Indiana home-care margin recovery: a new managed-care program and a 180-day clock that does not wait.

Indiana made two changes that, together, make margin recovery unusually urgent. First, on July 1, 2024, it launched PathWays for Aging, a statewide managed long-term services and supports program for Medicaid-eligible Hoosiers aged 60 and older, run by three managed care entities. On the same day it replaced the Aged and Disabled Waiver, sending older members into PathWays and others onto the new Health and Wellness Waiver. Second, and easy to forget underneath the program churn, Indiana holds one of the shortest filing windows in the country: 180 days for fee-for-service claims. A reconciliation gap that an agency in another state has a year to catch, an Indiana agency has six months.

This page is about where that money leaks in Indiana specifically, and why catching it means reading your EVV and authorization data against the claims before the 180-day clock runs out.

PathWays for Aging, and the waiver rename underneath it

Before July 2024, Indiana paid most senior home care through traditional channels and the Aged and Disabled Waiver. After it, members aged 60 and older are enrolled with one of three managed care entities, Anthem, Humana, or UnitedHealthcare, and the agency bills the plan rather than the state directly. Members who were not moved into PathWays and still need home and community based services went onto the new Health and Wellness Waiver.

The rename carried a real policy change that reshapes who can be paid. Under the Health and Wellness Waiver, parents and spouses can no longer be paid caregivers through Attendant Care. For agencies that built attendant-care arrangements around family caregivers, that change forces a rework of how those services are staffed and billed, and a claim that does not reflect the new rule does not pay. Structured Family Caregiving continues across the Health and Wellness, traumatic brain injury, and PathWays for Aging waivers, but the boundaries between what each program allows are exactly where claims fall out of step.

Sandata, CoreMMIS, and the EVV enforcement gap

Indiana runs EVV through Sandata under an open model. A provider can use its own EVV system as long as it exports data to the Sandata aggregator, which integrates with CoreMMIS, the state claims system. EVV was required for personal care services for dates of service on or after January 1, 2021 and for home health services on or after January 1, 2024. Indiana then began denying non-EVV-compliant personal care claims for dates of service on or after January 1, 2023, so there was roughly a two-year gap between the requirement and hard denial enforcement.

CoreMMIS matches EVV-required claims against the Sandata visit data, and missing or unmatched EVV data produces a denial through EVV-specific explanation-of-benefits edits. Separately, claims deny on authorization mismatches when the service does not match the approved prior authorization on units, dates, or service line. The exact edit-code numbers are published in IHCP bulletins and are worth confirming against the current bulletin before relying on a specific number, so the reliable way to find these is to reconcile the EVV and authorization data against the claim rather than wait for one tidy code.

Where the margin actually leaks in Indiana

• Waiver-and-PathWays coding mismatches. Claims coded under the old Aged and Disabled structure for members who moved to PathWays or the Health and Wellness Waiver. This is the uniquely 2024-forward Indiana error.
• Paid-caregiver rule changes. Attendant Care arrangements that no longer fit the Health and Wellness Waiver rule on parents and spouses, billed as if nothing changed.
• EVV mismatch denials. Personal care claims with no reconcilable Sandata visit in CoreMMIS, denied on EVV-specific edits.
• Authorization mismatches. Services that fall outside the approved prior authorization on units, dates, or service line.
• The 180-day trap. Recoverable claims that age past Indiana's short filing window before anyone reconciles them, turning a fixable gap into a permanent loss.

None of these are visible from inside the scheduling view. The schedule says the visit happened. The EVV system says the caregiver clocked in. It is only when you reconcile the Sandata visit data against the CoreMMIS authorization and the actual remittance that the gap appears, and in Indiana you have to find it fast.

Why a read-only recovery layer is the right tool for this

Reeve sits read-only over whatever EMR and EVV export an agency already runs, whether that is WellSky, AxisCare, HHAeXchange, AlayaCare, or anything else, and compares what was delivered with what was authorized and what was actually paid. For an Indiana agency, that means lining up the Sandata visit data, the claim lines, and the CoreMMIS authorizations, then surfacing every place they fail to reconcile: the waiver-and-PathWays coding mismatches, the EVV mismatch denials, the authorization gaps, and the silent underpayments, fast enough to act inside the 180-day window.

Because Reeve is read-only and neutral across every EMR, it never writes to your billing workflow without your control, and it has no reason to look past a finding that implicates a billing module. It hands you a ranked list of recoverable dollars with the reason attached. The ones still inside the 180-day window are the ones you can rebill now, and in Indiana that window is the whole game.

This is the same engine described across the rest of the site. For the broader map of revenue loss in home care, see where home-care margin leaks. For the filing-window side specifically, see home-care timely filing limits. For the full playbook on getting uncollected revenue back, see home care revenue recovery.

What the free Indiana Margin Teardown does

The way to find out whether the PathWays transition or EVV mismatches are draining your margin is to look at a real, de-identified slice of your own data, before you spend a dollar. The Margin Teardown is a one-time, read-only read of where margin is leaking in your book: the coding mismatches, the EVV denials, the authorization gaps, and the underpayments, with the 180-day window front of mind. It is free, and it is yours to keep whether or not you ever work with Reeve. It carries the same 3×-or-free guarantee the rest of the engine does. If Reeve does not surface at least three times its monthly fee in recoverable margin you agree is real, you do not pay.