INDIANAPOLIS – Gov. Eric Holcomb on Tuesday formally requested the renewal of a federal waiver that allows Indiana’s HIP 2.0 program to serve hundreds of thousands of low-income Hoosiers.
"Indiana has built a program that is delivering real results in a responsible, efficient and effective way," he said. "I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers."
It is the start of an eight-month process with the U.S. Centers for Medicare & Medicaid Services that is expected to be smooth under the administration of Republican President Donald Trump.
The Healthy Indiana Plan originated under former Gov. Mitch Daniels, and HIP 2.0 was launched in February 2015 under then-Gov. Mike Pence as a quasi-Medicaid expansion funded mostly by the Affordable Care Act. The waiver expires Jan. 31, 2018, and the extension would go until 2021.
Pence is now vice president, and Indiana’s program is seen as a possible model for the rest of the nation if Obamacare is repealed.
One change requested by Holcomb is to expand access to substance use disorder services for all Medicaid recipients. Specifically, the waiver would add new covered services, including residential treatment services and addiction recovery management.
HIP 2.0 has several cost-sharing components for enrollees – including an average monthly contribution – aimed at pushing members to seek preventive care and make good health care choices. This is a key difference from traditional Medicaid, which bears all costs of care.
"This is a plan built by Hoosiers for Hoosiers," Holcomb said in his request letter to the acting secretary of the U.S. Department of Health and Human Services. "Our consumer skin-in-the-game approach has yielded better health outcomes and helped members be better informed."
The program has about 390,000 members enrolled and is available to all non-disabled Hoosiers ages 19-64 with incomes at or below 138 percent of the federal poverty level. That is up to $16,590 for a single person or $33,934 for a family of four.
The program currently has two tiers. Both plans meet minimum requirements required by the Affordable Care Act, but one is more generous than the other.
Anyone whose income is below 100 percent of the federal poverty line would be placed in the HIP Plus plan. This requires a monthly contribution depending on income. It also provides access to dental and vision coverage, less treatment limitations, a better prescription plan and no co-pays.
But enrollees who don’t pay the monthly contribution will be switched to the HIP Basic plan, which has reduced benefits, more prescription restrictions and no dental or vision coverage. Most importantly, it requires copays for all health care services except preventive and family-planning services.
Those with incomes between 100 percent and 138 percent of the poverty level go to HIP Plus automatically. If they don’t make their monthly contribution, their coverage is suspended for six months rather than switched to the basic plan.