Nonprofits say services for older Hoosiers at-risk of getting cut amid state changes

Alisha Cobb takes care of her elderly and chronically-ill mom full time so that she doesn't have to live in a nursing home, an industry long plagued with understaffing and neglect problems.

She gets paid as a caregiver through a government program that's managed by a local nonprofit for the disabled and aging populations, CICOA Aging and In-Home Solutions. Through the organization, she also gets help buying medication and medical equipment like wedge pillows, and gets support from a counselor who talks her through the challenges she faces as a caregiver.

"Sometimes it's hard to talk to family and friends," she said. "...Now you have another person there, and it's a no judgement zone. I'm venting, I'm letting my feelings out. And at the same time, this person has experienced what you went through, so they're able to understand where you're coming from"

But the state is pushing through a number of changes that some say will upend the lives of people like Cobb and her mother and threaten the operations of the nonprofit aging organizations that support them.

The Holcomb administration plans to hand over management of the program to three insurance companies on July 1, which would take over a portion of the cases and cut the reimbursements to the nonprofits by almost half. Indiana Family and Social Services Administration said the reduced reimbursements are meant to reflect the change in workload and a shift to a model that pays for good health outcomes instead of for each service provided. However, the nonprofits and their supporters say these changes will disrupt the work they do.

Negotiation over payment to the 15 nonprofits that manage this program have reached an impasse and may fall apart soon, according to a letter from the Secretary of Indiana Family and Social Services Administration, Daniel Rusyniak, dated April 3. If the negotiating party for the nonprofits won't accept the rate FSSA proposed by Friday, the state plans to negotiate with individual organizations.

This may mean that some nonprofits could stop administering the program.

"This puts us in between a rock and a hard place," said Erica Seabaugh, the vice president of in-home services at CICOA. "Deciding between continuing to serve this population we've been serving for 50 years and are trusted members of their care team for older adults to live independently, or not."

Hannah Carlock, a spokesperson for the negotiating party, said they're discussing this issue Thursday.

"Right now, they're looking at their finances to see if they can or cannot swing it," she said.

Reduced funding

Nonprofit administrators say that the reduction in reimbursement and loss of clients means they will have to look to cut services like transportation help and healthy meal deliveries.

Tauhric Brown, the CEO of CICOA, said the Medicaid program makes up about half of the budget for the nonprofit, which services Indianapolis and the surrounding counties. For Thrive West Central, which serves Terre Haute and nearby counties, the program makes up 60% of its financial operations.

Rep. Ed Clere, a New Albany lawmaker who chairs a legislative subcommittee dedicated to health and medicaid, said senior programs may become collateral damage as budgets at nonprofits shrink.

These nonprofits offer senior activities and holiday events, which "help hundreds of seniors get out and be active and socialize," he said.

"It helps reduce isolation, which has been a bigger problem among seniors since the pandemic."

Who should run the Medicaid program?

These changes are separate from but related to a proposal to reduce pay for caregivers for elderly or disabled loved ones in order to bridge a $1 billion Medicaid budget shortfall, which prompted protests and an online petition that garnered more than 36,000 signatures.

More: After $1 billion Medicaid budget shortfall, Indiana to cut program paying family caregivers

A number of major changes that affect the aging and disabled population are set to take effect July 1.

The state has been planning to contract out the work of managing the Medicaid program to insurance companies as part of an effort to cut down on the cost of health care and improve the health outcomes of Hoosiers. Indiana's budget for Medicaid has ballooned over the last decade and was projected to make up nearly 18% of the state's general fund in fiscal year 2024-2025.

The idea is the insurance companies would focus on preventive care like screenings and the management of chronic diseases to avoid paying for expensive hospital stays when untreated or unmanaged health issues become life threatening emergencies. In practice, this type of model has had mixed results and struggles to rein in the cost of health care.

The central problem here isn't the model of care, but rather the question of who should be in charge of the program and determine the rates. The state says insurance companies, specifically Anthem Blue Cross and Blue Shield, United Healthcare Community Plan and Humana Health Horizons of Indiana. Local nonprofits like CICOA and their supporters say it should stay with them.

The insurance companies did not comment for the story.

Nonprofit administrators like Brown say that local organizations with decades of experience in their communities are better equipped to manage the program that insurance companies that answer to shareholders.

"[Insurance companies] are looking at their bottom lines," said Brown. "They can say it's not about the bottom line, but services will be reduced for older Hoosiers."

Big insurers

Jessica Tellstrom, the co-owner of East Side's Rabble Coffee, is worried that these changes may affect the services that she depends to take care of her son, who has multiple disabilities.

"[The state's] asking the wrong people. They're not asking enough families and what all this means for them before making a decision," she said.

In the short term, people caring for aging adults can chose between the local nonprofits and the insurance companies for the management of the program.

But Tellstrom is worried that people with busy lives who are already have troubling navigating Medicaid may not make an informed choice.

"They're not going to have time to read the fine print," she said .

As for Cobb, she doesn't want to lose the person she can call at CICOA.

"I can call Ms. Mary at this number and she gets back to me and has my best interest, versus talking to some random person." she said.

"And how long is the hold time? Is this a direct number? How long will it take to call me back?"

Binghui Huang will be reached at 317-385-1595 and Bhuang@gannett.com

This article originally appeared on Indianapolis Star: Nonprofits say services for older Hoosiers may get cut amid state changes