Indiana’s version of Medicaid, the Healthy Indiana Plan, offers much more than just access to lower-cost health insurance. It also can provide help in finding a job, housing, and transportation as well as a free cellphone and access to educational services.
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WASHINGTON – Gov. Eric Holcomb is seeking permission from the federal government to require some Medicaid recipients to work or do work-related activities.
Indiana’s governor announced Wednesday he’s amending the state’s January application for its alternative Medicaid program to ask for that — and other changes — as the federal government decides whether to keep the Healthy Indiana Plan going past this year.
Holcomb said his request is in response to encouragement from Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma — a former Indiana health care consultant who helped create HIP, Indiana’s Medicaid program. After joining the Trump administration, Price and Verma told governors they want to give states more freedom to run their Medicaid programs.
It’s unclear, however, how much leeway the federal government has within the law to allow states to impose work requirements or some other changes.
But the House version of the Republican effort to repeal and replace the Affordable Care Act would change the law to allow states to impose work requirements for able-bodied recipients.
The nonpartisan Kaiser Family Foundation reported last year that 59 percent of all Medicaid beneficiaries who were not receiving disability payments were working. If they weren’t, they were either sick, taking care of a family member or in school.
Holcomb said Indiana needs a healthy workforce and his proposed change would help the state meet the demand for new workers expected over the next decade.
The requirement would be phased in and would not apply to some participants, including pregnant women, those being treated for substance abuse, the medically frail and those older than 60.
The state estimates about 30 percent of current recipients would have to comply. If they’re not already working at least 20 hours a week or going to school, recipients would have to participate in the state’s “Gateway to Work” program. That program was created for the Healthy Indiana Program to connect unemployed recipients with job openings and with work search and job training programs. Participation has been optional since HIP 2.0 began in 2015 and not enough recipients are taking advantage of the services, the state argues. That’s despite the fact that about 244,000 HIP 2.0 beneficiaries are unemployed and another 58,000 work less than 20 hours a week, according to the state.
“The process to date has not been successful in connecting individuals with sustained employment,” the state said in its waiver request.
Those who don’t comply will be suspended from receiving health care benefits until they meet their required participation hours for a month. The state estimates about one-fourth of those referred to Gateway to Work will chose not to participate.
In the request the state filed to amend its renewal application, Holcomb also is asking for changes that would make it easier to expand drug abuse treatments and would simplify administration of the monthly payments recipients are required to make if they are above poverty or are in poverty but want to access a higher level of benefits.
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Participants pay up to 2 percent of their income into a monthly Personal Wellness and Responsibility Account, which helps pay for their care, a hallmark feature of HIP 2.0.
The program — which provides health care to more than 400,000 Hoosiers — has the enthusiastic support of Indiana’s hospitals, the insurance companies which offer the Medicaid plans, and some groups in the state which had urged Indiana to expand Medicaid under the Affordable Care Act.
But many — including some participants — complain the program is too complicated and confusing, isn’t as effective as traditional Medicaid and hasn’t proven that its “consumer-driven” components make patients better health care consumers.
A spokeswoman for the Indiana Hospital Association said the group is still studying the state’s proposed work requirement. While declining comment on that aspect, Executive Vice President Brian Tabor praised Holcomb’s “continued leadership in addressing the substance abuse crisis and his support for renewing the vital HIP 2.0 program.”
Tabor also said in a statement that hospitals are focused on ensuring there’s enough federal funding for HIP as Congress revamps the Affordable Care Act.
The nonpartisan Congressional Budget Office estimated Wednesday that Medicaid enrollment would be about 17 percent less than under Obamacare if the House health care bill — which cuts Medicaid funding by $834 billion — becomes law.
The Senate is still working on its approach to repealing and replacing Obamacare.
The law allowed Indiana to expand Medicaid eligibility with the federal government picking up most of the new cost. As governor, now-Vice President Mike Pence received permission from the Obama administration to test HIP 2.0 as an alternative Medicaid program for three years.
Holcomb has asked the Trump Administration for another three-year waiver of Medicaid rules.
The public can comment on the state’s latest proposed changes until June 23.
The federal government does not have a deadline to respond. But the state has said federal officials have been working expeditiously on their renewal application.
USA TODAY’S Jayne O’Donnelly contributed to this story.
Contact Maureen Groppe at mgroppe@gannett.com. Follow her on Twitter: @mgroppe.