Presentation on theme: "Comprehensive Training for Indiana Navigators February 2015."— Presentation transcript:
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 Passed the Indiana General Assembly in 2007 as an alternative to traditional Medicaid Consumer-driven design creates incentives for members to exercise personal responsibility and live healthy lifestyles Utilizes a POWER account similar to an HSA to empower enrollees to become active consumers of health care services while evaluating cost and quality of services
HIP 2.0 Overview Coverage for low-income, non-disabled Hoosier adults ages 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 householdHIP Basic Income up to 100% FPL HIP Plus Income up to ~138% FPL 1$973$1, $1,311$1, $1,650$2, $1,988$2,775.54
HIP 2.0 Timeline May June July AugSept OctNov Dec Jan May 15 th Governor Pence announced proposed expansion of the HIP program June 22 nd Initial public comment period ended July 2 nd Indiana submitted HIP 2.0 Waiver Application to CMS September 21, 2014-January 2015 Negotiations between the federal government and state persist January 27 th HIP approval! August 22 nd CMS approved the Waiver Application; 30- day federal public comment period began September 21 st Federal public comment period ended July 17 th Indiana notified by CMS of unmet requirement for tribal consultation November 15 th Open Enrollment began
HIP 2.0 Programs HIP Basic HIP Plus HIP Link HIP State Plan
HIP Plus For Hoosiers with incomes up to 138% FPL Required POWER account contributions (2% member income) No other required cost- sharing (copayments)* Offers vision, dental, and more comprehensive prescription drug benefit Covers maternity services with no cost-sharing Power account jointly funded by member and the State of Indiana 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 contributions o 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 them o 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 limit o 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 quarter o 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
13 HIP Plus – POWER Account Member contributes approximately 2% of household income per year ($1-$100 per month) Unused member contributions rollover to offset next year’s required contribution Amount doubled if preventive services complete—up to 100% of contribution amount
HIP Plus Maximum POWER Account Contributions FPL Monthly Income, Single Individual Maximum Monthly PAC*, Single Individual Maximum Monthly Income, Household of 2 Maximum Monthly PAC, Spouses** <22% Less than $214$4.28Less than $289$2.89 each 23%-50% $ to $487$9.74$ to $656$6.56 each 51%-75% $ to $730$14.60$ to $984$9.84 each 76%-100% $ to $973 $19.46$ to $1,311$13.11 each 101%-138% $ to $1, $27.17 $1, to $1, $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 Basic plan for Hoosiers ≤100% FPL No required POWER account contributions Requires copayments for all services Reduced benefit package and more limited prescription drug benefit Covers maternity services with no cost-sharing POWER account is completely state- funded 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
17 HIP Basic– POWER Account Member not required to make monthly contributions Cannot be used to pay HIP Basic copays If preventive care complete, members can offset required contribution for HIP Plus by up to 50% for next year
HIP Basic ServiceHIP Basic Copay Amounts ≤100% FPL Outpatient Services$4 Inpatient Services$75 Preferred Drugs$4 Non-preferred Drugs$8 Non-emergency ED visitUp to $25 Copayments for HIP Basic members
HIP State Plan Available for qualifying individuals Keep HIP Plus or HIP Basic cost- sharing Some additional benefits, including transportation, dental and vision 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 Members ≤100% FPL Moved from HIP Plus to HIP Basic Copays for all services Members ≥100% FPL Disenrolled from HIP Plus Locked-out of HIP for 6 months Penalties for members not making PAC contribution:
Plan Comparison HIP Plus More affordable Predictable monthly contributions More benefits Option to earn reductions to future monthly contributions May reduce future contributions by up to 100% HIP Basic May be more expensive Unpredictable costs Fewer benefits Potential to reduce future monthly contributions for HIP Plus enrollment, but these reductions are capped at 50% 24
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 PortalIndiana’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: GET-HIP-9 ( ) 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 Februarynotices 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 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.letters 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:letters o No need to complete an application o Automatically conditionally eligible for HIP based on state’s data May choose a health plan or one will be assigned o Will receive a bill for PAC o 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:letters 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 coverage o 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
Pregnancy and HIP 2.0 Women who are in HIP 2.0 and become pregnant can stay in HIP 2.0 or can opt to go to the Medicaid pregnancy category. Women that are pregnant prior to or at application time will transfer to the Medicaid pregnancy category (HIP 2.0 will not be an option during pregnancy for this group) If pregnant at redetermination, pregnant women will transition to Medicaid pregnancy category (per CMS guidance). Women that deliver while enrolled in Medicaid pregnancy category will be able to move into HIP 2.0 (there is a potential for gap in coverage if a POWER account contribution must be made and the payment is not made soon after delivery).
Positive Outcomes of HIP 2.0 HIP 2.0 will cover approximately 350, ,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 money o 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.