Medicaid, prior authorization to be major topics for Legislature in 2025
What little new revenue is expected over the next two years likely will be swallowed up by Medicaid costs as lawmakers work to craft the state’s next budget.
Medicaid
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Education, health care highlight budget pitches for lawmakers
In the latest round of budget pitches, state agency heads detailed their funding requests before members of the General Assembly Monday, claiming victories and minimizing missteps over the last two-year budget cycle.
Seniors, disabled Hoosiers and children all on the state’s waiting list for services
Two separate waitlists overseen by the Family and Social Services Agency have been likened to crises by critics, delaying much-needed health and child care services to Hoosiers in need. And now FSSA has added a third waiting list for applicants seeking child care services under the Child Care Development Fund and On My Way Pre-K.
Elevance Health sues feds over ‘arbitrary and capricious’ star ratings for Medicare Advantage plans
At stake are billions of dollars in bonuses that the Centers for Medicare and Medicaid Services awards to insurers that achieve a certain star rating on their Medicare Advantage scores.
Lawmakers scrutinize “black box of state PBM spending”
A review of five years of data from the state’s major pharmacy benefit managers cataloged more than 63 million claims and nearly $6.7 billion paid to the entities across state-sponsored plans — including Medicaid and the health plan for state employees, according to an analysis presented before lawmakers on Tuesday.
FSSA provides update on growing waitlist, hears about provider issues under managed care
Two committees tasked with studying and addressing issues related to aging met Thursday, concluding that Medicaid waitlist progress was “barely treading water” and dissecting ongoing provider issues with the transition to managed care.
FSSA exploring narrow relief options for Hoosiers on Medicaid waitlists
Responding to pressure, state officials are considering whether or not they can tap into a pool of federal dollars to provide relief for a narrow subset of Hoosiers on Medicaid waiver waitlists. Indiana Medicaid Director Cora Steinmetz described the process during a two-hour Medicaid Oversight Committee Tuesday alongside updates on various Medicaid initiatives.
Medicaid advisory panel weighs in on HIP lawsuit, PathWays transition
Legislators on the state’s Medicaid Advisory Committee spent hours Wednesday questioning state officials about Indiana’s ongoing lawsuit over provisions of the Healthy Indiana Plan as well as progress reports on the state’s transition to managed care, otherwise known as PathWays.
Indiana adult day programs, already few in number, worry about their future
Like the rest of Indiana’s Medicaid landscape, adult day services face a monumental change this summer when the state transitions to managed care. For providers, that means a Managed Care Entity will handle their claims and payments rather than the state.
Lawmakers to examine AI, Medicaid costs and more over interim
When Indiana lawmakers next converge upon the Statehouse for interim committee meetings, they’ll take on artificial intelligence (AI), Medicaid spending and more — but won’t take another look at marijuana.
Families call on Holcomb administration to pivot on attendant care transition
Six moms of medically complex children pressured Gov. Eric Holcomb to reform his administration’s approach to transitioning families from attendant care to another caregiving program in a private Monday meeting at the Statehouse
Biden administration unveils new rule on nursing home staffing levels
The Biden administration has introduced a controversial set of new regulations intended to increase staffing levels and improve patient care in nursing homes.
FSSA implements waitlist for Aged and Disabled Waiver services
The Family and Social Services Administration (FSSA) last week announced a waitlist for the Aged and Disabled Waiver, meaning that Hoosiers in need of skilled nursing care and other services will be forced to wait.
Former Medicaid supervisor sentenced to 18 months in federal prison
Yolanda Brooks, 52, of Indianapolis was also ordered to serve three years on probation after her prison stay and pay $920,148.51 in restitution.
Bills on antisemitism, school chaplains hang in balance as legislative session nears end
Indiana’s lawmakers have just days to finalize legislation in key areas like health and education — from literacy and antisemitism to ambulances and a Medicaid shortfall. And some continued attempts to increase legislative oversight of the executive branch are on track for passage, but others appear dead.
Covering $1B shortfall in Medicaid forecasting means dipping into reserves
The state’s April Medicaid expenditure forecast missed the mark by roughly $984 million due to a combination of state budget reversions and unexpected growth of services for aging and disabled Hoosiers.
Families say autism therapy helped their kids. Indiana’s Medicaid cuts could put it out of reach
Families reliant on Medicaid worry changes coming in January will limit access to the therapy as Indiana attempts to limit the cost and, along with other states, cut the size of the low-income health care program.
Committee provides updates on Medicaid programs for aging, maternal health
An estimated 130,000 Hoosiers over the age of 60 using Medicaid will receive notices in early 2024 advising them to choose a Managed Care Entity (MCE) to coordinate their health coverage under the state’s Pathways for Aging program.
COA remands for fuller analysis of woman’s Medicaid eligibility
An administrative law judge’s analysis of a woman’s irrevocable trust as it relates to her Medicaid nursing home benefits eligibility was incomplete, the Court of Appeals of Indiana ruled in a Tuesday reversal.
More than 744k Hoosiers on Medicaid affected in software breach
The names, addresses, case numbers and Medicaid numbers of more than 744,000 Hoosiers on Medicaid were exposed in a contractor’s late May security breach, Indiana’s Family and Social Services Administration announced Friday.