IHCA/INCAL Issues Statement on Proposed Long-Term Services and Supports Reform Efforts

INDIANAPOLIS, IN (January 22, 2021) – Zach Cattell, President of the Indiana Health Care Association/ Indiana Center for Assisted Living (IHCA/INCAL), issued the following statement addressing the proposed long-term services and support (LTSS) reform efforts in Indiana.

“The IHCA/INCAL has long supported steps to rebalance LTSS to ensure Medicaid recipients can access the right care across the entire continuum, in addition to proposals to allocate a portion of supplemental payment program dollars to quality metrics.  A plan was nearly reached during the Pence administration to help appropriately right-size the state’s nursing facility capacity and increase funding for home and community-based services, but that agreement was put on hold during the transition of administrations.

IHCA/INCAL’s efforts to resume the planning process included advocacy to ensure that future reforms were not detrimental to beneficiary access and provider operations, as has occurred in many states that have turned to “managed care” for elderly, frail and disabled Medicaid recipients.  From these efforts a broad group of stakeholders was convened in mid-2019 by the Indiana Family & Social Services Administration to discuss LTSS, and at that time, all stakeholders agreed on the goal of elderly Hoosiers being able to access their care of choice within 72 hours, with all delivery system options to achieve that goal on the table.  Unfortunately, a federal rule and the COVID-19 public health emergency delayed the continuation of these stakeholder meetings. When the stakeholders were reconvened on December 30, 2020, capitated risk-based managed care was presented as the pathway to achieve the previously agreed upon goals.

The introduction of managed care entities into the health care of a very fragile and vulnerable population should be appropriately vetted and only implemented with transparent safeguards to ensure elderly Hoosiers continue to receive the care they need.

Too many times have recipients enrolled in existing managed care products from Medicaid and Medicare been denied appropriate services.  In addition, more expensive bureaucratic processes are piled on the providers that render hands-on care and services.

Assuming capitated risk-based managed care is the only way misses other innovative and integrated models across the country, as well as our track record here in the state.  Today, most of Indiana’s Medicaid program is under a traditional capitated risk-based managed care model, portions of it for nearly twenty years, yet Indiana continues to see some of the poorest health outcomes in the nation.  Deficiencies in state and federal oversight of managed care entities to deliver on what is promised, particularly for the elderly, frail and disabled, have also recently been highlighted by the federal Government Accountability Office.

There are no easy solutions to these important and complex issues, but IHCA/INCAL remains ready and willing to engage to grow home and community-based services, ensure care across the continuum is accessible, and improved quality of care is achieved.”

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About IHCA/INCAL

IHCA/INCAL is the state’s largest trade association and advocacy group representing for-profit and not-for-profit nursing homes, as well as assisted living communities and independent living. The association provides education, information, and advocacy for health care providers, consumers, and the workforce on behalf of its more than 444-member facilities.