Indiana Medicaid Unwinding PHE Coverage Changes

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Part 3
IHCP Unwinding the PHE
Return to Normal Medicaid Processing
Options for those Losing IHCP Coverage
What we are Anticipating
Communication and Education
1

Indiana and PHE Unwinding
Redetermination Process
Indiana FSSA has identified that approximately 75% of
those enrolled in Indiana Health Coverage Programs
(IHCP) have continued to meet all eligibility
requirements during the PHE. For these members,
eligibility can be approved for an additional 12 months.
However, they can anticipate that they could now face
loss or reduction in coverage if they do not respond to
requests for information or if changes make them
ineligible in the future.
2

Redetermination Process
The remainder of members, about 25% of current
enrollment, have been identified as having coverage
only because the state was not allowed to close their
coverage due to PHE rules.
This represents some 500,000 people. FSSA will process
1/12 of this group each month.
3

Annual Redetermination
When FSSA cannot verify continued eligibility
through the ex parte process, the member will need
to complete and sign the redetermination form and
submit any requested verification. Redetermination
mailers are sent out to IHCP members 45 days prior
to their redetermination due date.
These are the members who are at risk of losing
IHCP coverage.
4

Result of Review
60 Day Review
State Review
Ex Parte Result
Medicaid
Redetermination
Ex Parte review
Unable to verify
eligibility
Cannot
immediately
close coverage
Mail a request
for verification
Enrollee
responds
If eligible
coverage will
continue
No longer
eligible –
coverage closes
Enrollee fails to
respond
90 days to be
reinstated
Coverage
Closes
Continued
eligibility
verified
No further
action needed
5

This Photo by Unknown Author is licensed under CC BY-SA
Let’s Practice!
Donna was enrolled in HIP coverage April
2021. FSSA was unable to verify her
continued eligibility using the ex parte
process. A redetermination form was mailed
to her March 15, 2023, giving her 45 days to
respond. Donna moved to another part of the
state and did not receive the notice. She tries
to fill a prescription on May 20, 2023, but
discovers her coverage has closed. What
options are available to Donna?
6

Redeter
mination
form
mailed
Ex Parte unsuccessful
Coverage
closes
effective
4/30/2023
No response to
redetermination
form
Unable to
obtain
prescription
5/20/2023
Coverage closure
discovered
Returns all
documents
6/1/2023
Contacts FSSA
Coverage
is restored
effective
6/1/2023
FSSA reviews
documentation
Let’s
Practice!
7

Impact on Effective Dates for New Applications
In addition to reviewing eligibility for those already enrolled in
IHCP coverage, FSSA is also returning to normal application
processing procedures.
Under Public Health Emergency rules, the effective date of IHCP
coverage is dependent on the date of application.
When FSSA returns to normal processing, some IHCP category
effective dates will be dependent on payment of a premium or
contribution to a health savings account. This may result in a
delay in the effective date of coverage.
8

Return to Cost Sharing
For those that will still qualify for IHCP
programs, the return to cost sharing
may prove to be an unwelcome burden
for members who have not experienced
this for nearly 3 years.
The premiums and contributions for
some IHCP programs could result in loss
of coverage or delay in the effective date
of coverage leaving patients and health
care providers with costly gaps in
coverage.
9

Return to Cost Sharing
FSSA has announced that the return to normal cost sharing
requirements will begin July 2023. Members will begin to be
notified of this change June 2023.
July 2023, IHCP members will have small copays for
prescriptions, transportation, inpatient and outpatient services.
For categories that require a premium or contribution to a
health savings account, these payments will be required to
maintain ongoing coverage.
10

Options for those losing IHCP coverage
Members who face losing IHCP coverage will
have options. In addition to enrolling in
employer-based coverage, those who qualify for
Marketplace coverage will have expanded
enrollment windows to access this coverage.
11

HIP Workforce Bridge
Many who face losing IHCP coverage will
face sticker shock as they consider other
health coverage options. To assist with this
transition, Indiana created the HIP
Workforce Bridge or HIP Bridge program.
Designed to reduce the fall off in coverage
for HIP members who lose coverage due to
an increase in earnings, the HIP Workforce
Bridge program provides outgoing HIP
members an account containing up to
$1000 for members to use for healthcare
expenses related to commercial insurance.
12

Allowable expenses include:
 Premiums
 Deductibles
 Copayments
 Coinsurance
 Premiums and cost sharing for Marketplace
plans
 HIP covered services during any waiting period
for commercial coverage to start such as
 Prescriptions
 Office visits
 Urgent care
13

 Outgoing HIP members will start the Workforce Bridge
program in conditional status. Members will be sent a
letter containing instructions on how they may “opt-in” to
the program.
 Members will have 45 days to “opt-in”.
 There are a limited number of Workforce Bridge slots each
fiscal year.
 The account will remain active for the member for 12
months or until the funds in the account have been
exhausted.
 Enrollment in the Workforce Bridge program will end if the
member becomes eligible for any other IHCP category.
14

As part of the Affordable Care Act requirements, states must refer those losing
or denied coverage to the Marketplace for consideration of that coverage.
Outgoing IHCP members will have their information shared with the
Marketplace.
15

It is important to note that this transfer of information will not generate a
prepopulated application, so Navigators will need to treat this as any new
applicant.
16

Options for those losing IHCP
coverage
A notice from the Marketplace
may sent encouraging them to
apply for coverage online or with
an assister.
17

Let’s Practice!
Gary was determined to over
income for all ICHP programs
August 15, 2023, as his
income is now 145% FPL,
and he receives a notice that
his coverage will close
effective 8/31/2023. What
options are open to Gary?
This Photo by Unknown Author
is licensed under CC BY-NC-ND
18

Let’s Practice! No health
coverage
offered
through
employer
Employer-based
coverage
Qualifies for
Low-Income
Special
Enrollment
Period
Marketplace Coverage
Qualifies for
Silver Plan
with Cost
Sharing
Reductions
Marketplace Application
Coverage
can begin as
early as
9/1/2023
Enrolls in Marketplace
plan
19

This Photo by Unknown Author is licensed under CC
BY-SA
Let’s Practice!
Carina was 16 when she was
enrolled in Hoosier Healthwise
September 2020. Her case was
reviewed September 2023 and
she is now 19. What options
are available to Carina?
20

Let’s Practice! No longer
eligible for
Hoosier
Healthwise
Eligibility reviewed
FSSA requests
verification of
Household
Information
FSSA reviews for other
potential coverage
Carina is
conditionally
approved for
HIP
Income is below 138% FPL
Carina has 60
days to make
POWER
Account
Payment
POWER Account Invoice
Effective date
is 1st of the
month of
POWER
Account
Payment
Payment is made to MCE
21

IHCP Unwinding the PH
It is estimated that as many as 18 million Americans could lose
coverage as part of this unwinding process.
22

What we anticipate will happen
With the continuous enrollment period,
many who may have qualified for
employer coverage did not choose to
enroll in that coverage because the
comprehensive free IHCP coverage was
available.
Additionally, some IHCP members
enrolled in employer-based coverage
along side IHCP coverage which allowed
them to be protected from the out-of-
pocket costs of these coverages.
23

The cost of transitioning to
employer-based health coverage
or Marketplace health coverage
may result in many opting to go
without insurance at all marking a
spike in self-pay patients after
April 30, 2023.
24

Key dates in the timeline for these changes are expected to be
25

Communication with Members
Of great concern to all stakeholders is the loss of coverage simply because FSSA cannot
locate the member. Consequently, the primary focus of preparing for this change is on
communication and ensuring that FSSA has the most current address for all IHCP members.
Members may update their address on the FSSA benefits portal, call FSSA and provide a
correct address, or call their MCE to provide a current address.
26

Communication with Members
FSSA began the process of reaching out
to IHCP members early this year by
sending out postcards.
Information has also been made public
on the Indiana Medicaid for Members
website.
It is anticipated that the first
disenrollments will be effective
4/30/2023 for MAGI categories. Non-
MAGI closures could begin effective
June 30, 2023.
27

28

Indiana Medicaid Unwinding PHE Coverage Changes

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