1115 Medicaid Waivers in Indiana
CMS approved the “Healthy Indiana Plan 2.0” 1115 waiver to expand Medicaid on January 27, 2015. A waiver amendment adding a work requirement (among other changes) was approved February 2, 2018, expiring December 31, 2020.
On July 25, 2019 the state submitted another waiver amendment to exempt members of federally recognized tribes and caretakers of dependent children under the age of 13 from the work requirement. The proposed amendment also creates “Workforce Bridge Accounts” for enrollees who lose Medicaid eligibility due to increased income. This proposed amendment to the HIP 2.0 waiver does not address the unavoidable issue of coverage losses that will result from the work reporting requirement. Furthermore, the proposed amendments add additional complexity to what is already an administratively burdensome individual account structure.
On September 23, 2019 a lawsuit was filed in federal district court to challenge CMS’s approval of the waiver
The HIP 2.0 program began February 1, 2015 and is approved through January 31, 2019.
- Families USA’s Comments on Pending Healthy Indiana Plan 1115 Workforce Bridge Account Amendment (2019)
- Families USA Comments on HIP 2.0 Waiver Extension Amendment (2017)
- Families USA comments on Indiana’s Healthy Indiana HIP 2.0 Section 1115 waiver request to modify and expand eligibility (2014)
- View All Federal Comments for 1115 Medicaid Waivers
HIP 2.0 covers childless adults in the Medicaid expansion population (19-64) who make less than 138 percent of the federal poverty level, or about $16,000 per year for a single person.
- Health Savings Accounts
- Impact on oral health
- Wellness Program
- Employment/Job Search Program
- Retroactive Coverage
Premiums are in the form of health savings account, called “POWER” account contributions. All enrollees have a POWER account and are charged premiums. Those with incomes above 100 percent of poverty must make monthly POWER account payments in order to stay enrolled. However, enrollees who pay premiums are enrolled in a more generous benefit package (HIP Plus) and do not pay copays. Enrollees with incomes below 100 percent of poverty who cannot not make POWER accounts premium payments are enrolled in a less generous benefit package with no premiums but copays. Premiums are limited to 2 percent of income. For enrollees with incomes below 5 percent of poverty premiums are $1 per month.
If enrollees above the poverty line fail to pay premiums within a 60 day non-payment grace period, they are disenrolled from Medicaid and locked out of Medicaid coverage for six months. Individuals may re-enroll after six months if they pay all back premiums and the first month’s reinstatement premium. Those below the poverty line who fail to pay POWER account premiums cannot be locked out. Instead, they are moved into the less generous benefit package with copays. Learn more and get advocacy strategies to combat premiums.
The state received approval to test higher than standard cost-sharing for non-emergency use of the ER. This approval was authorized under section 1916(f) of the Social Security Act, not under the Secretary’s section 1115 waiver authority. Learn more and get advocacy strategies to combat cost sharing.
HIP 2.0 includes a two tier benefit package—HIP plus and HIP Basic. HIP Plus includes enhanced benefits such as vision and dental coverage and enrollees must pay a premium (i.e. contribute to their POWER account). HIP Plus is the only benefit option available to enrollees with incomes above 100 percent of the federal poverty level. HIP Basic is a more limited benefit package and is only available to enrollees with incomes at and below 100 percent of poverty. Enrollees are not required to make POWER Account contributions, but instead pay standard Medicaid copays at the point of service. Learn more and get advocacy strategies to combat benefit reductions.
Indiana received a time-limited approval to waive non-emergency medical transportation benefits with required evaluation. Learn more and get advocacy strategies to combat waivers of NEMT.
Health Savings Accounts
Individual accounts, called POWER accounts, are funded by the state, enrollee contributions, and potentially third-party donations. POWER account funds are used to pay for the first $2,500 of an individual’s annual claims. If there are insufficient funds in an account to cover the first $2,500 in claims, Medicaid will cover any shortfall and all claims beyond the initial $2,500 will are fully covered by the Medicaid managed care plan. If enrollees have money left over in their POWER account at the end of the year AND have completed specified wellness activities, leftover money can be rolled over to the next year’s account to reduce individual monthly contributions. Learn more and get advocacy strategies to combat HSAs.
- Impact on oral health: Adults who are not medically frail and are not caring for dependent children can only get dental care through POWER accounts.
HIP 2.0 includes a wellness program. Enrollees who complete certain healthy behaviors can roll over unused POWER account funds to the next year. Learn more and get advocacy strategies to combat wellness programs.
Employment/Job Search Program
HIP 2.0 includes a voluntary work search referral program. Learn more and get advocacy strategies to combat work requirements.
Retroactive Coverage/Coverage Start Date
Indiana is not required to provide benefits retroactive 90 days prior to the month of application. For individuals with incomes above 100 percent of poverty, coverage begins with the first POWER account payment, rather than being tied to application date. For individuals below 100 percent of poverty, coverage is delayed until either the first POWER account payment or 60 days. Learn more and get advocacy strategies to combat retroactive coverage.