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Comprehensive Training for Indiana Navigators February 2015
Comprehensive Training for Indiana Navigators
February 2015
Learning Objectives
I. Dissect and understand aspects of the new HIP 2.0 program
II. Discuss the application and transitioning processes
HIP Background
HIP 2.0 Overview
Coverage for low-income, non-disabled Hoosier adults ages 19-64 under 138% FPL who are ineligible for Medicare other Medicaid categories
$16,105 annually for an individual in
2014
$32,913 annually for a family of four
in 2014
Monthly Income Limits
# in household HIP BasicIncome up to
100% FPL
HIP PlusIncome up to ~138% FPL
1 $973 $1,358.10
2 $1,311 $1,830.58
3 $1,650 $2,303.06
4 $1,988 $2,775.54
HIP 2.0 Timeline
May June
July Aug Sept Oct Nov Dec Jan
May 15th Governor Pence announced proposed expansion of the HIP program
June 22nd Initial public comment period ended
July 2nd Indiana submitted HIP 2.0 Waiver Application to CMS
September 21, 2014-January 2015 Negotiations between the federal government and state persist
January 27th HIP approval!
August 22nd CMS approved the Waiver Application; 30-day federal public comment period began
September 21st Federal public comment period ended
July 17th Indiana notified by CMS of unmet requirement for tribal consultation
November 15th Open Enrollment began
HIP 2.0 Programs
HIP Plus
Initial plan selection for all enrollees* Exception: using ER for routine care
HIP Plus – Other Benefits
100 visit limit for home health Coverage for Temporomandibular Joint
Disorders (TMJ) Bariatric surgery 75 visits annually of physical, speech and
occupational therapies 100 day limit for skilled nursing facility Early periodic screening diagnosis and testing
(EPSDT) services for 19 & 20 year olds Dental—limited to 2 cleanings and 4
restorative procedures per year Pregnant women receive transportation and
chiropractic services
POWER Account
• Like an HSA, members use first $2,500 to pay for services o Members receive monthly statement
• Employers & not-for-profits may assist with contributionso Employers and not-for-profits may pay up to 100%
of member POWER account contribution (PAC) o Payments made directly to member’s selected
managed care entity
• Spouses split the monthly PAC amount
• If members leave the program early with an unused balance, the portion of the unused balance they are entitled to is returned to themo Members reporting a change in eligibility and leaving
the program (e.g. move out of state) will retain 100% of their unused portion
o Members leaving for non-payment of the POWER account will retain 75% of their unused portion
• If members leave the program early but incurred expenses, they may receive a bill from their health plan for their remaining portion of the health expenses
POWER Account
5% of income limit
• Member cost-sharing is subject to a 5% of income limito Members are protected from paying more than 5% of their quarterly
income toward HIP cost sharing requirements, including the total of all:• POWER account contributions (PAC)• Emergency Room copayments• HIP Basic copayments
• Members meeting their 5% of income limit on a quarterly basis will have cost sharing responsibilities eliminated for the remainder of the quartero Individuals meeting the 5% limit and enrolled in HIP Plus will receive the
minimum $1 minimum monthly contribution for the remainder of the quarter
Members should keep record of their expenses and if they think they have met their 5% of income limit, they should
contact their MCE
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HIP Plus – POWER Account
HIP Plus
Maximum POWER Account Contributions
FPLMonthly Income, Single Individual
Maximum Monthly PAC*, Single
Individual
Maximum Monthly Income, Household of 2
Maximum Monthly PAC, Spouses**
<22% Less than $214 $4.28 Less than $289 $2.89 each
23%-50%$214.01 to
$487$9.74
$289.01 to $656
$6.56 each
51%-75%$487.01 to
$730$14.60
$656.01 to $984
$9.84 each
76%-100%$730.01 to
$973$19.46
$984.01 to $1,311
$13.11 each
101%-138%$973.01 to $1,358.70
$27.17$1,311.01 to
$1,831.20$18.31 each
*Amounts can be reduced by other Medicaid or CHIP premium costs**To receive the split contribution for spouses, both spouses must be enrolled in HIP
HIP Basic
Fall back option for members
HIP Basic– Other Benefits
100 visit limit for home health 60 visits annually of physical, speech and
occupational therapies 100 day limit for skilled nursing facility Early periodic screening diagnosis and testing
(EPSDT) services for 19 & 20 year olds Pregnant women receive transportation, vision,
dental and chiropractic services
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HIP Basic– POWER Account
HIP Basic
Service HIP Basic Copay Amounts ≤100% FPL
Outpatient Services $4
Inpatient Services $75
Preferred Drugs $4
Non-preferred Drugs
$8
Non-emergency ED visit
Up to $25
Copayments for HIP Basic members
HIP State Plan
Qualifying individuals include: • Low-income (<19% FPL) Parents and Caretakers • Low-income (<19% FPL) 19 & 20 year olds• Medically Frail• Transitional Medical Assistance (TMA)
HIP State Plan– Other Benefits
No visit limit for home health Coverage for Temporomandibular Joint
Disorders (TMJ) Chiropractic services Bariatric surgery Requires authorization for physical, speech
and occupational therapies—but unlimited No limit for skilled nursing facility Early periodic screening diagnosis and testing
(EPSDT) services for 19 & 20 year olds Pregnant women receive access to all
pregnancy-only benefits on HIP Plus or HIP Basic plan and full State Plan benefits
HIP (Employer Benefit) Link
For people with access to “unaffordable” insurance through an employer
Employer must sign-up
and contribute
50% of member’s premium
Members make PACs and receive
defined contribution
from the state
• Enrollment in HIP Link is optional
• Coming Soon!
Gateway to Work Program
Connects members
to
Enables members
Consumer Responsibility
job training and job search
to move up and out of
HIP
programs
Non-payment Penalties
Members remain enrolled in HIP Plus as long as they make PACs and are otherwise eligible
Penalties for members not making PAC contribution:
Plan Comparison
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Managed Care
• Health coverage is provided by one of the three managed care entities (MCE)
• Dental coverage is through DentaQuest • Vision coverage is through Vision Service Plan
(VSP)
Applying for HIP 2.0
• Apply online through Indiana’s Division of Family Resources (DFR) Benefits Portal
– Now a single, streamlined application for all Indiana Health Coverage Programs (IHCP), including HIP 2.0
– Spanish version can be printed and faxed/mailed to DFR
• Apply over the phone: 1-877-GET-HIP-9 (1-877-438-4479)
• Apply via HealthCare.gov – Application data will be sent to DFR which will assess eligibility for all IHCP
• Presumptive Eligibility application with qualified hospitals for temporary coverage – Applicants must complete Indiana Application for Health
Coverage to maintain eligibility
Transitioning to HIP 2.0
Current HIP Members
• The state sent notices and provided information to current enrollees in January, and these individuals will be enrolled in HIP 2.0 starting in February
• Current HIP members will be transitioned to HIP 2.0 without any break in coverage.• Remain enrolled with the same health plan
• All members will be given a new POWER account to manage, and monthly contributions will be adjusted. HIP.IN.gov features a special “conversion”
section that details how members are impacted.
Transitioning to HIP 2.0
Hoosier Healthwise/Medicaid Members
• State sent members letters detailing transition in January; HIP 2.0 coverage begins February.
• Current low-income parents or caretakers or 19- and 20-year-olds will change from Hoosier Healthwise to HIP 2.0.o No break in coverage o Remain enrolled with the same health plan. o Have POWER account and can participate in HIP Plus.
• No changes for other current Hoosier Healthwise members.o Pregnant women and children currently enrolled in
Hoosier Healthwise will continue to receive coverage through Hoosier Healthwise.
Transitioning to HIP 2.0
Family Planning Members
• These members will be sent letters that explain:o No need to complete an applicationo Automatically conditionally eligible for HIP based on
state’s data • May choose a health plan or one will be
assignedo Will receive a bill for PACo Coverage can begin as soon as February 1, 2015
• To begin HIP coverage without a gap in coverage these members will need to make their initial POWER account contributions before the end of February.
Transitioning to HIP 2.0
Marketplace Enrollees
• The state will send letters to Hoosiers with incomes between 100 and 138% FPL that: o Explain eligibility for HIP Plus o Urge immediate action to avoid tax penalty o Explain how to “Report a life change” on Marketplace
Will receive notice that Marketplace is sending information to IHCP for eligibility determination
• Once approved, member will need to contact current Marketplace plan to cancel coverageo Use HIP coverage start date to choose when to end
Marketplace plan and avoid a gap in coverage.
Transitioning to HIP 2.0
HIP 2.0 Waiting List
• The state will process any applications received since July 2014 who were placed on the “wait list” • These applicants do not have to reapply. • Applicants may receive requests for additional
information to determine their HIP 2.0 eligibility.• This information must be returned by the due date
indicated on the letter or the application cannot be processed, and the person would have to reapply.
• Some applicants may simply receive notice that they are eligible for HIP 2.0 with instructions. • Will receive deadlines for choosing a health plan
and making a PAC
Positive Outcomes of HIP 2.0
• HIP 2.0 will cover approximately 350,000-559,000 uninsured, nondisabled Hoosiers
• Vision and dental • No enrollment caps • Maternity coverage with no cost-sharing
• Remove annual and lifetime limits • Lock-out date for non-compliance will
decrease from 12 months to six months o As an alternative to disenrollment, HIP Plus
members will be moved to HIP Basic
Incentivizing Features of HIP 2.0
• Members making 12 consecutive contributions will:– Receive a free pass to Indiana State Parks – Be eligible for roll-over POWER account balances
• The state will double this amount if the member received all recommended preventive care services during the plan year
HIP Plus
HIP Basic
• Members receiving recommended preventive care have the opportunity to reduce their POWER account contributions in future years for HIP Plus up to 50%
Who’s Paying?
• The program will be funded by:o Federal moneyo Agreement with Indiana hospitals
• HIP 2.0 will be fully funded at no additional cost to Hoosier taxpayers
• Consumers making copayments in HIP Basic and POWER Account contributions in HIP Plus
• Providers accepting HIP will be paid Medicare rates
Rolling it Out
• Educate your patient population and community about notices, responsibilities and deadlines o Incorporate into current outreach and inreach o Send letters to uninsured population and those on your waiting lists o Host HIP 2.0 enrollment events o Advertise!
KEY GOALS FOR ASSISTERS:
An estimated 70 percent of Marketplace enrollees impacted are enrolled with HIP
MCEs. These MCEs, like Anthem, are helping with the transition by sending notices.
