Proposed Coordinated Care Program for Medicaid Disabled Population

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On April 23, 2014, Joe Moser, the Indiana Medicaid Director, presented a new Coordinated Care Program for Indiana Medicaid’s Disabled Population (“Program”).  The new Program, a Medicaid managed care program for the Aged, Blind and Disabled (“ABD”) populations, arose from House Enrolled Act 1328 (2013), which required the FSSA (through the ABD Task Force) to report on managing Indiana Medicaid ABD enrollees.  FSSA and its ABD Task Force submitted a report to the Indiana General Assembly and will now implement risk-based managed care; care will be capitated and managed by managed care entities (MCEs), for the ABD population.

Currently the Medicaid enrollees who will be served by this Program are receiving their benefits under a fee-for-service (FFS) Medicaid program, with a voluntary Care Select program available to a subset of this population.   Under the new Program, Care Select will cease and certain disabled Medicaid enrollees will be served under a new managed care program. 

The State’s goals for the new Program are to: (1) improve care coordination across the healthcare delivery system; (2) promote preventive and holistic care addressing physical, behavioral, medical and social needs; (3) increase consumer engagement in the management and treatment of conditions; (4) improve quality of care and health outcomes; and (5) introduce greater accountability by health plans.

Enrollment for the Program is expected to equal 75,500.  The populations included in the Program will consist of:

  1. SSI recipients currently enrolled in Hoosier Healthwise (“HHW”) that will move into an ABD category effective June 1, 2014 due to the 1634 transition;
  2. Individuals age 16-64 who are working and disabled with income below 350% of the federal poverty level (M.E.D. Works Non-Dual);
  3. Individuals qualifying for Medicaid because of disability who have at least one chronic medical condition qualifying them for the current Care Select program;
  4. Individuals who will transition to full Medicaid eligibility with Indiana’s 1634 transition on June 1, 2014[1]; and
  5. Individuals qualifying for Medicaid because of disability and who reside in the community and are not enrolled in a Home and Community Based Services (“HCBS”) waiver.
Individuals dually eligible for Medicare and Medicaid, Institutionalized Individuals (Nursing Facilities and ICFs/IID), HCBS Waiver Enrollees, and Money Follows the Person Grant Enrollees will be excluded from the Program.  Other excluded populations are undocumented citizens eligible for emergency services only, wards, present and former foster care children, children receiving adoption assistance, the present Hoosier Healthwise and Healthy Indiana Plan populations, those in the Family Planning Eligibility Program, Breast and Cervical Care Program enrollees, and Medicare Savings Program enrollees.

The Program will provide primary care, acute care, prescription drug, behavioral health, emergency services, and transportation care, but will carve-out Medicaid Rehabilitation Option (MRO) services delivered by Indiana’s community mental health centers, 1915(i) HCBS offered through the Medicaid State plan, dental services, FirstSteps, and individualized education plans, which are care plans developed by schools for special needs students. 

FSSA released the Request for Information (RFI) related to the Program on April 15, 2014, and plans to issue a Request for Proposal (RFP) soon.  It is anticipated that the MCEs which currently have Medicaid managed care contracts with the State will respond: MDWise, Anthem and Managed Health Services, as well as new MCEs. The State plans to select the winning MCEs by fall, and hopes to begin Member Enrollment by January 1, 2015.  For more information on this Program see the attached presentation slides or contact Meghan McNab at or Leah Mannweiler at

Indiana was historically referred to as a “209(b)” state, which means that Indiana did not follow federal social security guidelines for Medicaid disability eligibility and instead applied stricter eligibility requirements. On June 1, 2014, Indiana is transitioning to a 1634 state, which means Indiana will follow the federal guidelines for Medicaid eligibility and any individual who receives Supplemental Security Income (SSI) will automatically qualify for Medicaid.  As part of the transition from a 209(b) state to a 1634 state, Indiana will no longer be required to operate a spend down program.