Indiana health insurance plan at risk after federal ruling
An Indiana health insurance plan used by hundreds of thousands could be in danger after a Washington, D.C. judge ruled in favor of a lawsuit against the Department of Health and Human Services and vacated the plan’s federal approval.
Chief Judge James E. Boasberg found issues with specific premium requirements included in the program and the HHS’s approval of these premiums, as well as the program’s lack of retroactive coverage.
It’s not clear how the ruling will affect the program. As of Thursday night, a spokesperson with Indiana’s Family and Social Services Administration (FSSA) reported the agency was reviewing the ruling.
The Healthy Indiana Plan is a health insurance plan with two “pathways”: HIP Basic and HIP Plus. The “premium” HIP Plus requires monthly contributions to a POWER account, which earns users better benefits, and HIP Basic requires copayments for doctor or hospital visits. However, these payments have been paused since March 2020. They were set to restart July 1.
In his opinion, Judge Boasberg raised concerns about loss of coverage caused by these premiums. He pointed to data: from February 2015 and November 2016, almost 10,000 people were disenrolled from HIP Plus for nonpayment of premiums, and nearly 4,000 were disenrolled from HIP Basic for the same reason.
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An additional nearly 48,000 Hoosiers were found eligible for HIP Plus but never enrolled because they did not make their first premium payment.
The state previously argued that Indiana law requires the FSSA to charge for the POWER Account contributions to continue the HIP Plus program. The judge disagreed, saying that state law would not end HIP Plus and that plaintiffs would remain eligible for Medicaid even if approval is vacated.
The judge also raised issue with the program’s lack of access to retroactive coverage, which would allow people who sought medical care without insurance and later learned they qualified for HIP to have some or all of those previously incurred costs covered.
Indiana offers retroactive coverage in some other Medicaid health plans, but here the state argued that by not providing it, HIP users would be incentivized to seek coverage earlier.
In his opinion, Judge Boasberg stated this reduces coverage overall.
HIP, which provides health insurance to 762,276 Hoosiers, has been offered since 2007, under former Gov. Mitch Daniels. However, the program was only expanded to include the premium option in 2012. HHS approved the program first in 2015, which Judge Boasberg’s decision said waived several key Medicaid requirements, and again in 2020.
The Biden administration announced it would review the program once they’d taken over; however, they stated at the end of 2023 that while there were concerns, they would not move to withdraw approval.
Contact IndyStar politics Pulliam fellow Nadia Scharf at [email protected] or follow her on Twitter @nadiaascharf.
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