Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Governor Pence Gets Federal Nod for HIP 2.0

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Gov. Mike Pence received a federal nod for his Healthy Indiana Plan (HIP) 2.0 Medicaid expansion on Tuesday, January 27, from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS).

According to the Indianapolis Star, Gov. Pence announced Tuesday morning at a packed speech at St. Vincent Health that the state also will begin taking applications for the program that day for coverage that begins February 1.

“With today’s agreement, Indiana will become the 28th state, plus the District of Columbia, to expand Medicaid under the Affordable Care Act. This agreement will bring much needed access to health care coverage to an estimated 350,000 uninsured low-income Hoosiers over the next three years,” said CMS Administrator Marilyn Tavenner in a prepared statement. “HHS and CMS are committed to working with states to design programs uniquely their own, while maintaining essential health benefits guaranteed under the Affordable Care Act and other key consumer protections consistent with the law.”

The Indiana plan is a consumer-driven Medicaid alternative for Hoosiers with incomes below 138 percent of the federal poverty level (FPL). Indiana is among only four states to apply private market measures, such as requiring participants to make monthly contributions to help cover the benefit, the Indy Star reported.

HIP 2.0 utilizes a two-tiered plan structure. HIP Plus includes essential benefits plus enhanced coverage, like dental and vision, and uses Power Accounts that combine state and beneficiary contributions. Beneficiary contributions range from $3 to $25 and are based on income. As long as monthly contributions are made, beneficiaries enrolled in HIP Plus will have no other cost sharing except for certain emergency room services.

The HIP Basic Plan is for Individuals with incomes at or below 100 percent FPL who do not make Power Account contributions. These beneficiaries can not lose essential health benefits, but if they do not meet the Plus plan contributions, they will be forced into the HIP Basic plan where they will take on cost sharing for services and lose some of the enhanced coverage of the Plus plan. For HIP Basic, cost sharing will comply with regular program limits and total cost sharing will not exceed 5 percent of the family income. Beneficiaries in this category also will be given a 60-day grace period after non-payment of premiums before being automatically enrolled in HIP Basic.

For beneficiaries who fall between 100 and 138 percent of FPL and are not considered medically frail, failure to make Power Account contributions will result in being locked out of coverage for six months (reduced from one year from the original plan submitted by Gov. Pence).

The expansion is paid for with 100 percent federal funds through 2016. Federal funding rates gradually decline beginning in 2017 but never fall below 90 percent of costs. Hoosier funding for the plan at that time would come from cigarette tax revenues as well as from the hospital assessment fee.

According to CMS, several features of the current HIP 1.0 program were not approved for HIP 2.0 Medicaid expansion, including the following:

  • Capped enrollment;
  • Premium payments as a condition of eligibility for people with incomes below the federal poverty level; and
  • Premium payments in excess of 2 percent of income.

Also, CMS did not approve a work requirement that was part of the originally submitted plan.

For more information, visit the state’s HIP 2.0 webpage.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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