Indiana launched a significant structural change on July 1, 2024: PathWays for Aging, a managed care program for Medicaid members 60 and older. The prior Aged and Disabled Waiver split into two programs — PathWays for Aging (60+, managed care through three MCEs) and the Health and Wellness Waiver (under 60, still fee-for-service). Getting to billable status in PathWays requires three sequential steps that each take time and cannot be done in parallel. And Sandata EVV hard edits have been active since April 2024 — claims without matching EVV records are automatically denied.
PathWays for Aging is Indiana's new mandatory managed care program for Medicaid members 60 and older who are eligible for full Medicaid benefits. It replaced the Aged and Disabled Waiver for the 60+ population on July 1, 2024. The A&D Waiver split: members 60+ moved to PathWays (managed care through three MCEs), and members under 60 remained in the Health and Wellness Waiver (administered by the Division of Disability and Rehabilitative Services, fee-for-service).
PathWays is managed care — claims go to the MCE, not to IHCP directly for most members. The MCE develops the member's Plan of Care (POC) and Notice of Action (NOA), which authorizes specific services. Agencies must be contracted with the member's MCE to bill for PathWays services.
PathWays covers personal care, homemaker, adult day services, home modifications, respite, and other HCBS for members 60+ who meet nursing facility level of care. Maximum slots: approximately 39,842. As of January 2025, approximately 5,680 members are on the waitlist. Monthly invitations go out from FSSA to move waitlisted members forward.
The functional assessment is completed by the Area Agency on Aging as a Level of Care (LOC) screening. Members who pass the preliminary LOC receive a waitlist placement letter. When their name reaches the top, full eligibility determination proceeds.
Adults under 60 with disabilities who need HCBS remain in the Health and Wellness Waiver, administered by the Division of Disability and Rehabilitative Services (DDRS). H&W is fee-for-service through IHCP — claims go to IHCP/Gainwell, not to an MCE.
Provider certification for H&W services is handled by OMPP (same portal as PathWays). After certification, providers are added to the applicable waiver's pick list through DDRS. Contact BDSProviderServices@fssa.in.gov for H&W enrollment after OMPP certification.
Indiana's HCBS provider enrollment for PathWays is sequential. Each step has a dependency on the one before it. Attempting steps out of order wastes time and will result in incomplete credentialing.
MCEs cannot pay claims to providers who are not contracted with them. Being enrolled in IHCP gives you the right to serve members — but only MCE credentialing gives you the ability to get paid for PathWays members enrolled in that MCE.
April 2024 — Sandata hard edits permanently active. Claims for PathWays HCBS services without a matching Sandata EVV record are automatically denied. There is no soft-edit grace period. IHCP began an enforcement test period November–December 2023 before turning hard edits on permanently in April 2024. If your EVV records in Sandata have gaps, mismatches, or wrong member data, those claims will not be paid.
Indiana uses Sandata as the state-sponsored EVV aggregator under an open model — providers may use their own EVV system as long as it integrates with Sandata for state-level aggregation. The Sandata-provided mobile solution is available at no cost. The six federally required EVV data elements must be captured per visit.
Claims for PathWays managed care members: Bill the member's MCE directly using the MCE's claims portal (Availity for Anthem and Humana; UHCprovider.com for UHC). Each MCE has its own timely filing window. Clean claim processing must occur within 21 calendar days for electronic claims (7 business days for HCBS claims). EVV data must match the claim for the MCE to process it.
| Member Type | Claim Destination | Authorization Source |
|---|---|---|
| PathWays MCE member — waiver services | Member's MCE (Anthem, Humana, or UHC) | MCE POC/NOA (Plan of Care / Notice of Action) |
| Health and Wellness Waiver member (under 60) | Gainwell (IHCP FFS) | DDRS service authorization |
| PathWays FFS (exempt groups) | Gainwell (IHCP FFS) | Traditional IHCP authorization — verify member exemption status |
PathWays for Aging launched July 1, 2024, and replaced the Aged and Disabled Waiver for Medicaid members 60 and older. The A&D Waiver split: members 60+ moved to PathWays (a managed care program through three MCEs — Anthem, Humana, UHC), and members under 60 moved to the Health and Wellness Waiver (fee-for-service, administered by DDRS). PathWays is mandatory for most eligible Hoosiers 60+. The 29,268 members in the A&D Waiver at launch were automatically transitioned to PathWays. New applicants 60+ go through PathWays' waitlist process through their Area Agency on Aging.
You cannot complete subsequent steps without the prior ones. MCEs require your IHCP Medicaid provider ID as part of their credentialing application — you cannot start MCE credentialing until IHCP enrollment is complete. IHCP will not enroll you for PathWays waiver services until you have OMPP certification. Providers who attempt to serve members before completing all three steps may deliver services that cannot be billed. OMPP also restricts providers to one active application at a time, so submitting incomplete applications can create delays that compound across all three steps.
The PathWays Waiver has approximately 39,842 slots. As of January 2025, approximately 5,680 seniors are on the waitlist. Each month, FSSA sends invitation letters to waitlisted members to complete the full application process. Persons transitioning from nursing home or hospital settings receive priority — 200 slots per year are reserved for this group. The wait for non-priority members varies by how quickly existing slots turn over. Members already enrolled in PathWays for acute care can request an upgrade to HCBS through their MCE, potentially bypassing the waitlist. For new applicants, the preliminary LOC screening through the AAA is the starting point.
Indiana agencies building PathWays operations need to sequence enrollment correctly from day one — OMPP certification first, then IHCP, then all three MCEs. CareBravo delivers the ongoing operational work — scheduling, Sandata EVV compliance, POC-matched billing across Anthem, Humana, and UHC — as completed work once you're enrolled.