THE VBP Blog
Indiana MLTSS: How PathWays for Aging Is Performing and What Comes Next
A consumer-focused look at Indiana’s long-term care program, its early results, and the state’s next Medicaid procurement.
September 24, 2026 – Indiana is still relatively new to managed long-term services and supports (MLTSS). Indiana PathWays for Aging launched on July 1, 2024, moving Medicaid members age 60 and older into a statewide managed care model that brings medical care, behavioral health services, home and community-based services (HCBS), and care coordination under managed care organizations (MCOs).
Indiana’s first PathWays external quality review reported that 116,785 people shifted into the program at launch. Two years later, Indiana has issued RFP 27-88343, combining PathWays with the state’s three other Medicaid managed care programs in one statewide solicitation. For consumers, this is an important time to examine what PathWays was designed to do, what early performance data show, and which protections should be strengthened in the next contract cycle.
How Indiana PathWays for Aging Works
The rollout was not entirely smooth. Indiana initially recommended four MCEs for PathWays, but FSSA discontinued Molina Healthcare’s readiness review in 2023 after the company was unable to secure the D-SNP contract required for participation. PathWays ultimately launched with Anthem, Humana, and UnitedHealthcare. Enrollment is generally automatic for Medicaid members age 60 and older who meet program eligibility rules, although there are some exclusions where individuals can choose whether to enroll. Members select an MCO or are assigned to one, and the MCO is responsible for integrating most Medicaid-covered physical health, behavioral health, and long-term care services.
The current PathWays contract emphasizes person-centered service planning, continuity when members move between providers or settings, timely access to services, and support for members to live in the setting of their choice. Members receiving HCBS work with service coordinators to develop and update service plans, while broader care coordination is intended to connect medical, behavioral health, social, and long-term care needs.
Indiana also built temporary continuity protections into the PathWays launch. During the first two years, MCOs were required to accept claims from qualified providers regardless of whether they were contracted with the plan. After that period, an MCO may request FSSA approval to limit members to its contracted network if it demonstrates adequate access. MCOs must also accept any willing qualified HCBS or LTSS provider for the first three years of PathWays operations, after which selective contracting may be permitted subject to network-adequacy requirements. Whether Indiana will reinstate similar open-network or any-willing-provider protections when the new contracts begin is not yet clear from the initial procurement materials. That is an important issue to watch as the solicitation develops.
What Early Performance Data Show
Because PathWays is only two years old, available evidence says more about implementation than long-term outcomes. Indiana’s 2025 external quality review found a mixed picture. All three MCOs received high overall compliance ratings, but reviewers also identified weaknesses involving care-management data, service authorization, grievances and appeals, provider directories, and network access.
Network findings were particularly important for consumers. All MCOs were missing data for provider types, with most missing categories involving LTSS and HCBS. In a “secret shopper” survey, it was also found that network access was inadequate for the majority of provider types reviewed for each MCO, and problems were identified with distance standards, provider-to-member ratios, appointment availability, and directory accuracy. Those concerns also appear in member complaints. During the first reporting year, the three MCOs resolved over 800 grievances specifically related to network adequacy or access to care, including difficulties locating qualified providers and excessive travel or wait times. These results show why a provider appearing in a network file is not enough. Consumers need providers who are actually available and able to deliver services when needed.
The review also identified care-management reporting problems, including discrepancies in reported data and MCOs inability to produce evidence of care-plan completion for members in a randomized sample. In an MLTSS program, those findings matter because service plans and coordination are supposed to translate assessed needs into actual support in a member’s home or community.
Some of the most consequential consumer issues sit outside traditional medical quality measures. Indiana currently has around 40,000 PathWays Medicaid Waiver slots, but demand exceeds available capacity. FSSA implemented a waiting list after reaching federal waiver capacity in 2024, and 12,266 people remained on the list as of September 2026. Individuals transitioning from nursing facilities, hospitals, or the state-funded CHOICE program receive priority, while other applicants are generally invited based on their original level-of-care assessment date. Importantly, this is a waiting list for HCBS waiver services, not for enrollment in PathWays itself. That means a person can therefore be enrolled in a managed care program designed to support community living and still be waiting for the HCBS capacity needed to make that possible.
Medicare Integration and Value-Based Payment
PathWays is also becoming more integrated for people who have both Medicare and Medicaid. On January 1, 2026, Indiana launched PathWays Dual Care, a voluntary program using Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs). Members who choose this option receive Medicare and Medicaid benefits through an aligned organization with a single care-coordination structure, an approach intended to reduce fragmentation between the two programs. However, PathWays Dual Care is voluntary. Eligible dual-eligible members may choose an aligned FIDE SNP, but they retain the ability to receive Medicare through other options.
Indiana also ties part of MCO payment to performance. Under the current PathWays Pay for Outcomes program, 2% of MCO capitation payments are withheld in calendar year 2026 and may be earned back based on performance. That number started at 1.85% in 2024 and is set to increase to 2.15%. Measures include care and service coordination caseloads, reassessment and service-plan timeliness, participant experience, and care-plan updates after inpatient discharge. Participant experience accounts for 15% of the amount at risk and includes getting needed care, getting care quickly, and health plan customer service.
The contract also establishes a broader value-based payment framework for providers, rather than fixed spending mandates that states like Florida impose. FSSA may set VBP methodologies for HCBS, nursing facilities, and other covered services, and MCOs must participate in the state-directed program and help develop HCBS arrangements. The state may also establish minimum VBP provider-participation targets. However, the contract does not specify a fixed percentage of LTSS spending that must be paid through VBP arrangements.
What the New Medicaid Procurement Could Mean for PathWays
Indiana’s new procurement is notable not because it redesigns PathWays, rather it changes how the state purchases managed care. Under RFP 27-88343, PathWays, Hoosier Healthwise, the Healthy Indiana Plan, and Hoosier Care Connect are being procured together through one statewide solicitation covering approximately 1.5 million Medicaid members. Public bid materials suggest that many core PathWays features, including person-centered planning, LTSS coordination, and quality incentives. Physical health, behavioral health, and LTSS are already integrated under a PathWays MCO and will remain so, but the new procurement also continues Indiana’s Medicare-Medicaid integration strategy. PathWays contractors are required to operate companion D-SNPs beginning in 2029, and dual-eligible members may voluntarily choose an aligned FIDE SNP that brings their Medicare and Medicaid coverage under affiliated plans.
For PathWays consumers, the bigger question is what happens to protections that were intentionally temporary. The open-network period has expired, and the any-willing-LTSS-provider requirement is scheduled to end in 2027, after the third program year of the current contract. Whether Indiana will reinstate a similar protection when the new contracts begin in 2029 is not yet clear from the initial procurement materials. The procurement gives Indiana an opportunity to decide whether stronger continuity and provider-choice protections should continue, particularly given the network weaknesses identified during the program’s first external review.
If the next procurement changes the MCOs serving PathWays, older adults and people with complex LTSS needs could also face another plan transition only a few years after the 2024 launch. Strong transition-of-care standards, accurate provider information, protection of existing service plans, and clear communication with members and caregivers will be essential if plan assignments change.
Advocate’s Perspective
Indiana built PathWays with many promising consumer protections, including person-centered planning, statewide plan choice, service coordination, consumer-experience measures, Medicare-Medicaid integration, and financial incentives tied to LTSS performance. The first two years show, however, that contract design and consumer experience are not the same thing. Network data remain uneven, some care-management processes have fallen short, more than 12,000 people are waiting for PathWays waiver services, and temporary provider-choice protections are beginning to phase out. The new procurement gives Indiana an early opportunity to respond before those problems become embedded. From a consumer advocate perspective, success should be measured by whether older adults can obtain authorized services, maintain meaningful provider choice, remain in the community when they choose, understand their rights, and experience better coordination across Medicare, Medicaid, and LTSS.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.
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