Big Changes in Indiana Medicaid

Lately, Indiana Medicaid seems just like Indiana weather—it’s always changing.  These changes are due to federal regulations, annual updates to the Federal Poverty Level (FPL), new state legislation, and other policy changes.  If you are already enrolled in an Indiana Medicaid program, it’s important to stay updated on any changes to your policy.  If you are interested in being enrolled in an Indiana Medicaid program, these changes may help you be applicable for a program for which you were previously denied.

The Supreme Court ruling on the Affordable Care Act (ACA) allowed states to option of accepting the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.  Indiana, along with 23 other states, chose to not expand Medicaid.  States that chose to expand Medicaid (including our neighboring states of Illinois, Ohio, Michigan, and Kentucky) are able to offer a wider variety of health insurance programs for their low income residents.  Navigators in Indiana need to be a little more creative in finding coverage programs for low income residents in our state. 

Indiana state and federal officials in September 2013 finalized a deal for a one-year extension to the Healthy Indiana Plan (HIP), which serves low-income residents that do not qualify for Medicaid and resembles a health savings account. Gov. Mike Pence (R) has said that any future expansion of Medicaid would be through a plan that resembles HIP, and state officials said that the extension negotiations with the federal government left the door open for such a move in the future.  Just this month, Governor Pence revealed a snapshot of his plans for a HIP expansion entitled “HIP 2.0.”  HIP 2.0 would raise the number of low income Hoosiers who can participate in HIP by raising the FPL for this program from 100% to 138%.  HIP 2.0 is contingent upon the approval of the State’s waiver by the Federal Centers for Medicare and Medicaid Services and approval of a final financing plan by the state budget committee. The State’s goal is to secure these necessary approvals and begin HIP 2.0 enrollment in 2015.  You can find more information about this program at http://www.in.gov/fssa/hip/2445.htm.

There have also been major changes in the Medicaid Disability program in Indiana as we shift from a 209b to a 1634 state effective June 1^st.  A familiar program referred to as “spend-down” will cease to exist, SSI recipients will automatically be enrolled into the Medicaid program, and current members over 100% FPL will no longer have access to intensive community-based mental health services provided under MRO.  As a response to this change, Indiana introduced the BPHC (Behavioral and Primary Health Coordination) program also referred to as 1915 program.  There are a number of stipulations and requirements for eligibility into this program, but it is intended to provide supportive and intensive community based services to individuals with serious mental illness who demonstrate impairment in self-management of healthcare needs.  If you believe you or a loved one may be eligible for this program, you should contact your local CMHC (Community Mental Health Center) for more information.  Meridian Health Services, my employer, is such a facility.

For more information about health insurance enrollment, please see a Navigator in your area.  You can search for local Navigators at www.healthcare.org or you can check your state Department of Insurance (here is Indiana’s:  www.in.gov/idoi).  You can also find out more information about CHIP at www.insurekidsnow.gov.  Medicaid enrollment is available all year round.  If you are eligible for health insurance, you have not missed out.  Don’t wait—do it today!