By Nancy Johnson
For years, counselors at the nonprofit Covering Kids & Families of Indiana had to give bad news to some low-income people seeking health coverage: They earned too much to qualify for Medicaid, were too young for Medicare and couldn’t afford a commercial plan.
But that changed dramatically early this year after Gov. Mike Pence (R) announced that the state had received approval from the federal government to use Medicaid funds for an expanded version of the Healthy Indiana Plan.
Dubbed HIP 2.0, the new plan could extend coverage to as many as 350,000 Hoosiers in 2015 and another 162,000 next year
In its first two months, about 127,000 people had been newly enrolled in the expanded coverage, according to the governor’s office.
“It’s wonderful to tell folks that no matter where you are in the income spectrum, we can help you get enrolled in something,” said Caitlin Priest, director of public policy at Covering Kids & Families, which helped at least 2,000 people apply during the first month. “Now we can say there is a culture of coverage in Indiana.”
HIP 2.0 is available to nondisabled adults from 19 to 64 who earn up to $16,437 for an individual or $22,246 for a couple. Others may take advantage of coverage under the Affordable Care Act.
About 57,000 residents in the “pre-Medicare” age group—those 50 to 64—are now eligible for HIP 2.0 coverage, said June Lyle, AARP Indiana state director.
Help before Medicare
“A lot of our members under 65 have lost jobs or for other reasons haven’t had access to coverage,” Lyle said. “When people go many years without health coverage, they can become very sick from one or more chronic conditions by the time they are eligible for Medicare at 65. This will help people stay healthy.”
“At AARP, we see this as something we have advocated for, for some time,” Lyle added. “We see this as very good news.”
HIP 2.0 emphasizes what state officials call “personal health responsibility,” with most participants paying contributions of approximately 2 percent of annual family income.
The contributions, combined with government funding, create a Personal Wellness and Responsibility (POWER) account, which participants use to pay for the first $2,500 of care.
The plan uses a mix of incentives and disincentives to encourage preventive care and keep emergency room visits to a minimum. For example, the plan has a copay for recipients who use an emergency room for non-emergency service. A newly enrolled participant who fails to pay contributions could be dropped from the program for six months.
With its multiple parts and requirements, the expanded HIP is more complex than any other state plan using Medicaid funds, according to the Kaiser Family Foundation, which analyzes Medicaid spending in all the states.
The plan covers doctor and emergency room visits, hospitalization, maternity care, mental health, lab work, prescription drugs, rehabilitation and preventive services such as smoking cessation and mammograms. Once approved, members can choose a managed care plan among Anthem, MDwise or Managed Health Services (MHS).
The complexity of the plan means that counselors for Covering Kids & Families are spending a lot of time in one-on-one sessions with clients, helping them understand how it works. “Many people have no experience making payments toward a commercial insurance program,” Priest said.
The original HIP program had widespread public support and was effectively administered, which helped Indiana get federal approval and move quickly to administer the expanded plan, said Brian Neale, Pence’s health care policy director.
“Indiana was in a unique position from the start,” said Neale, who oversaw creation of the plan. “The Healthy Indiana Plan was a bipartisan-created program operating successfully over seven years with a high member satisfaction rate.”
To learn about HIP 2.0 eligibility or to apply, go to hip.in.gov or call 877-438-4479 toll-free. People can also apply at local Division of Family Resources offices.
Nancy Johnson is a writer living in South Bend.