Digging Into the Data: What Can We Learn from the State Evaluation of Healthy Indiana (HIP 2.0) Premiums
Issue Brief
The Lewin Group, Health Indiana Plan 2.0: POWER Account Contribution Assessment (March 31, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf. The distribution of the 55% does not add to 100% because individuals may be enrolled in more than one category over the period.
Under federal law, states may charge premiums for enrollees with incomes above 150% of the federal poverty level (FPL), including children and adults. Enrollees with incomes below 150% FPL may not be charged premiums. Overall, premium and cost sharing amounts for family members enrolled in Medicaid may not exceed 5% of household income. This 5% cap is applied on a monthly or quarterly basis. Samantha Artiga, Petry Ubri, and Julia Zur. The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings. Kaiser Family Foundation, June 2017. https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/
HIP CMS Metrics, 12/19/2017. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-2017-dec-metrics-rpt-12192017.pdf
Ibid.
The Lewin Group, Health Indiana Plan 2.0: POWER Account Contribution Assessment (March 31, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf. About 2,500 people experienced more than one negative consequence for failing to pay a premium, according to the state’s evaluation: they applied and were determined eligible for coverage but never enrolled because they never paid their first premium, and then later re-applied, enrolled, paid, but then were disenrolled for missing a subsequent payment, or vice versa.
HIP CMS Metrics, 12/19/2017. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-2017-dec-metrics-rpt-12192017.pdf
The Lewin Group, Health Indiana Plan 2.0: POWER Account Contribution Assessment (March 31, 2017), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf. The distribution of the 55% does not add to 100% because individuals may be enrolled in more than one category over the period.
Ibid.
Ibid.
Ibid.
Ibid. State quarterly reports note that data on employers and non-profits with formal arrangements to make premium payments on behalf of enrollees do not include those with informal arrangements such as family or friends.
The waiver requires health plans to conduct active outreach and member education related to tobacco-cessation benefits and provides that the tobacco surcharge will be removed in the following year if a beneficiary informs the state that they have stopped using tobacco. Indiana’s waiver renewal also changes standard premiums from a flat 2% of income to premium tiers, a change that the state requested citing administrative complexity of the original premium structure.
Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage – United States, 2016 (Dec. 9, 2016), https://www.cdc.gov/mmwr/volumes/65/wr/mm6548a2.htm.