get everything where it needs to be so there’s no loss of services,” she said.
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