Indiana PathWays for Aging: Eligibility, Enrollment & What Families Need to Know

Your parent just got discharged from the hospital and the social worker mentioned something called "PathWays for Aging." Now you're trying to figure out what it actually covers, whether your parent qualifies, and how the enrollment process works — all while the facility is billing $10,000 a month in private-pay rates.

Indiana PathWays for Aging is the state's mandatory Medicaid managed long-term services and supports (MLTSS) program for residents aged 60 and older. Launched July 1, 2024, it replaced the old fee-for-service Aged and Disabled (A&D) waiver by rolling acute care, Medicare-aligned services, and long-term supports into a single managed care framework.

How PathWays for Aging Works

Instead of navigating Medicaid benefits through the state directly, enrolled members choose one of three contracted Managed Care Entities (MCEs):

• Anthem PathWays Dual Care
• Humana PathWays Dual Care
• UnitedHealthcare PathWays Dual Care

Each MCE assigns a Care Coordinator who develops an individualized service plan covering nursing facility care, home and community-based services (HCBS), personal attendant care, and care transitions. For dual-eligible individuals (those on both Medicare and Medicaid), enrolling in a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) aligns both insurance programs under one provider.

The key shift: your parent's MCE now controls authorizations for home care hours, facility placement, and service modifications — not the local Area Agency on Aging.

Who Qualifies

Your parent must meet both financial and clinical criteria:

Financial thresholds (2026):

• Gross monthly income at or below $2,982 (if over, a Miller Trust is required)
• Countable assets at or below $2,000 for a single applicant
• Primary home exempt up to $752,000 in equity if the applicant intends to return or a spouse lives there

Clinical requirement: Your parent must meet the Nursing Facility Level of Care (NFLOC) standard, assessed by Maximus (the state-contracted Level of Care Assessment Representative). This requires documented need for direct daily assistance with at least three of five ADLs: bathing, dressing, eating, toileting, and mobility.

Age requirement: 60 or older. Individuals under 60 who need the same level of care use the Health and Wellness (H&W) Waiver instead.

How to Enroll

1. Initiate the clinical screening through your local Area Agency on Aging or contact Maximus directly at 1-833-597-2777
2. Submit a Medicaid application via the FSSA Benefits Portal (fssabenefits.in.gov) or by calling 1-800-403-0864, using State Form 55390
3. Select your MCE through the PathWays Enrollment Broker at 1-877-284-9294 within 90 days of enrollment

If you don't choose a plan during the enrollment window, the state auto-assigns one — and switching later requires waiting for the next open enrollment period.

PathWays vs. the Health and Wellness Waiver

The H&W Waiver serves Hoosiers aged 59 and under who meet the same NFLOC clinical standard. It operates under traditional Medicaid fee-for-service (no MCE involvement) and is coordinated by the Bureau of Disabilities Services and local AAAs. Unlike PathWays, which launched with statewide enrollment, the H&W Waiver maintains a separate waiting list exceeding 7,400 individuals.

The Waiting List Problem

PathWays for Aging itself doesn't maintain a traditional waiting list the way the old A&D waiver did — the managed care structure is designed for immediate enrollment once eligibility is confirmed. However, the broader HCBS waiver system in Indiana still has over 12,000 people waiting for home-based services. If your parent qualifies financially and clinically but HCBS slots through their MCE are limited, they may face delays in getting home care hours authorized.

Nursing facility placement through PathWays doesn't have the same bottleneck — facilities that accept Medicaid can admit your parent once coverage is active.

What Families Get Wrong

The most common mistake is assuming PathWays covers everything. It does not pay for room and board in assisted living — only the care services delivered there. Your parent (or family) still pays the monthly rent. It also doesn't cover the spend-down period before eligibility kicks in.

If your parent's income exceeds the $2,982 cap, you'll need to establish a Qualified Income Trust (Miller Trust) before the application will be approved. And if countable assets exceed $2,000, you'll need a compliant spend-down strategy — not gifts to family members, which trigger penalty periods under the five-year lookback.

For a step-by-step walkthrough of Indiana Medicaid eligibility, Miller Trust setup, asset protection strategies, and the complete application process, the Indiana Medicaid Long-Term Care & Asset Protection Guide covers every stage from the initial crisis through enrollment and beyond.

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