Part 2 2022 IHCP Updates and Policy Reminders

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Part 2
IHCP Updates and Policy Reminders
IHCP Cost Sharing
Transitioning from HIP/HCC to
Traditional Medicaid
16

IHCP Member Cost Sharing
Some IHCP members are
required to contribute toward
the cost of their health
coverage. Cost sharing can
take the form of copayments
for services, premium
payments or contributions to
health savings accounts.
2
This Photo by
Unknown Author is
licensed under CC BY

Copayments
A copayment is a fixed amount that
is paid for healthcare services. In
IHCPs, members make the
copayment to the provider at the
time of service. Services subject to
copayments include transportation
services, pharmacy and non-
emergency services provided in the
Emergency Room.
3
This Photo by
Unknown Author is
licensed under CC BY

Fee For Service Medicaid, Hoosier Care Connect (including MEDWorks), and
CHIP
Copayments
4

Copayments
Copayments in the Healthy Indiana Plan are limited to those members enrolled in
HIP Basic.
5

Premium
A premium is the amount that
you pay for your health
insurance every month. In
addition to your premium, you
may have to pay other costs
for your health care. The 2
IHCPs with premiums are
Children’s Health Program
(CHIP) and MEDWorks.
6
This Photo by Unknown Author is licensed under CC BY-ND

Premiums
Children’s Health
Insurance Program
7
Number of
Children
FPL Range Monthly
Premium
1 158% > 175% $22
175% > 200% $33
200% > 225% $42
225% > 250% $53
2 or more 158% > 175% $33
175% > 200% $50
200% > 225% $53
225% > 250% $70

Premiums
MEDWorks
8
Qualifying Status FPL Range Monthly Premium
Individual 150% > 175% $48
175% > 200% $69
200% > 250% $107
250% > 300% $134
300% > 350% $161
Over 350% $187
Married 150% > 175% $65
175% > 200% $93
200% > 250% $145
250% > 300% $182
300% > 350% $218
Over 350% $254

IHCP Member
Cost Sharing
Premiums
Premiums for
Package C and
MEDWorks are
made to the State
of Indiana.
9

Contributions
One unique feature of Healthy Indiana
Plan is the creation of a special health
savings account known as a POWER
Account. Every HIP Plus member has a
POWER Account and must contribute
to the account on a monthly basis. The
amount that members are expected to
contribute is based on household
income. Payments to the POWER
Account give members access to HIP
Plus.
10

Contributions
Contributions are based on household income and divided into 5 tiers. Members who
continue use of tobacco products after 1 year of coverage, will see a 50% in their
contribution amounts.
11

Contributions
Contribution payment methods can
vary based on the Managed Care Entity
(MCE).
The plan comparison tool lists all the
methods of payment for each MCE.
12

Contributions
Another useful means of contribution
to the Power Account is the Fast Track
payment. A Fast Track payment is a
prepayment of the POWER Account.
Applicants have the opportunity to
pay $10 at the time of application that
will be applied to their Power Account
obligation. The payment can be made
at the time of application, or it can be
paid with an invoice that is sent to the
applicant by the MCE.
13
This Photo by Unknown Author is licensed
under CC BY-SA

Fast Track = pre-payment
• HIP applicants are able to expedite the start of their HIP
Plus coverage through the FastTrack option.
• Fast Track allows individuals to make a $10 payment toward
their first POWER account contribution while the
application is being processed.
• If the HIP application is approved, coverage may begin the
first of the month in which the FastTrack payment was
made.
• Individuals can make a FastTrack pre-payment by credit
card or debit card at the time of application.
• Must choose a Managed Care Entity (MCE) at that time.
Once payment is made, they will not be able to change
their selected MCE until Open Enrollment November 1 –
December 15.
14

Why make a Fast Track Payment?
The benefit to paying the FastTrack pre-payment at time of application is that it
preserves eligibility back to the beginning of the month in which the payment is
made (if PE is not filed in that same month). Services rendered earlier in the
month, prior to the FastTrack payment have the potential of being covered.
Forms you need:
HIP Initial PAC or Fast Track Payment Consent Form – If assisting in making a
payment
MCE specific AR Form
Fast Track Notification Form
15

IHCP Member
Cost Sharing
Contributions
The application flow
allows applicants to
indicate that they plan
to make a Fast Track
payment at the time
of application and to
select an MCE.
16

IHCP Member
Cost Sharing
Contributions
At the end of the
online
application,
Navigators will
select the button
to start the Fast
Track process.
17

Contributions
Fast Track payments can be made
on behalf applicants. Those
assisting applicants with Fast
Track payments need to have the
Written Consent for Initial
POWER Account Payment signed.
18

Contributions
For providers that assist
individuals with Fast Track
prepayments and render services
before an applicant is enrolled, a
Fast Track Notification Form must
be submitted to the MCE to
ensure accurate retroactive Prior
authorization.
19

Contributions
Key Reminders
o This form is used for
INPATIENT stays
o This form must be submitted
within 5 days of admission
o During the Public Emergency
period, this form should be
completed and sent to ALL 4
MCEs
20

Fast Track Payments
21
Applicants may also make a Fast Track payment when
invoiced by the MCE during the application process.
MCEs will send applicants an invoice with a 60-
day “invoice period” during which applicants
can make a Fast Track payment while waiting
for FSSA to make a determination on their
POWER Account obligation.

22
• Applicants receive an invoice from the MCE with a
60-day invoice period.
• Coverage begins the first of the month in which the
POWER account payment was made.

23
5/1
HIP Basic benefits
begin.
3/15
Individual
qualifies for HIP.
Receives bill from
MCE.
5/15
POWER account
payment period ends.
Individual moved to
HIP Basic
2/1
Individual with
income less than
100%FPL applies
for IHCP
Example:
100% FPL or lower
• Automatically placed in the HIP Basic Plan.
• Coverage effective 1st of the month in
which 60-day invoice period ends.
100% - 138% FPL
• Case closed. No coverage.
• Lock out period imposed on
those over 100% FPL, if
member’s coverage was opened
and payment was applied.

24
LOCKOUTS
HIP members who fall behind on their POWER
Account obligations are subject to losing
coverage as well as being locked out from
coverage for 6 months. At the end of the lockout
period, all past due POWER Account payments
must be caught up before coverage can be
reinstated.
Lockouts do not apply to HIP State Plan
members!

25
Let’s Practice!
Meet Olivia. You assisted her with an
application for HIP coverage 6 months
ago. She was approved for HIP Plus
with a Power Account obligation of $20
per month. She has returned for your
assistance because she received a
notice that her coverage will close at
the end of this month because she has
just missed her 3rd Power Account
payment. How can we help Olivia?

26
Closure
Notice
FSSA is notified by MCE
that Power Account
payments are more than
60 days past due
Can She
Be
Exempt?
If Olivia can qualify for
HIP State Plan, she can be
exempt from closure
HIP
State
Plan
If the MCE finds Olivia to
be Medically Frail, she
could be switched to HIP
State Plan be exempt from
closure
Closure
Notice
FSSA is notified by MCE that
Power Account payments are
more than 60 days behind
No Option
for
Exemption
Olivia does not meet any criteria
for HIP State Plan
Coverage
is Closed
Olivia’s coverage is closed, and
she will be unable to reapply for
6 months. All past due Power
Account payments must be
caught up at the end of the
lockout period
Can we prevent closure? Unable to Prevent Closure

27

This Photo by Unknown Author is licensed
under CC BY-SA
POWER Account Payments
FAQs
1) What if my POWER Account obligation
is more than the Fast Track amount?
A) The Fast Track payment will cover the first
month and the remainder will be added to your
next month’s payment.
2) What happens to the Fast Track
payment if the application is denied?
A) The MCE will refund the money to the account
that made the payment.
28

Let’s Practice!
 Your hospital staff approve HPE coverage for John in the ED 6/7. You meet
with John and file a full application and pay the Fast Track payment at the
time of application on 6/10. You receive an approval notice on 7/7. What
will be the effective date of John’s HIP Plus coverage?
29

06/07 HPE approved
06/19
Full application
filed – Fast Track
payment made
07/07 Full application
approved
08/01
HIP Plus
coverage begins
30

This Photo by Unknown Author is licensed under CC BY-SA
Let’s Practice!
 Maria comes to the ED 4/2,
but no one files an HPE
application. You meet with
Maria 4/15 and file a full
application and make the Fast
Track Payment. On 5/3, you
receive the approval letter.
What is the effective date of
coverage?
31

04/02 ED visit
04/15
Full application
filed – Fast Track
payment made
5/03 Full application
approved
04/01
HIP Plus
coverage begins
32

This Photo by Unknown Author is licensed under CC BY
Let’s Practice!
 Kristina meets with you on 8/2
to file an application for
Healthy Indiana Plan. You are
not able to make a Fast Track
payment at the time of
application. You receive a
conditional approval letter
8/31. If no Power Account
payment is made, what will
happen to her application?
33

08/02
Full application filed –
NO Fast Track
payment
08/31
Conditional Approval
letter from FSSA
Invoice from MCE
10/31
FSSA notified no
POWER Account
payment received.
FSSA authorizes case
10/01
HIP Basic coverage
begins
34
08/02
Full application filed –
NO Fast Track payment
made
08/31
Conditional Approval
letter from FSSA
received
Invoice from MCE
10/31
FSSA is notified that no
POWER Acct payment.
FSSA denies application
INCOME BELOW 100% FPL INCOME ABOVE 100% FPL

Cost Sharing Cap
In accordance with federal regulations, IHCP members with cost sharing
obligations are not required to pay more than 5% of the family’s total countable
income. The calculation is done a quarterly basis. If a household reaches their 5%
cost sharing limit in a given quarter, they will receive written notice that cost
sharing will be suspended for the remainder of that quarter. The written notice can
be submitted in lieu of payment when the cap has been reached.
35

Cost Sharing Cap
IHCP providers cannot refuse service to any
IHCP member who cannot pay their cost
sharing obligation. The provider may,
however, still bill the member for the cost
sharing obligation.
36

Cost Sharing – Who’s Exempt?
The following member categories are
exempt from cost sharing obligations:
 American Indians
 Alaskan Natives
 Under 18, Package A members
 Pregnant women
 Those receiving hospice care
 Eligible for Medicaid due to a
diagnosis of breast or cervical cancer
37

38
Moving from Managed Care to Fee for Service
When to report a change in category
Patients with serious or worsening medical
conditions and who have been or who expect
to be hospitalized longer than 30 days may now
qualify for Medicaid. This includes:
 Patients enrolled in Healthy Indiana Plan
(HIP)
 Patients who have been approved for
QMB/SLMB
 Patients who have been denied or have
never applied for Medicaid

39
HIP members moving to a nursing
home can be transitioned to Fee For
Service Medicaid by reporting a
change.
This allows the effective date of the
category change to be first day of the
month following the reported
change.

40
When to report a change in
category
For HIP members that do not have a
Social Security Administration finding
of disability, Medicaid Medical Review
team will review medical records and
members ability to perform the
Activities of Daily Living (ADL) to make
a determination of disability.

41
Any admission to a nursing facility must be
reported to the Division of Aging (DA) and
Division of Family Resources (DFR) within 10
days of the event.
IHCP recommends that a request to
transition from HIP to FFS Medicaid be
submitted to DFR in writing along with a
request for an eligibility interview at the
same time that the admission to the nursing
facility is reported.

42
The reporting of admission to a nursing facility
will not guarantee the category change from
HIP to FFS Medicaid. To change category, HIP
members must be determined to be disabled
by SSA or MMRT and meet income and
resource criteria for the FFS Medicaid
category.
HIP members are entitled to 100 days of
nursing coverage without a category change.

43

44
Special Income Limit - SIL
Indiana allows applicants who have
been hospitalized or who anticipate
hospitalization for 30 days or longer to
qualify for Medicaid with income up to
300% of the SSI level or $2523 for
2022.
When these applicants return
home, they will be subject to
regular Medicaid income
standards.

45
After the member has been approved for FFS Medicaid, DFR should backdate
the coverage start date to first of the month after the reported change. If that
has not been accomplished within 3 weeks, providers should follow the
Troubleshooting process.

46
Let’s Practice!
Meet Doug. He has been hospitalized
for 3 weeks and currently has HIP
coverage. Hospital staff have asked
for your assistance because he needs
to go to the nursing home, but they
are having difficulty getting
placement with HIP coverage. He is
getting $1500 per month is Social
Security disability as his only income.
He has no resources. How can we
help Doug transition from HIP to
Traditional Medicaid?

47
Patient
needs SNF
placement
Doug needs long term placement
in a skilled nursing facility
Clinical staff
updates
information
Clinical Staff must update PASARR
via Assessmentpro.com
Notify FSSA
IHCP recommends written request
for category change. If patient has
not been approved for Social
Security Disability, then MMRT
must make a determination. FSSA
will make financial determination.
Level of
Care
Established
Clinical staff establishes Level of
Care
FSSA
changes
Category
CORE should reflect category
change within 4 weeks of the
report to FSSA

Part 2 2022 IHCP Updates and Policy Reminders

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