HMA Medicaid Market Solutions helped the State of Indiana secure approval for an extension of its Medicaid Section 1115 Waiver, the Healthy Indiana Plan. Below is a summary of what the renewal entails.
On February 1, 2018, Indiana received approval from the Centers for Medicare and Medicaid Services (CMS) to continue its long-standing Healthy Indiana Plan (HIP) with a three-year renewal. This CMS approval maintains the core of the HIP program and incorporates additional features, including expansion of the current Gateway to Work initiative to add required community engagement for non-exempt HIP members beginning in 2019. Also new is a substance use disorder component that will be available to all Indiana Medicaid members, including those enrolled in HIP.
HMA Medicaid Market Solutions helped the State of Indiana secure a renewal to their groundbreaking Medicaid Section 1115 Waiver, the Healthy Indiana Plan. Below is a summary of what the waiver entails.
Indiana has operated HIP through an 1115 demonstration waiver since 2008, when the program began covering nearly 60,000 childless adults and parents and caretakers who were not previously eligible for Medicaid. Since its inception, HIP has incorporated a member deductible funded by a Personal Wellness and Responsibility (POWER) account similar to a health savings account. Members are asked to make monthly contributions to their POWER account, and HIP contributes the remaining balance to ensure the member deductible amount is fully funded. Like commercial plans, after the deductible is met HIP assures full provision of health coverage by the member’s health plan.
Indiana leveraged HIP to expand Medicaid in February 2015, adding additional benefit packages and increasing the POWER account and deductible amount from $1,100 to $2,500. Today, HIP covers over 400,000 childless adults, and parents, and caretakers. Under this renewal, HIP coverage will continue to be available and incorporate the program modifications below.
Renewal Updates to HIP
- HIP POWER account contributions move from two percent of household income to a flat rate tiered amount ranging from $1 to $20 based on enrollee federal poverty level.
- HIP health plan enrollment, benefit limits, and POWER accounts are based on a calendar year and will be tracked and reinstated for individuals who disenroll and then reenroll in HIP.
- Pregnant women at the HIP income level may enroll and stay in HIP for the duration of their pregnancy, with all Medicaid cost-sharing and benefit protections in place. This eliminates coverage transitions between HIP and Indiana’s Hoosier Healthwise program during and after pregnancy.
- HIP adds a tobacco cessation surcharge to the required POWER account contribution for individuals who attest to tobacco use and do not successfully quit within the following year. The first tobacco surcharges will be applied in 2019.
- Expansion group HIP members who are required to provide information to renew their coverage and fail to do so will have 90 days to re-enter the program after coverage termination. They then will be subject to a three-month period of non-eligibility unless they qualify for an exemption.
Gateway to Work
Gateway to Work was included in Indiana’s initial expansion of HIP in 2015. This program provided voluntary referrals to workforce programing for HIP members not working over 20 hours per week. Under the waiver renewal, Indiana will expand the Gateway to Work program and make community engagement mandatory for non-exempt HIP members beginning in 2019. Exempt members include, but are not limited to, the homeless, students, individuals in active substance use disorder treatment, people who are medically frail, people over age 59, and parents or caretakers of school-age children. Individuals must meet the work hour requirement through a variety of means, including working, community service or volunteer work, job training, homeschooling, and caregiving.
This is the second community engagement initiative in Medicaid that CMS has approved. As with the Kentucky HEALTH approval, this community engagement initiative only applies to non-disabled adults and does not have an impact on other Medicaid coverage categories including aged, blind, disabled, pregnant women, or children. Indiana’s approved Gateway to Work program includes the following components:
- An hour phase-in starts at zero hours and ramps up to a minimum of 20 hours per week over a period of 18 months.
- Non-exempt HIP members must meet the Gateway to Work requirement in 8 out of 12 months of the calendar year.
- The program requirement operates as a calendar year lookback and will suspend HIP benefits effective on January 1 of each year for any non-exempt members who did not meet the requirement in the previous year.
Substance Use Disorder
The HIP renewal includes a substance use disorder component that will add new services and gain federal financial participation on inpatient services provided in Institutions for Mental Disease (IMD) to address the growing opioid use and substance use disorder epidemic. All Indiana Medicaid enrollees will have access to these expanded services.
For the full waiver approval documents please click here.
Written by Kaitlyn Feiock, MPH Senior Consultant with HMA Medicaid Market Solutions, [email protected].