On October 1, some Hoosiers covered by Indiana’s Medicaid expansion program, Healthy Indiana Plan (HIP), now have to report 40 hours of work, education, or volunteerism to meet Indiana’s new Gateway to Work requirements.
The program, which was approved by the Centers for Medicare and Medicaid (CMS) and implemented on January 1, 2019, is slowly ramping up for HIP beneficiaries who don’t qualify for an exemption and aren’t already working 20 hours a week. For the first six months, no reporting was required. Beginning July 1, 2019, 20 hours per month of qualifying activities had to be reported. Starting October 1, that number jumps to 40; on January 1, 2020, the number jumps again to 60 hours per month. And beginning July 1, 2020, participants must report 80 hours of qualifying activities each month for at least eight months each year to remain eligible for HIP benefits.
One of Six States
Indiana is one of six states that have received waivers from CMS to add work requirements to Medicaid expansion programs. According to a recent Fierce Healthcare article, however, Indiana is the only state actively running the program.
Two other states with waivers, Kentucky and Arkansas, are locked in a legal battle over their work requirements. Just last week, judges of the U.S. Court of Appeals for the District of Columbia heard oral arguments about a lower court’s decision against the work requirements for Medicaid expansion beneficiaries in those states. Fierce Healthcare’s Robert King reported that the judges appeared “highly skeptical of the Trump administration’s argument that Medicaid work requirements meet the objectives of Medicaid, signaling a possible new legal defeat for the administration.”
Indiana’s Program Stands Apart
According to a September 1, 2019, article in The Washington Post, so far Indiana has avoided legal challenges to its Gateway to Work program. Also, according to state officials, no one has lost coverage because of the program, and the Indiana Secretary of State has vowed no one will.
“We don’t want to hurt anybody, we’re just making progress in Indiana in improving our health outcomes. We don’t want to change that — that trajectory is important,” Indiana Family and Social Services Administration Secretary Jennifer Walthall said in an interview with Washington Post reporter Paige Winfield Cunningham.
What makes Indiana’s program less onerous and more effective than other states’? Some believe the gradual roll-out has helped. As well, since the program affects only those in the HIP program, it represents a small percentage of the total Medicaid population. Gateway to Work also includes more than a dozen exemptions and offers a variety of qualifying activities for those who need to report their hours. Finally, the program does not include a lockout period, which means HIP eligible individuals can reenter the program as soon as they come back into compliance with Gateway to Work.
Not Everyone Agrees
Despite its “kinder, gentler” approach, Indiana’s Medicaid work requirements do have their detractors. A rally against the program was held on Monument Circle on July 1, the first day of Gateway to Work reporting requirements. And Fran Quigley, director of the Health and Human Rights Clinic at Indiana University’s law school, believes the Gateway to Work program ultimately will cause people to lose coverage and experience decreased healthfulness in the long run.
“Let me just be real blunt about this . . . this is a politically motivated lie,” he said. “They are inevitably going to cut people in Indiana off of their health care.”
To learn more about Indiana’s Gateway to Work program, check out the following resources:
- Indiana Family and Social Services Administration’s “Learn about Gateway to Work” webpage.
- “Indiana seeks to impose slower, kinder work requirements on Medicaid recipients” by Paige Winfield Cunningham for The Washington Post on September 1, 2019.
- “Rally against ‘Gateway to Work’ requirements in Indianapolis” for RTV6 on July 1, 2019
- “Judges skeptical of Medicaid work requirements in appeals hearing on Kentucky, Arkansas programs” by Robert King for Fierce Healthcare on October 11, 2019.
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