Indiana Agreement Wins the Award for Bureaucratic Complexity and Red Tape

I am still waiting for paper but here is what I know about Indiana so far. The good news is that Indiana becomes the 29th state (including D.C.) to extend Medicaid coverage. The less than good news is that this is an enormously complicated program which will likely prevent some low-income adults from getting the health care services they need.

The basic structure of HIP 2.0 was approved with two benefit packages – HIP Basic and HIP Plus. If you pay premiums and you are below poverty you get PLUS – which includes more dental and vision coverage. If you don’t you get Basic. Currently enrolled parents keep the same benefits but can have POWER accounts – so we are looking at a situation with adult Medicaid beneficiaries in at least 5 different categories with different benefits and cost-sharing rules.

I guess a lot of people will be getting Basic as apparently CMS has approved premiums (or so called POWER account payments) all the way down to 0% of the poverty line. Yes that is not a typo. If you have less than 5% of federal poverty you can pay (or someone could pay for you) $1 to get HIP Plus. That is a monthly income of $49 by the way. So CMS has preserved the principle of eligibility for coverage not being conditioned on premium payment for those below poverty, because those that don’t pay will be enrolled in Basic. But the specter of establishing POWER accounts for people who are likely homeless strikes me as bordering on the absurd.

But I digress … With respect to the lockout, it looks like Indiana got what it wanted here – a six-month lockout for those above the poverty line who do not pay their premiums with some limited exceptions. And the date of effective coverage for those who do pay premiums is complicated – I will await the paper to dig into that one, but I think it is fair to say that new ground has been broken here and it is not going to make for good policy I am guessing.

More to come after I read ….

Editor’s Note: More information about the final agreement between CMS and Indiana is now available here and here.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.