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No More Monthly Payments for Medicaid in Indiana: Federal Judge Rules

No More Monthly Payments for Medicaid in Indiana: Federal Judge Rules

A federal judge has vacated the approval of Indiana’s Medicaid program, which means that the state will no longer be able to require monthly payments for the program.

A recent court ruling has found that certain policies within the Healthy Indiana Plan, or HIP, limit people’s ability to access coverage and services. The ruling came as a result of a lawsuit filed against the federal government.

The lawsuit contested various policies that are said to jeopardize coverage and access.

Monthly payments known as POWER account contributions are necessary to access the enhanced coverage provided by HIP Plus. Failure to make payments may lead to downgrading to the basic plan or even losing coverage altogether.

In 2020, the U.S. Department of Health and Human Services gave its approval for the plan to be renewed.

During the onset of the COVID-19 pandemic, the payments for Medicaid members were temporarily halted. After the state finished its process of returning to normal following the end of the COVID-19 public health emergency, the requirement was scheduled to restart in July.

The lawsuit brought attention to certain policies, one of which was the state’s power to refuse retroactive coverage. When a Medicaid member is no longer eligible for a program, they are given a “reconsideration period.” Typically, in most programs, individuals who regain eligibility during a specific period receive retroactive coverage. This means that they do not have to wait until the following month to be fully covered. The state had been given the authority to refuse coverage for HIP.

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Advocates sent a letter last year to the Centers for Medicare and Medicaid Services, urging them to eliminate Indiana’s ability to maintain these policies. In December, CMS made the decision not to take any action. The decision was made not to make any changes during the Medicaid unwinding process, as it was deemed too disruptive. However, there is a possibility of taking action in the future.

The judge ruled that HHS did not fulfill the goals of the Medicaid Act when they approved the program in 2020 and denied the request in 2023.

The ruling stated that the government clearly does not believe that states are unable to adapt to changes during the process of unwinding Medicaid.

The judge pointed out that the Secretary of HHS had recently revoked Wisconsin’s ability to impose premiums during the unwinding process, just a month before issuing the 2023 letter as per WFYI News.

Starting in July, Hoosiers enrolled in the Children’s Health Insurance Program (CHIP) and the MEDWorks program can expect cost-sharing to resume.

The Indiana Family and Social Services Administration is currently reviewing the ruling.

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