Indiana gets 10-year extension for low-income insurance plan

Indiana has received federal approval to extend its Healthy Indiana Plan, which provides health insurance for more than 572,000 low-income Hoosiers, through December 2030.

Gov. Eric Holcomb announced the approval from the U.S. Centers for Medicare and Medicaid Services on Oct. 26. But there's a large question hanging over the announcement.

The program is funded by federal Medicaid dollars. Indiana Attorney General Curtis Hill is backing a multistate lawsuit that would eliminate the Affordable Care Act. The suit is scheduled to come before the U.S. Supreme Court on Nov. 10, and the court is expected to rule before its term ends in June.

Without federal funding, Indiana likely could not afford to continue HIP. The federal government provides 90% of the funding, worth billions of dollars a year.

Hill, who is leaving office at the end of the year, has argued that the Affordable Care Act amounts to congressional overreach.

"Congress should never have imposed the one-size-fits-all mandate in the first place," he said last year. "Choice, freedom and the roles of the individual states must remain part of the health care equation in America."

Holcomb's announcement did not mention the possible ending of federal money for the Healthy Indiana Plan if the Supreme Court strikes down the Affordable Care Act. Instead, it focused on the future of the program without any possible interruptions.

"Today's extension empowers more than half a million Hoosiers to continue receiving quality health care coverage from our innovative HIP program," Holcomb said in written remarks. "As a national model for a state-led, consumer-driven approach, HIP helps Hoosiers experience improved health outcomes and better lives."

The governor's office referred IBJ's questions regarding the implications of losing federal funding to Indiana's Family and Social Services Administration. The agency released a statement that said it is monitoring the Obamacare lawsuit.

"In the event of an outcome that impacts the current financing of HIP, we would work with our partners such as the Indiana General Assembly, Indiana Hospital Association and other provider organizations, to look for solutions to preserve coverage," the statement said.

The current incarnation of the Healthy Indiana Plan developed after the Obama administration offered states the option to expand Medicaid under the Affordable Care Act, aka Obamacare. Holcomb's predecessor, Gov. Mike Pence, got federal permission to create a different kind of model. It used funding from the Affordable Care Act to build out the pre-existing Healthy Indiana Plan, and required participants to put some "skin in the game" by contributing from $1 to $27 a month. But all cost-sharing has been suspended during the COVID-19 public health emergency.

"Hoosiers have led on state health care innovation for years, including under former Gov. Mike Pence and continuing today under Gov. Holcomb," said U.S. Department of Health and Human Services Secretary Alex Azar, in written remarks. "This 10-year extension of the successful Healthy Indiana Program allows the state to make new progress on the kind of patient-centered health care system President Trump envisions.

"State innovation is an opportunity to test out ideas for delivering our ultimate goal of better health and well-being, and we encourage states to continue working with us, like Indiana has, to tailor their programs to their unique needs."

Additionally, the approval from the U.S. Centers for Medicare and Medicaid Services grants five-year extensions of some of the newer components of Indiana's HIP program that have provided treatment for substance use disorder and serious mental illness for 88,000 Hoosiers across all Medicaid programs, Holcomb said.

In 2018, Hoosiers covered by HIP made more than 545,000 visits for preventive services, and mammograms and vaccinations are at record highs for members. The program combats Indiana's top contributor to chronic disease-smoking-by waiving co-pays and covering all therapies, the state said.

HIP also provides full maternity services, including prenatal services, dental, behavior health, and substance use disorder treatment, at no cost to the member for the duration of her pregnancy and 60 days after delivery. Enrollment in pregnancy management programs increased at an average annual growth rate of 41% from 2015 to 2018.

"With this approval, our health policy leaders at FSSA will be able to spend more time operating, evaluating and improving HIP, as well as engaging members and partners," said Dr. Jennifer Sullivan, secretary of Indiana's Family and Social Services Administration, which oversees Medicaid programs.