Digging Into the Data: What Can We Learn from the State Evaluation of Healthy Indiana (HIP 2.0) Premiums

Issue Brief
  1. 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.

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  2. 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/

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  3. 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

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  4. Ibid.

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  5. 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.

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  6. 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

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  7. 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.

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  8. Ibid.

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  9. Ibid.

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  10. Ibid.

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  11. 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.

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  12. 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.

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  13. 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.

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