Advocates call on federal agencies to suspend two waivers in HIP, warning loss of coverage

A group of Indiana organizations wants to address parts of the state’s Medicaid system that could lead to coverage losses and gaps in coverage. Advocates wrote a letter to the Center for Medicaid and CHIP Services requesting it suspend two waivers in the Healthy Indiana Plan: one that allows the state to deny retroactive coverage and one that allows the state to collect premiums.

Advocates said the Medicaid unwinding process – following the end of the COVID-19 federal public health emergency – highlights flaws in Indiana’s system.

Tracey Hutchings-Goetz, the communications and policy director for Hoosier Action, said retroactive coverage denials and the reintroduction of HIP premiums may lead to people going into medical debt or avoiding care.

“There’s a real human cost to these confusing policies as well as an economic cost because it drives up the costs for Indiana’s Medicaid programs by contributing to a churn,” Hutchings-Goetz said.

If a member is found to be ineligible during redetermination and their coverage is terminated, they have 90 days to “come back into compliance” and potentially regain eligibility. With most Medicaid programs, when someone regains eligibility within those 90 days they get retroactive coverage, meaning they don’t have to wait until the next month to be fully covered. HIP has a waiver that allows the state to deny that coverage.

READ MORE: New data shows decrease in Medicaid disenrollment for Hoosiers in latest reporting period

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While the denial of retroactive coverage is already affecting Hoosiers, there’s still some time until premiums are reintroduced.

Premiums, or POWER account contributions, are meant to function as “a special savings account that members use to pay for health care.” The state pays for most of the amount in the POWER account, but members are responsible for a monthly payment depending on income. This payment allows them to enroll in HIP Plus, which offers vision, dental and chiropractic coverage.

“POWER accounts were a very common concern with the program — people getting kicked off because of them or getting kicked to lower health care coverage,” Hutchings-Goetz said.

Advocates are concerned about how reintroducing POWER accounts might affect Medicaid members.

“That is going to really drive up terminations and reductions in health care coverage, just by layering on this additional complexity,” Hutchings-Goetz said.

The 2022 Healthy Indiana Plan Summative Evaluation Report found provider association interviewees mentioned challenges with the program “noting that the language and overall structure of the POWER account is sometimes difficult to understand for both members and administrators.”

The report also found that while most members indicated they understood POWER accounts “generally,” fewer members understood the consequences of nonpayment.

Adam Mueller, executive director of the Indiana Justice Project, said the U.S. Department of Health and Human Services is required to monitor the programs and act when they aren’t working.

“Right now especially, it’s sort of one of those times where we’re really worried that folks are going to incur a significant amount of unnecessary medical debt,” Mueller said.

POWER accounts payments are expected to come back as the state continues its return-to-normal procedures.

Abigail is our health reporter. Contact them at [email protected].