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!

"Thanks, Mom."

As Mother’s Day approaches, I often think back on the advice my Mom gave me.  Things like, keep your feet clean, wash behind your ears, milk is good for you, eat some more vegetable, and so on.  When I was a kid those words flowed into one ear and out the other.  Now that I’m grown with a child of my own her words seem to have more resonance in my life.

My Mom has always taken good care of herself.  She gets regular check-ups with her physician and various specialists.  She eats good food, exercises, and always gets a flu shot in the fall.  Because of this she is able to enjoy her age and her life.  My brothers and I have lived healthier lives by following her example.

In Indiana, we have a number of Medicaid programs.  Two of them are the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW).  HHW is a program intended for children, pregnant women, and families with low income in Indiana.  HHW covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, surgeries, and family planning at little or no cost to the member or the member's family.  You can find more about both programs at http://indiana.gov/fssa

HIP is an affordable health insurance program for uninsured adult Hoosiers. The program is sponsored by the State and only requires minimal monthly contributions from the participant. HIP is for uninsured Hoosiers between the ages of 19-64. It offers full health benefits including hospital services, mental health care, physician services, prescriptions and diagnostic exams.  If you qualify for the HIP program, you are set-up with a POWER Account.  POWER Accounts give participants a financial incentive to adopt healthy behaviors that keep them out of the doctor's office. When they do seek health care, plan participants will seek price transparency so they can make value conscious decisions to better manage the funds in their account.

Both of these programs make me think of the advice Mom has given me for years:  take care of yourself and your health.  If you do not live in Indiana or you need information about other Medicaid programs, you can contact a Navigator (like me) or by calling 1-877-KIDS-NOW.  You can also visit healthcare.gov to find information about the Affordable Care Act and find a Navigator in your area.  And if you have a mom or caregiver in your life that has made a big difference, take a minute to say, “Thanks, Mom” this Sunday. 

Me, Mom, and her dog, Bella.

My Hoosier Healthwise Story

About 5 years ago I had a job as a real estate agent.  Like most real estate agents, I worked as a private contractor and health insurance was not available through my company.  I went to a private insurance agency and since I had a pre-existing condition, the insurance plans that were available to my family were over $500 per month.  This was unaffordable.  Even though I was concerned about my own healthcare, I was more concerned about my daughter.  I wanted to be sure that my daughter received the services she needed like annual check-ups, dental cleanings, vision checks, vaccinations, and the ability to see a doctor if she got sick.  I didn’t have the money to pay for an expensive insurance plan, but I also didn’t have the money to pay for an emergency room bill if things got really bad.  I didn’t know what to do and I was worried.

Luckily a friend told me about Hoosier Healthwise.  I had no clue what Hoosier Healthwise was or how CHIP (Children’s Health Insurance Plans) worked.  At first I didn’t see any point in applying because I didn’t think our family would qualify.  I didn’t make a ton of money, but I made enough to pay my bills.  I thought Medicaid was only for people who weren’t able to work.  I did a little research and my friend told me to go ahead and apply.  What did I have to lose? 

After I submitted my application online, I received a letter asking for a bunch of other stuff:  verification of income at my job, verification of my rent, etc.  I faxed the information and in a few weeks, I got an insurance card for my daughter.  I was so excited!  I could finally take her to get her teeth cleaned, update her vaccinations, get her annual check-up, and not be worried about what I would do if she fell and broke her arm.  Having health insurance for my daughter gave me a wonderful “peace of mind” and was one less thing I had to worry about. 

Later, I got a different job that offered employer sponsored health insurance, but even if that wouldn’t have happened the Affordable Care Act makes sure that people are no longer charged more for health insurance due to pre-existing conditions.  It’s good to know that this new rule will help many who could never afford health insurance in the past. 

I hope that you will not hesitate to enroll your children in a health insurance plan.  If you do not live in Indiana and are therefore not offered our Hoosier Healthwise program, please check with your local social services office or call 1-877-KIDS-NOW to learn about Medicaid and  CHIP programs in your state.  Having health insurance is important for all families—for you and your kids.  Children and teens up to age 19 may be eligible for Medicaid or CHIP, but if you are enrolling you children, please make sure you talk to a Navigator about enrolling yourself as well.  When families are enrolled in health insurance it makes them more financially secure, more productive at work, and allows them receive preventative care to help avoid emergencies.

For more information about enrollment, please see a Navigator in your area.  If you are in Jay or Randolph Counties in Indiana, you can email me directly at sara.hall@meridianhs.org.  You can search for local Navigators at www.healthcare.gov 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 Medicaid and CHIP at www.insurekidsnow.gov.   Medicaid and CHIP enrollment are available year round.  If you are eligible for health insurance, you have not missed out.  Don’t wait—do it today!