The Indiana Family and Social Services Administration recently announced that it would be extending Healthy Indiana Plan (HIP) benefits through April.
HIP, which was originally slated to end benefits for 10,000 low-income Hoosiers at the end of this month, extended coverage to allow for more time to sign up on the federal exchange.
FSSA Secretary Debra Minott said many HIP enrollees have struggled to enroll on the exchange due to technical issues.
Earlier this year, the administration sent letters to over 10,000 HIP enrollees informing them that they would be losing their coverage due to stricter guidelines regarding income level. Under the original plan, only people making below 100 percent of the poverty level would be able to remain. This means that an individual making more than $11,940 or a family of four earning more than $23,550 yearly would be kicked off the state-run program.
“The most recent announcement about the extension of the Healthy Indiana Plan really pertains only to between 10,000 and 11,000 current members of the plan that are over 100 percent of the poverty level,” said Minott. “Under the terms of the waiver renewal that the Centers for Medicare & Medicaid Services granted us in September, the government and state of Indiana agreed that those in the Healthy Indiana Plan over 100 percent of poverty level would be transitioned to plans on the federal marketplace which would free up more slots for those under 100 percent of poverty to join.”
In a letter to the state, U.S. Health and Human Services Secretary Kathleen Sebelius said her office would work with the state to get HIP up to federal standards as many of the current rules are not acceptable.
HIP which is a high-deductible health plan with a health saving account called POWER, requires enrollees to participate by paying a specified contribution to their account monthly as a condition of continued enrollment. Failure to do so may result in being removed from the program for up to a year.
Minott specifies that the mandatory contribution is not a co-pay.
“We have been in discussions at the federal government level to determine what they would be willing to accept as far as HIP’s design and then we have to decide what we’re willing to compromise on,” she said. She cites the “very important elements of personal responsibility” as key features that Gov. Mike Pence wants to make sure are retained in any sort of plan that would be used for expansion.
The current rules also include enrollment caps. HIP currently serves 35,000 Hoosiers and is looking to enroll 10,000 who have been on waiting lists.
These issues are causing some to continue to speak out in favor of Medicaid expansion. Groups such as Cover Indiana and Hoosiers for a Commonsense Health Plan rallied at the Statehouse in an effort to shine a light on the thousands of Hoosiers who would benefit from Medicaid expansion.
According to the Center on Budget and Policy Priorities, the expansion of Medicaid would increase state spending by $1.1 billion, just 4.2 percent more than the state would have spent on Medicaid with the absence of the Affordable Care Act. The CBPP also projects that an additional 495,000 adults who will be newly eligible for the program will enroll. This number is comprised of mostly uninsured adults, but also includes some adults who are currently covered under other health care plans.
In Iowa, a state with a plan similar to HIP, the federal government has approved its state-run plan but has rejected parts of the plan that would require many poor enrollees to pay premiums if they failed to participate in specified wellness tasks.
In regards to Indiana, Secretary Minott says that if CMS was to deny parts of HIP she doesn’t know what their recourse would be. “We will certainly continue to discuss other options, discuss ways that you might create incentives for healthy activities, but I think that at this point they’re just ideas on a drawing board. We have not settled upon what we think would be a different approach.”
Impact of the coverage gap
Information released by the Kaiser Family Foundation revealed these facts about the impact of the coverage gap:
– Today, there are significant racial and ethnic disparities in health coverage among adults. Overall, among adults, people of color are more likely to be uninsured than whites (27 percent vs. 15 percent), with Hispanics at the highest risk of lacking coverage (33 percent).
– Given these high uninsured rates, the expansion of Medicaid offers a particularly important opportunity to increase health coverage among people of color. Overall, more than half (53 percent) of uninsured adult people of color have incomes at or below the Medicaid expansion limit.
– However, in states that do not expand Medicaid, millions of poor adults will be left without a new coverage option, particularly poor uninsured Black adults residing in the South, where most states are not moving forward with the expansion. Four in 10 uninsured Blacks with incomes low enough to qualify for the Medicaid expansion fall into the gap, compared to 24 percent of uninsured Hispanics and 29 percent of uninsured whites. These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access.
