Hoosier State Today

The Family and Social Services Administration (FSSA) is collaborating with its attorneys and consulting federal partners at the Centers for Medicare and Medicaid Services to explore all legal remedies following a recent court ruling concerning the Healthy Indiana Plan (HIP). Currently, cost-sharing measures for HIP, including POWER account contributions and co-pays, remain paused. However, MEDWorks and CHIP co-pays will resume as planned on July 1.

Indiana officials have expressed strong disagreement with the June 27 ruling, citing unintended consequences that could impact the state's healthcare coverage. The FSSA is assessing the decision's implications for Indiana and the 762,000 residents relying on HIP for their healthcare needs. HIP was established to provide healthcare coverage to non-disabled adults aged 19-64, encouraging them to engage actively in their health care.

Despite individuals on HIP remaining covered at this time, there is uncertainty regarding which services are included in that coverage. The lawsuit targeted HIP’s POWER account contributions or premium-like payments, leading to the revocation of a 10-year waiver approval granted in 2020. This has created ambiguity about covered services and administrative operations within HIP while conflicting with state law.

Chief Judge James E. Boasberg of the U.S. District Court for the District of Columbia vacated federal approval for various aspects of HIP 2.0 on June 27. The judge criticized the U.S. Department of Health and Human Services’ (HHS) approval from 2020, which included elements like POWER Accounts and lack of retroactive coverage.

Initially introduced by former Governor Mitch Daniels in 2007 and further developed by Governor Mike Pence, HIP’s consumer-driven approach aimed at moderate-income workers expanded Medicaid coverage. The recent ruling's full extent remains unclear as FSSA continues reviewing it.

POWER Accounts had been paused since the COVID-19 pandemic began but were scheduled to restart on July 1 for HIP beneficiaries. State law mandates charging a POWER Account contribution; however, striking these accounts could potentially unravel the entire program according to state arguments—a stance Judge Boasberg disagreed with.

“Because Plaintiffs — like all members of the expansion population — derive their eligibility for Medicaid through Indiana’s state plan … they would remain Medicaid eligible even if the Secretary’s 2020 approval is vacated unless and until the State takes additional action to terminate their coverage,” Boasberg wrote.

HIP offers a two-tiered plan for non-disabled adults in Indiana with incomes at or below 138% of the federal poverty level (FPL), imposing restrictions such as monthly income-based premiums without retroactive coverage. Data indicated that premiums have threatened coverage for thousands of Hoosiers; between February 2015 and November 2016, nearly 60,000 Hoosiers were disenrolled or never enrolled due to non-payment.

Coverage loss continued between 2017 and 2018 when over 26,000 enrollees were disenrolled from HIP Plus for failure to pay premiums according to Boasberg’s citations.

Three plaintiffs utilizing HIP sued HHS over its approval of POWER Accounts alongside work requirements and rules barring retroactive coverage while blocking payments for non-emergency medical transport—prevailing in court against these stipulations despite previous removal of work requirements by Biden Administration policies.

Retroactive coverage examples include scenarios where uninsured individuals seeking emergency care later discover eligibility under HIP, allowing retrospective expense claims once approved—a benefit extended under other Medicaid plans but restricted within HIP currently.

Plaintiffs represented by Indiana Justice Project noted HHS's uncertainty regarding POWER Account premiums' benefits highlighted in a December letter approving state pursuits despite objections—ultimately permitted by CMS during unwinding processes without disrupting ongoing operations as per judicial observations suggesting continuation sans premiums might be viable without causing inadvertent disenrollment among beneficiaries.

This article is from Indiana Capital Chronicle – Read it here

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