Section 405 IAC 14-6-1 - Member enrollmentAuthority: IC 12-15-1-10
Affected: IC 12-15-12
Sec. 1.
(a) Individuals at least sixty (60) years of age enrolled in Medicaid based on eligibility under one (1) of the following categories are mandatorily enrolled in an MCO through the PathWays managed care program, including those meeting age requirements and are served on the PathWays waiver operated by the office under Section 1915(c) of the Social Security Act or are in a nursing facility: (4) SSI recipients (MASI).(5) MED Works (MADW, MADI).(6) Full benefit dually-eligibles (QMB-Also, SLMB-Also, and FBDE).(b) Members meeting any of the following are excluded from PathWays managed care enrollment: (1) Individuals enrolled in an HCBS waiver operated by the office other than the PathWays 1915(c) waiver.(2) Partial benefit dual eligibles.(4) Individuals who have chosen to enroll in the Program of All-Inclusive Care for the Elderly.(5) Individuals under sixty (60) years of age.(6) End state renal disease Section 1115 Demonstration enrollees.(7) Residential care assistance program enrollees.(9) Enrollees with a traumatic brain injury in an out-of-state treatment facility.(10) Individuals receiving psychiatric treatment in a state hospital.(c) The following individuals meeting the PathWays criteria described in subsection (a) may opt into the PathWays program:(1) American Indian/Alaska Native members of a federally recognized tribe.(2) Individuals receiving participant directed home care services under 1915(c) waiver authority.(3) Individuals receiving hospice services after becoming sixty (60) years of age or receiving hospice services after initial implementation of PathWays July 1, 2024, regardless of the individual's age.Office of the Secretary of Family and Social Services; 405 IAC 14-6-1; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA