Part 2 2024 Indiana Health Coverage Program Updates NAV CE

This material is proprietary to ClaimAid. Not for duplication or distribution
without the express permission of ClaimAid.
Part 2
IHCP Updates
PHE Unwinding Update
IHCP Policy Updates
Authorized Representatives
18

IHCP Updates
Public Health Emergency Unwinding
Update
March 2023, Indiana began the process of
reviewing Medicaid eligibility for its members.
After spending 3 years of guaranteeing coverage
for anyone approved, Family and Social Services
Administration (FSSA) began reviewing
households to see if they continue to be eligible
for coverage.
19

IHCP Updates
Update
At the beginning of the process, Indiana Health
Coverage Programs (IHCP) enrollment was at an
all-time high of 2,230,620 Hoosiers.
FSSA estimated that approximately 500,000 or
25% were at risk of losing IHCP coverage.
20

IHCP Updates
Public Health Emergency Unwinding Update
Disenrollments as of December 2023 were running below the anticipated pace.
223,744 Hoosiers lost IHCP coverage for procedural reasons or because they
were found to ineligible. This represented 11% of IHCP enrollment going into
this process.
21

IHCP Updates
Public Health
Emergency Unwinding
Update
Those losing IHPC coverage
are mainly those who were
enrolled in Healthy Indiana
Plan (HIP) who make up 64%
of those losing health
coverage. The second largest
group affected by the
unwinding are children. 30%
of those enrolled in HHW
have lost coverage.
22

IHCP Updates
Update
Actual IHCP enrollment at the end of 2023 was
2,012,389. This includes 4,407 Hoosiers that
were either reenrolled or were newly eligible.
Going into 2024, FSSA reported that 84,852
redeterminations were still awaiting processing.
23

IHCP Updates
Update
Why are Hoosiers losing coverage? Of the
223,744 losing IHCP coverage, about 15% or
32,920 were found to be ineligible for IHCP
programs.
Most losing coverage lost coverage due to
“procedural reasons.”
24

IHCP Updates
Update
Procedural disenrollments were the main
concern as federal and state officials laid out
plans for unwinding PHE provisions.
Procedural disenrollments occur because the
state cannot verify continuing eligibility. CMS
and FSSA worked to minimize the number of
Hoosiers who lost coverage due to simply not
submitting a form.
25

IHCP Updates
Public Health Emergency
Unwinding Update
In Indiana procedural
disenrollments include
• Those who did not respond to
redetermination mailer.
• Those FSSA has verified
ineligibility AND did not
respond to redetermination
mailer.
• FSSA had incomplete
information or had information
that verified other reasons for
ineligibility.
26
107890, 56%
62537, 33%
20407, 11%
Procedural Disenrollments
Did not respond
Confirmed Ineligible and
did not respond
Incomplete Information

IHCP Updates
Key Takeaways
CMS allowed states many flexibilities to minimize procedural disenrollments. States are
hoping to see some of these flexibilities become permanent.
• Utilization of the National Change of Address to update contact information.
• Sending text messages and automated calls.
• Greater cooperation with Managed Care Entities (MCE).
• Utilization of information provided for SNAP benefits to verify Medicaid eligibility.
• Increased use of ex parte or automatic renewals for the Non-MAGI populations.
• Utilization of the “Zero-Income Strategy”
• This allows states to complete an ex parte or automatic renewal when there is
no income reported from electronic data sources AND FSSA has verified income
below 100% FPL in the last 12 months.
27

IHCP Updates
Key Takeaways
Cooperation and communication between FSSA and community stakeholders has been
touted as a bright spot in Indiana’s unwinding process.
• Community stakeholders were given access to toolkits that included free printed and
digital materials.
• Regular meetings between community stakeholders and FSSA created feedback loops
to alert FSSA of potential problems.
• Unwinding data published on FSSA website.
28

IHCP Updates
Key Takeaways
Many who losing IHCP coverage due to state error has led to higher levels of
distrust and an unwillingness to reapply.
Enrollment in Marketplace coverage for those losing IHCP coverage remains
low, in part because many are unaware of the enhanced affordability features.
Indiana Navigators are key players in rebuilding trust and getting Hoosiers
enrolled in the coverage they qualify for.
29

IHCP Updates
Key Takeaways
Notices from FSSA regarding coverage are confusing. Many have contradictory
messages, and changes in category can be particularly confusing.
When a child enrolled in HHW Pkg A is transitioned to CHIP coverage, a notice is
sent advising parents/guardians that the child will lose state coverage. A
second notice is also sent indicating that the child has been enrolled in CHIP.
Timeframes to respond to notices are often too short.
30

IHCP Updates
Key Takeaways
Experiences for Hoosiers with limited English proficiency are encountering
difficulty when calling the FSSA call center.
Staff at the call center have required that the call center interpreter be used
instead of bilingual navigators creating more confusion with multiple parties on
the call.
Notices in languages other than English have been noted to be poor
translations.
31

IHCP Updates
Return to Cost Sharing
FSSA has made changes in co-payments for some IHCP categories that will be
effective when cost sharing returns.
When Cost Sharing returns it will be required for:
• Healthy Indiana Plan (HIP) – POWER Accounts and HIP Basic Co-payments
• CHIP – premiums and copayments
• MEDWorks – premiums
32

IHCP Updates
Return to Cost Sharing
Who is exempt from cost-sharing?
• Pregnant women and during the postpartum period
• Those receiving Emergency Services Only
• Former Foster Children
• Members of federally recognized American Indian tribes
• Low-Income children
33

IHCP Updates
34
April-May
2024
• Notices
regarding
return to
cost sharing
go out
June 2024
• MCE notices
about cost
sharing go
out
July 2024
• Copayments
start for HIP
and CHIP
• Invoices for
HIP POWER
Accounts
and CHIP
and
MEDWorks
premiums
go out
August
2024
• Fast Track
payments
for new
applications
begin
• HIP POWER
Account
payments
due
• CHIP &
MEDWorks
premiums
due
October
2024
• First
closures for
failure to pay
premiums or
certain
POWER
Accounts
• First denials
for failure to
enroll
Timeline for Return to Cost Sharing

IHCP Updates
35
HIP Cost Sharing Reminders
Healthy
Indiana
Plan
$10 Fast
Track
POWER
Account
Payment
HIP Basic
Copays
• Fast Track - $10 prepayment
made at the time of application.
• POWER Account – monthly
payments ranging from $1-$20
per month. It is the path to HIP
Plus benefits.
• HIP Basic Copays – For HIP
members with household income
under 100% FPL who fail to make
POWER Account payments

IHCP Updates
36
HIP Effective Dates
The return to cost sharing means
that the effective date of HIP
coverage is no longer based on
the date the application is filed,
but rather based on when the
MCE receives a payment.
*if NO PE has been approved
This Photo by Unknown Author is licensed under CC BY-NC

IHCP Updates
37
Scenarios
HIP Application filed
7/1
$10 Fast Track
Payment made at
the time of
application
FSSA Processes
application 8/7
FSSA receives
confirmation of Fast
Track Payment and
authorizes case
Coverage effective
7/1

IHCP Updates
38
Scenarios
HIP Application
filed 9/1
No Fast Track
payment
FSSA Processes
application 10/2
Conditional letter
with POWER
Account obligation
mailed 10/2
POWER Account
payment made to
MCE 11/10
Coverage effective
11/1

IHCP Updates
39
Scenarios
HIP Application
filed 8/1 – income
below 100% FPL
No Fast Track
payment
FSSA Processes
application 8/27
Conditional letter
with POWER
Account obligation
mailed 8/27
NO Payment is
made to MCE by
end of invoice
period
HIP Basic open
effective 10/1

IHCP Updates
40
Scenarios
HIP Application
filed 8/1 – income
above 100% FPL
No Fast Track
payment
FSSA Processes
application 8/27
Conditional letter
with POWER
Account obligation
mailed 8/27
NO Payment is
made to MCE by
end of invoice
period
Application denied
“Failure to Enroll”
10/27

IHCP Updates
HIP Bridge
HIP Bridge, a program designed to reduce churn, the loss of IHCP coverage only
to be reenrolled a short time later, by providing $1000 to outgoing HIP
members to use for out-of-pocket medical expenses had its rollout delayed
during the unwinding process.
It is expected to roll out as the state completes the first full year of
redeterminations.
41

IHCP Updates
IHCP Updates
Continuous Eligibility for children under the age 19
Effective 1/1/2024, children under the age of 19 who have
been approved for any category of Medicaid will remain
continuously eligible for the duration of their eligibility period.
The only required change to be reported is a change of
address.
42

IHCP Updates
IHCP Updates
Closure can only happen or the following reasons:
• Death
• Moved out of state
• Written voluntary withdrawal
• Turning age 19
• Coverage was approved due to error, fraud or false
information
43

IHCP Updates
IHCP Updates
Once approved for Hoosier Healthwise (HHW) Package A or
Traditional Medicaid, the child cannot be moved to CHIP or
HHW Package C coverage. Children approved for CHIP or
HHW Package C can be moved to Package A, however.
44

IHCP Updates
IHCP Updates
Former Foster Care
Former Foster Care individuals of ANY state now qualify for
Medicaid coverage regardless of income.
• Must be between the ages of 18-26
• Must have been in foster care on their 18th birthday
• Must have been enrolled in Medicaid
45

IHCP Updates
IHCP Updates
An authorized representative is a designated individual or
organization acting on the client’s behalf to assist with
application and renewal services. The agency permits
applicants and beneficiaries to designate an individual or
organization to act responsibly on their behalf in assisting
with the individual's application and renewal of eligibility and
other ongoing communications with the agency. There are no
restrictions on who can serve as an authorized representative
including navigators, or individuals working for an enrollment
center, if the member permits. Any individual working for the
authorized agency may serve as the “qualified authorized
representative”, regardless of which associate signs
designated form.
46

IHCP Updates
IHCP Updates
The Authorized Representative for Health
Coverage form must be signed by the
representative and the applicant/recipient. The
use of electronic signatures is only acceptable
when signed with Docusign, Esign, Adobe
Acrobat, or UETA.
Typing a name in using Microsoft Word or other
software is not acceptable.
47

IHCP Updates
IHCP Updates
An Authorized Representative may also be appointed on the
phone.
One time - One-time only verbal authorizations are for that
specific moment in time. AR should not be added to eligibility
system and should only have access to information authorized
by member. When a member is on the telephone, he or she
may provide verbal authorization for anyone to act as the
authorized representative for that individual call only.
Subsequent phone calls will again require member’s verbal
permission for information to be shared.
48

IHCP Updates
IHCP Updates
An Authorized Representative may also be appointed on the
phone.
Ongoing-A verbal authorization is acceptable from the member for
any Authorized Representative (AR). A three-way call will need to be
completed between the member and AR to obtain and confirm the
specific AR details. The information must be entered on the
Authorized Representative or Legal Guardian Detail page during the
call. After the AR information is entered into the eligibility system and
the applicant and AR agree on the terms of authorization, it will
remain in the system as an authentic and verified agreement
unless/until the AR or applicant/recipient withdraws the
authorization. AR details must be documented in case notes.
49

IHCP Updates
IHCP Updates
Authorized Representatives assume responsibility for the
information provided. The Authorized Representative is
subject to the same penalties as the applicant/recipient for
misrepresenting information in order to gain eligibility.
Skilled Navigators will develop effective screening methods in
order to present the most accurate applications for coverage.
50

Part 2 2024 Indiana Health Coverage Program Updates NAV CE

More Related Content

Similar to Part 2 2024 Indiana Health Coverage Program Updates NAV CE

More from J Hopkins

Recently uploaded

Part 2 2024 Indiana Health Coverage Program Updates NAV CE