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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Four Indiana residents who participate in the state’s Healthy Indiana Plan argue in a federal lawsuit filed Monday that new work requirements will harm them and tens of thousands of other Medicaid recipients in the state.
The lawsuit was filed against the federal government, which oversees the Medicaid programs that states implement. States that wanted to adopt work requirements had to apply to the Centers for Medicare and Medicaid Services for waivers to do so. The suit attempts to block the approval of Indiana’s plan.
It is the fourth action brought on behalf of Medicaid recipients who live in states with work requirements. The suit, filed in the U.S. District Court for the District of Columbia, charges that the Trump administration has gone too far in its efforts to transform Medicaid, originally a congressional program.
“The provisions that were waived we think violate the federal Medicaid act and therefore they should not be implemented,” said Adam Mueller, director of advocacy for Indiana Legal Services Inc., which filed the suit along with the National Health Law Program. “It’s not evident that the work requirement will lead to better access to health coverage or healthier outcomes.”
At this point Indiana is the only state that has an approved implemented work requirement, according to the Kaiser Family Foundation. Five other states have received federal approval for their waivers but have not implemented them yet. Several other states have waivers pending to adopt their own work requirements.
States can apply for waivers to amend Medicaid requirements in a variety of ways, from instituting surcharges for tobacco use to requiring beneficiaries to complete health risk assessments.
Courts have set aside the Arkansas, Kentucky and New Hampshire work requirements, though The Trump Administration has appealed two of those decisions.
Indiana officials have repeatedly said that the details of Indiana’s work requirement program make it drastically different from those in states that have such policies approved. They argue that the work requirement will provide incentives for people to find work and eventually get off of Medicaid all together.
Detractors say that many of those who would be affected by the work requirement are not physically or mentally able to enter the workforce. They say the verification process of whether one has met the requirement is cumbersome with ample opportunities for missteps that could result in beneficiaries’ undeserved loss of coverage.
Unlike some of the other states, Indiana added a slow ramp-up to its policy, which went into effect in January of this year. Currently recipients must work, volunteer, or engage in care-giving activities five hours a week unless they have an exemption for doing so. Next month that goes up to 10 hours a week, and next July that amount doubles to 20 hours a week.
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The state’s waiver request noted that making the work requirement mandatory would encourage more people to take advantage of the Gateway to Work program, which offers job training and encourages people to volunteer.
Gov. Eric Holcomb said in a statement released Tuesday that time would prove that Indiana’s approach will help and not harm the state’s Medicaid recipients.
“We intentionally designed the Gateway to Work program to connect HIP members with opportunities to work, learn or serve,” he said in an emailed statement. “Importantly, we are building this program unlike any other state in the country. … It’s disappointing a lawsuit has been filed before the program has had an opportunity to prove its success.”
Struggles with the new requirements
Some recipients already are reporting that they are struggling with the new requirements. The plaintiffs named in the lawsuit come from across the state and are “a cross section of Hoosiers,” Mueller said.
The first named plaintiff, Monte Rose, a 48-year-old Bloomington man, has a condition that causes periodic headaches and dizzy spells. Rose applied for disability more than a decade ago but was denied. He has been on the Healthy Indiana Plan for two years. He has no driver’s license and no home Internet, making it difficult to report hours to the state.
Since he heard he would have to participate in the Gateway to Work plan, he has asked the state and his insurer whether he can count toward the requirement the time he spends in his gardening and helping an elderly neighbor. So far, the lawsuit said, he has not received an answer.
Meanwhile Mary Holbrock, a 54-year-old academic in Fort Wayne, has received conflicting information. She has a part-time job grading standardized tests, but her work hours fluctuate wildly. In addition, she has Lyme Disease, post traumatic stress disorder, and a number of other health problems.
Twice, her health plan told her she qualified as medically frail and twice her plan has revoked that status even though nothing had changed in her health. Her health plan frequently warns her it is evaluating her status.
She did receive a letter saying she is exempt from work requirements, but it had no explanation why. She thinks it’s because she’s medically frail but fears that if her health plan changes her status, she will have to work 20 hours a week, which she may not be able to do and then would subsequently lose coverage.
Erin Nicole Tomlinson, 25, also works fluctuating hours. Sometimes, if business at JoAnn Fabrics is slow, her employer sends her home early. On average she works about 17 hours per week. Tomlinson, who lives with her grandmother, has never received any notice from the state about the work requirement, according to the suit.
Only after getting in contact with Indiana Legal Services was she able to call her health plan to find out whether she would have to comply with the work requirement. At that point she was told her status was “reporting met,” but like Holbrock she fears she may find herself without enough hours to fulfill the requirement and lose coverage.
According to the lawsuit, the work requirements could lead as many as 24,000 people in Indiana to lose coverage.
Contact IndyStar reporter Shari Rudavsky at 317-444-6354 or shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.
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