On Tuesday, January 27, Indiana became the 28th State – along with the District of Columbia – to expand Medicaid under the Affordable Care Act. In the announcement, CMS Administrator Marilyn Tavenner said, “This agreement will bring much needed access to health care coverage to an estimated 350,000 uninsured low-income Hoosiers over the next three years. HHS and CMS are committed to working with states to design programs uniquely their own, while maintaining essential health benefits guaranteed under the Affordable Care Act and other key consumer protections consistent with the law.”
This expansion will benefit the Health Indiana Plan in some of the following ways:
- Beneficiaries will begin to have access to quality, affordable coverage with the essential benefits guaranteed by law beginning on February 1, 2015 for eligible individuals.
- Indiana’s plan establishes POWER Accounts, which beneficiaries will use to pay for some of beneficiaries’ health care expenses.
- Beneficiaries will have access to all of the essential health benefits that are required under the law.
- Individuals who are charged premiums (in the form of POWER account contributions) will enroll in HIP Plus and have no other cost sharing, expect for certain emergency room services.
- CMS did not approve a work requirement as part of this agreement.
- Co-payments for certain emergency room services to some individuals will be allowed in connection with a study testing whether copays encourage care in the most appropriate settings while not harming beneficiary health.
- Individuals with incomes at or below 100% FPL are not subject to a lockout of essential benefits.
- Several features of HIP 1.0 were not continued as part of this new demonstration.
You can read the full announcement here.