Cost-Share Restart

FSSA files motion to stay in HIP case, asks for CMS support

July 12, 2024

Today, the Indiana Family and Social Services Administration filed a motion to stay the District Court’s June 27 ruling in Rose v. Becerra, which vacated federal approval for the Healthy Indiana Plan.

Additionally, this week FSSA sent a letter to the Centers for Medicare and Medicaid Services asking CMS to support the state’s motion and reissue the HIP approval in its entirety if a stay is not granted. The letter also reiterated that the ability to collect POWER account contributions was fundamental to Indiana’s decision to expand Medicaid.

Without a stay or reissuance of the HIP approval, FSSA will be required to start transitioning HIP Plus members to a different benefit package that does not include vision, dental, and other services. The removal of the entire HIP approval also risks the state’s ability to collect the Hospital Assessment Fee, which helps fund coverage for HIP members. Without this funding, it is unlikely the state can continue to provide coverage at the current enrollment, utilization, and reimbursement levels.

The District’s Court’s ruling is far reaching and creates considerable uncertainty for the HIP program. Some implications of the ruling conflict with state law, which could eventually impact the state’s ability to provide health care coverage to the Medicaid expansion group. In addition to addressing the state law conflicts, FSSA will have to make substantial systems and operational changes that will take 12 months or more.

FSSA’s letter to CMS is posted in its entirety here

About the Healthy Indiana Plan

Indiana’s Healthy Indiana Plan began as a limited pilot program in 2007 and most recently was granted a 10-year approval by the U.S. Department of Health and Human Services in 2020. The Healthy Indiana Plan provides health insurance for approximately 760,000 Hoosiers, which is more than 10 percent of the state’s population, and accounts for nearly 40 percent of the total Indiana Medicaid enrollment.

HIP covers Hoosiers ages 19 to 64 who meet specific income levels. For example, an individual with an annual income of up to $20,793 may qualify. The HIP program is designed to encourage members to take better care of their health.

Cost-sharing for HIP program to remain paused at this time - July 1, 2024

FSSA is working with its attorneys and consulting with its federal partners at Centers for Medicare and Medicaid Services and will explore all legal remedies regarding the June 27 ruling regarding the lawsuit against the Healthy Indiana Plan.

At this time, cost-sharing for the HIP program, including POWER account contributions and co-pays, will remain paused. MEDWorks and CHIP co-pays will resume effective July 1 as planned.

Indiana strongly disagrees with the ruling and believes the actions have unintended consequences. The implications of the decision handed down are far-reaching. FSSA is still evaluating the impact for the state and the 762,000 Hoosiers who rely on healthcare coverage through the Healthy Indiana Plan. HIP was designed to provide healthcare coverage to non-disabled adults ages 19-64, empowering them to become engaged and active consumers of their health care.

At this time, individuals on the Healthy Indiana Plan remain covered, but there is uncertainty as to what services are included in that coverage.

While the lawsuit took aim at HIP’s POWER account contributions or premium-like payments, the June 27 decision revoked the entire 10-year waiver approval granted to Indiana in 2020 to operate HIP – creating uncertainty regarding which services are covered for HIP members and removing authority for certain administrative aspects of the program’s operation. The ruling also has implications that conflict with state law.