Indiana PathWays for Aging is the Medicaid managed care program for Hoosiers aged 60 and older who qualify through age, blindness or disability, and it covers physical therapy under Indiana Medicaid’s therapy rules. For members who also have Medicare, Medicare pays for therapy first and Medicaid helps with what is left, and the state’s therapy policy lets Medicaid pay the Part B deductible and coinsurance without a separate prior authorization. The matching team asks about both coverages and tells you honestly whether a therapist in the network can see you under them.
Last reviewed By the Monon Therapy Collective editorial team
- Who
- Medicaid members 60 and older (aged, blind or disabled)
- Started
- July 1, 2024
- Health plans
- Anthem, Humana and UnitedHealthcare
- Helpline
- 877-284-9294 (87-PATHWAY-4)
Who is enrolled in Indiana PathWays for Aging?
Hoosiers aged 60 and older who are eligible for Medicaid because of age, blindness or disability, including people who also have Medicare. Coverage in PathWays started on July 1, 2024, and the state lists Anthem, Humana and UnitedHealthcare as the PathWays health plans.
Some groups aged 60 and older are excluded, including partial dual-eligible members, people on certain developmental disability or traumatic brain injury waivers, and PACE members. If you are unsure which program you are in, the PathWays helpline at 877-284-9294 can tell you.
How does PathWays cover physical therapy?
PathWays covers physical, occupational and speech therapy as part of the standard Medicaid package, under the Indiana Health Coverage Programs therapy rules. Therapy must be ordered by an enrolled provider such as a physician, nurse practitioner or physician assistant, and the provider must be enrolled with the state’s Medicaid program.
The initial evaluation does not need prior authorization; most treatment after it does, unless it was ordered before you left the hospital, for up to 30 units in 30 days. Your PathWays health plan handles the authorization requests. The full rule set is on the page about Indiana Medicaid and HIP coverage.
How do Medicare and PathWays split a therapy bill?
Medicare pays first, and Medicaid helps with what remains. The IHCP therapy manual lists the deductible and copay or coinsurance for services covered by Medicare Part B among the exceptions to prior authorization, so Medicaid can pick up the Part B share without a separate approval.
Many dual-eligible members are in a Dual Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan built for people with full Medicaid. Indiana’s PathWays Dual Care pairs each PathWays health plan with an aligned D-SNP from the same company, so Medicare and Medicaid benefits are coordinated by one insurer. Members can also choose Original Medicare or another Medicare Advantage plan.
Can I keep the providers I already see under PathWays?
For now, generally yes. The state’s PathWays FAQ says the health plans have an open network until the state decides otherwise, so members can keep using providers as long as the provider remains an approved Indiana Health Coverage Programs provider, whichever plan you choose.
You can change PathWays health plans within 90 days of your initial enrollment, during the annual selection period that runs from mid-October through mid-December, or at any time for just cause.
What can a PathWays care coordinator do for physical therapy?
Every PathWays member has a care and service coordinator who helps you get the benefits you qualify for. For therapy, that can mean working out what your plan covers, connecting outpatient visits with any home and community services you receive, and pointing you to your health plan for provider searches. Rides to appointments are booked through your health plan’s transportation broker at least 48 hours ahead, with no mileage or frequency limits according to the state’s FAQ.
Rehab for older adults often centers on strength, walking and balance and fall prevention. Ask your coordinator what the plan covers, then complete the questionnaire so the matching team knows both your coverage and your goals.
