Medicaid wait lists are the target of a new lawsuit against the state of Indiana. Five residents there said they were deprived of access to assisted living communities covered under the state’s Medicaid benefit.
Five residents filed a complaint last week in US District Court for the Southern District of Indiana alleging that the Indiana Family and Social Services Administration effectively denied them access to assisted living communities by placing them on “long and indefinite” wait lists. The complaint is seeking class action status on behalf of thousands of older adult and disabled Hoosiers.
FSSA announced in April that it was implementing a waiting list for the Aged and Disabled Waiver after reaching maximum capacity. The state recently split the Aged & Disabled waiver into two distinct programs: The PathWays for Aging program for adults aged 60 or more years and the Health & Wellness Waiver for those aged 59 or fewer years. Both programs include access to Medicaid assisted living.
‘Irreparable harm’
The Indiana complaint states that the FSSA’s waitlist is causing “irreparable harm,” leaving residents “stuck in limbo” and forced to choose between institutionalization in a nursing home or foregoing care indefinitely.
The complaint also alleges that “despite having thousands of available waiver slots to use, the FSSA has not kept pace with the program’s attrition.” And the complaint alleges that assisted living facilities in the state are “nowhere close to capacity.”
Waiting lists in other states
Indiana is not alone in using waitlists for Medicaid home- and community-based service programs, and those waiting lists have steadily grown in the years following the COVID-19 pandemic.
Between 2016 and 2024, the number of states with Medicaid HCBS waiting lists has fluctuated between 27 and 41, with approximately 700,000 people on those waiting lists, according to KFF. Those people spend an average of 40 months on a waitlist before gaining access to services.
Although waiting lists may reflect states’ budget constraints, states also use waiting lists to manage shortages of HCBS workers, according to KFF, which added that ongoing workforce shortages will make it difficult to meaningfully reduce waiting lists in the short term.
Last month, the Indiana Assisted Living Association joined a state legislator at a press conference about the “devastating” effect that wait lists for the state’s managed care program are having on older adults in need of assisted living and other services.
Twenty-seven percent of residents in Indiana rely on the Medicaid program for their long-term care in assisted living, according to the National Center for Assisted Living.
Source: McKnights Seniorliving