Approved January 2015 with technical corrections approved May 2015; Amendments approved November 2016; an application to modify and extend the existing wavier through Jan. 31, 2021 was submitted to the federal government on Jan. 31, 2017.
Waiver Approval Period:
February 1, 2015 through January 31, 2018
Key Themes from Waiver:
- Cost sharing
- Health savings account lookalike
- Medicaid expansion
- The Healthy Indiana Plan 2.0 (HIP 2.0) expands the current HIP demonstration to extend Medicaid coverage to all non-disabled adults ages 19-64 with income at or below 138 percent of the federal poverty level (FPL). There are two primary paths to coverage: “HIP Plus” or “HIP Basic.”
- Beneficiaries above 100 percent FPL must enroll in HIP Plus. HIP Plus includes enhanced benefits, such as dental and vision, but requires monthly premium contributions to a Personal Wellness and Responsibility (POWER) account. Those above 100 percent FPL must participate in HIP Plus. If these individuals cease making contributions to their POWER account, they will, after a 60 day grace period, be disenrolled from coverage and disqualified from coverage for six months.
- Beneficiaries at or below 100 percent of the FPL will be enrolled in HIP Basic or HIP Plus. HIP Basic includes a more limited benefits package and requires co-payments, but does not require monthly POWER account contributions. Individuals under 100 percent FPL enrolled in HIP Plus who fail to make their monthly POWER account contributions will automatically be placed in HIP Basic.
- The state may collect POWER account contributions from individuals up to 133 percent of the FPL in an amount not to exceed 2 percent of household income. POWER contributions from individuals with income below 5 percent of the FPL will be $1 per month. The POWER account will be used to pay for some of beneficiaries’ health care expenses covered under the demonstration.
- All beneficiaries will be subject to a copayment for non-emergent use of the Emergency Department (ED). The state has the authority to demonstrate whether a graduated co-payment – $8 for the first instance and $25 for recurrent non-emergent use of the ED, along with education and referrals to primary care providers – will reduce unnecessary ED use and improve beneficiaries’ use of health care in the most appropriate setting.
- Children under age 19 and individuals with disabilities remain eligible for traditional Medicaid and CHIP coverage and are ineligible for coverage through HIP 2.0. Both HIP Plus and HIP Basic maintain Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for 19 and 20-year-olds.
The waiver is consistent with CHA’s principles