You are offered the opportunity to make a Fast Track payment before you have been found eligible for HIP. Now that you're a part of the Anthem family, we want to make sure you make the most of your benefits. 2023 Amends 405 IAC 10-4-11 to change how presumptive eligibility is treated. There are four health plans that serve Healthy Indiana Plan members (Anthem, CareSource, MDwise, MHS). ** Attention: The rates listed reflect the most updated information on Federal Poverty Levels. Allowing multiple entities to identify enrollees as potentially medically frail may help ensure that eligible enrollees are identified. If you do not pay your monthly contribution on time, you will be moved to HIP State Plan Basic. To avoid a gap in coverage, please tell MHS and theDFR as soon as your pregnancy ends. Key State Policy Choices About Medical Frailty Determinations for, Three in 10 nonelderly adults with Medicaid report having a disability, Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey, Status of State Medicaid Expansion Decisions: Interactive Map, Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers, Table 1: Share of Expansion Adults Identified as Medically Frail and Implications, 2018. Your eligibility year will remain unique to you. Plans. Federal regulations set out the general criteria that define medical frailty (Box 1). If you choose to leave the program early, your contributions not spent on health care costs may be returned to you. A POWER account is a special savings account that members use to pay for health care. input, Family and Social Services Administration, Transferring to or from Other Health Coverage, click here to see if your income qualifies you for HIP, Use this link to find a certified navigator in your area, Report POWER account contributions are a key part of the Healthy Indiana Plan. What happens if a HIP member becomes pregnant? If you wait more than 60 days to make a payment and your income is more than the federal poverty level, then your application will be denied and you will have to reapply for HIP coverage. In most states reporting very low shares of medically frail enrollees, medical frailty is limited to determining benefit package contents (MA, NJ, and ND). The findings are excerpted from a survey of the 50 states and the District of Columbia about Medicaid eligibility for seniors and people with disabilities conducted by the Kaiser Family Foundations Program on Medicaid and the Uninsured in fall 2018.1 Tables contain data for the 12 states. Fast Track is a payment option that allows eligible Hoosiers to expedite the start of their coverage in the HIP Plus program. If you make the contribution in August, you will begin HIP Plus August 1. These states include California, Indiana, Nevada, and New Jersey. The HIP State Plan benefits grant you comprehensive coverage including vision, dental, non-emergency transportation, chiropractic services and Medicaid Rehabilitation Option services. States with restrictive waivers, where medical frailty determines exemptions from conditions on coverage such as work requirements and premiums, report higher shares of medically frail enrollees than states where medical frailty only determines benefit package contents. A disability determination based on Social Security Administration criteria. Other data show that an increasing share of Arkansas enrollees who were subject to work and reporting requirements were identified as medically frail, and therefore exempt from complying, as the requirements were implemented in 2018. A penalty is deducted if an individual is disenrolled due to non-payment or withdrawing from the program without having other coverage. Settings, Start voice The ABP may be less likely to include home and community-based services (HCBS), such as personal care services, because ABPs usually are based on commercial insurance plans, which typically provide less coverage of HCBS than what is available through the Medicaid state plan benefit package.14 On the other hand, the state plan benefit package may not include behavioral health and/or preventive services to the same extent as the expansion adult ABP because those benefits are optional in the state plan benefit package, while ABPs are subject to mental health parity and essential health benefit requirements to cover such services.15. your access to these services is temporary while your health plan confirms your status as medically frail. CMS has required many, but not all, states with waivers imposing restrictions on coverage and benefits to identify and exempt enrollees who are medically frail. This contribution can be split when spouses are both enrolled in HIP. In the HIP program, the first $2,500 of medical expenses for covered services are paid with a special savings account called a Personal Wellness and Responsibility (POWER) account. HIP State Plan - The HIP State Plan provides "medically frail" members access to comprehensive Indiana Medicaid State Plan services and includes cost-sharing responsibilities through POWER account contributions ( HIP State Plan - Plus) or copayments ( HIP State Plan - Basic ), as determined by a member's eligibility category and income level. Need help with some of the HIP terms? You may not need to complete this form. CareSource Indiana Plans Medicaid Benefits and Services Care & Disease Management Care & Disease Management CareSource offers care and disease management programs. The member will continue to have a POWER account but will not be required to make payments. If you fail to verify your condition at the request of your health plan, you could still have access to comprehensive coverage including vision and dental, by participating in HIP Plus, but you would lose access to the additional HIP State Plan benefits including coverage for non-emergency transportation. You can also double your reduction if you complete preventive services. Over half of the states32 allow individuals to self-attest that they meet medical frailty criteria, instead of requiring documentation or other verification (Figure 5 and Appendix Table). Determines benefit package contents, as well as exemptions from work requirements. It is important to answer their questions to maintain HIP State Plan benefits. The Healthy Indiana Plan now makes coverage available to hundreds of thousands of Hoosiers who did not have an insurance option before. On average,HIP Plus members spend less moneyon their health care expenses than HIP Basic members. Will my health condition(s) affect the coverage I receive? A HIP member is considered medically frail if the individual has one or more of the following: Disabling mental disorder Chronic substance abuse disorder Serious and complex medical condition Figure 5: State Choices About Medical Frailty Verification Methods, The state Medicaid agency makes the final medical frailty determination in most states (Figure 6 and Appendix Table). The Healthy Indiana Plan (HIP) is an affordable health plan for low-income adult Hoosiers between the ages of 19 and 64. This includes people who report serious difficulty with hearing, vision, cognitive functioning (concentrating, remembering, or making decisions), mobility (walking or climbing stairs), self-care (dressing or bathing), or independent living (doing errands, such as visiting a doctors office or shopping, alone).19, Figure 1: Disability and SSI Status of Nonelderly Adults with Medicaid, 2016. Need help? HIP Plus The initial plan selection for all members is HIP Plus which offers the best value for members. Other entities that states allow to make final medical frailty determinations are health plans, treating providers, and third party enrollment brokers. The HIP Plus program provides comprehensive benefits including vision, dental and chiropractic services for a low, predictable monthly cost. Call your health plan for details about these options and locations. Other sources of verification include treating provider certification, medical records, claims data, and data match with another program such as Ryan White. You can see a doctor for preventive care visits. Box 1: Federal Medical Frailty Criteria for Adults2. Your eligibility year will remain unique to you. Medical Can you be kicked off of Medically Frail? Members who are medically frail will have greater coverage through HIP State Plan. The HIP State Plan benefits grant you comprehensive coverage including vision, dental, non-emergency transportation and chiropractic services. The Healthy Indiana Plan is the state of Indianas signature, consumer-driven health coverage program for non-disabled Hoosiers ages 19-64. A key principle of the Healthy Indiana Plan is that it gives members the opportunity to participate in HIP Plus. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. How can KI-HIPP benefit me? Your monthly POWER Account contribution will be based on your income. Settings, Start voice You will not have copays for healthcare services while pregnant. If your annual health care expenses are less than $2,500 per year, you may rollover your remaining contributions to reduce your monthly payment for the next year. The Healthy Indiana Planhas two pathways to coverage HIP Plus and HIP Basic. MCE Managed Care Entity has panels and departments that decide if a person is medically frail based upon criteria and diagnoses of the client, This should happen naturally within the first thirty days of the person being on a MCE with HIP Healthy Indiana Plan (Medicaid Policy 3515.05.00), Done by a review of medical claims and clinical history. To file a HIPAA complaint, call (800) 372-2973. Members with incomes above the poverty level, for example $14,580 a year for an individual, $19,720 for a couple or $30,000 for a family of four in 2023, that choose not to make their POWER account contributions will be removed from the program and not be allowed to re-enroll for six months. By contrast, three states (MI, MT, and ND) allow multiple entities to initiate the medical frailty determination. Fast Track is a payment option that allows eligible Hoosiers to expedite the start of their coverage in the HIP Plus program. Anthem works with the State of Indiana to bring you the Healthy Indiana Plan (HIP) healthcare program. If you are an adult age 19-64, who is not disabled, click here to see if your income qualifies you for HIP**. If you no longer have HIP because your received another category of insurance such as Medicaid or Medicare, became income ineligible*, or voluntary withdrawal, you will lose your Medically Frail Status. HIP Plus provides health coverage for a low, predictable monthly cost. Federal law provides that Medicaid enrollees who are medically frail or otherwise have special medical needs must have access to the traditional state plan benefit package. In HIP Basic, members make a payment every time they receive a health care service, such as going to the doctor, filling a prescription or staying in the hospital. With HIP State Plan Plus: HIP Basic offers limited benefits and can be more expensive than paying your low monthly HIP Plus POWER Account contribution. Benefits and Services. After the 12 month period members will transfer from HIP Maternity to HIP Basic to get HIP Plus benefits the member will need to make a POWER account contribution. Or, call an OB Nurse at 1-877-647-4848, Extension 20309 to complete it over the phone. Since it can take some time for the people to review claims, see codes matching medically frail categories and send them for review, you can send the person directly to the review board as the provider. HIP Basic - Members who do not pay their monthly POWER account contribution are disenrolled from HIP Plus. The POWER account is used to pay for the first $2,500 in health care costs. The HIP Basic plan will charge copayments for health care services. If you make a Fast Track payment and are determined to be eligible for HIP then your HIP Plus coverage will begin the first of the month that you submitted your application. Pregnant members will have all cost sharing eliminated and will receive additional benefits during their pregnancy including non-emergency transportation. Click here for conditions that may qualify you as medically frail. HIP Basic can be more expensive than HIP Plus. Can the member receive help paying for their required contribution? HIP is offered by the state of Indiana. HIP Plus members receive more visits for physical, speech and occupational therapists than the HIP Basic program, and coverage for additional services like bariatric surgery and Temporomandibular Joint Disorders (TMJ) treatments is included. Pregnant women enrolled in Hoosier Healthwise will not be affected by changes to the Healthy Indiana Plan and will continue to receive coverage through Hoosier Healthwise. Determines benefit package contents, as well as exemption from premiums. Medicaid Members: Time is running out! Section 1931 eligible parents and caretaker relatives eligible under 42 CFR 435.110, Low-income 19- and 20-year-old dependents eligible under 42 CFR 435.222, Members determined eligible for transitional medical assistance (TMA) by the State in accordance with Section 1925 of the Social Security Act. Log in to your portal account to fill out your End of Pregnancy form. Pregnant members are eligible to receive incentives for completing preventive care like all other HIP members. Policy developments in this area and assessments of whether state medical frailty criteria and procedures are appropriately identifying all eligible individuals will be important areas to continue to watch as Medicaid expansion and state implementation of restrictive waiver policies continues. Members deemed medically frail will receive HIP State Plan coverage and will be enrolled in HIP State Plan - Plus. The medical frailty process recognizes that not all people with physical and mental health needs are eligible for Medicaid based on a disability and is intended to ensure that these enrollees can access the benefit package that best meets their needs. Take charge of your health next year and POWER Up with HIP Plus. Call 1-877-647-4848 (TTY: 1-800-743-3333). HIP Basic does not include vision or dental coverage for members 21 and older. Your POWER account invoice will be for one of five tiers, ranging from $1 to $20. These states include Arkansas, Indiana, Michigan, Montana, Nevada, and New Jersey. If your 60 days to pay expires in August without you making either a Fast Track payment or POWER account contribution, then you would default to HIP Basic coverage effective August 1 if your income is below the federal poverty level. With HIP Plus, members do not pay every time they visit a doctor or fill a prescription. (d) A medically frail member in HIP State Plan Basic may choose to enroll in HIP State Plan Plus at annual renewal or prior to the rollover determination as provided in section 2 (c) of this rule by making POWER account contributions in accordance with 405 IAC 10-10-3 (a). This will occur based on what month you entered the program. While receiving SSI benefits is a pathway to Medicaid eligibility for some people with disabilities, the SSI disability standard is more stringent than the ACS definition.20 In addition, SSI financial eligibility criteria are more restrictive than those for Medicaid expansion adults and other disability-related Medicaid coverage pathways.21 As a result, people with disabilities who do not receive SSI can be eligible for Medicaid asexpansion adults or low-income parents22or through an optionaldisability-related pathway.23 People who are eligible for Medicaid based on their status as an SSI beneficiary are excluded from coverage in the ACA expansion group. The Healthy Indiana Plan (HIP) is a health insurance program for qualified adults. HIP members who are pregnant may keep their HIP coverage for the duration of their pregnancy. The out of state reimbursement plan for hospital and medical insurance ("the reimbursement plan") is available to certain retired The plan pays for medical costs for members and can include dental, vision and chiropractic. Contribution amounts may be higher for smokers. HIP State Plan members still have a POWER Account and can pay an affordable monthly contribution for these benefits as if you were in HIP Plus. You can pay either the $10 Fast Track payment or your POWER account contribution amount. What's the difference between HIP Plus and HIP Basic? Make sure you keep paying your POWER Account contributions to keep HIP Plus benefits. MaryBeth Musumeci , These HIP State Plan benefits will continue as long as your health condition, disorder or disability status continues to qualify you as medically frail. Enhanced benefits are available to individuals whose health status qualifies them as medically frail. options Additionalservicescovered - dental&vision(HIPPlus&StatePlanonly) NewCost-sharingstructure Nowaitlistforapplicants HealthCoverageforadultsthathaveState income than 138% FPLPlan nomore IP2.0Basics: KeyChanges PersonalWellnessandResponsibility(POWER)Account- combinationofmemberand What happens to the POWER account in the Basic plan? If you are not found eligible for HIP and you have made a Fast Track payment, this payment will be refunded to you by the MCE (Anthem, Caresource, MDwise or MHS) that took the payment. All the forms must be done by the medical professional who is treating the person (doctor, NP, therapist, counselor, etc) or the direct staff such as a nurse. Few states elected the ABP option prior to the Affordable Care Act (ACA), but ABPs became more widespread after the ACA required states to provide an ABP to Medicaid expansion adults. HIP Basic members do not have a simple, predictable monthly contribution. McLaren Health Care and/or its related entity, Commitment to Quality Care | Healthy Indiana Plan, Find a Drug | Healthy Indiana Plan State Plans, Benefits and Services | Hoosier Healthwise, Affordable Connectivity Program | Hoosier Healthwise, Commitment to Quality Care | Hoosier Healthwise, Getting Help with a Problem | Hoosier Healthwise, Renewing Your Coverage | Hoosier Healthwise, Nondiscrimination/Accessibility (English), Nondiscrimination/Accessibility (Spanish). In addition, enrolled members may also include Non -Medicaid policy holders with at least one Medicaid member on their plan. Other states reported much smaller shares of medically frail expansion adults, ranging from 3% in Iowa to less than 1% in New Jersey and North Dakota (Table 1). (d) A medically frail member in HIP State Plan Basic may choose to enroll in HIP State Plan Plus at annual renewal or prior to the rollover determination as provided in section 2 (c) of this rule by making POWER account contributions in accordance with 405 IAC 10-10-3 (a). Note: Having a condition on this list does not guarantee you will be considered frail. The information and documents posted within this section are offered to assist state agencies and Kentucky's partners in understanding the obligations imposed by the Health Insurance Portability and Accountability Act (HIPAA). A medically frail designation can expand the scope of services available to enrollees. HIP Basic requires members to make a small payment, called a copayment, each time they go to the doctor or hospital except for preventive care or family planning services. You will need Adobe Reader to open PDFs on this site. If a member does not wish to change health plans, they do not need to take any action and will automatically stay with their current health plan for the new year. HIP State Plan Plus members who fail to make the payments will stay on Plus but with co-pays if otherwise they would be entirely kicked off HIP (105-138% of poverty not eligible for Basic) During the public health emergency we are currently in this does not matter, but will be very important later when it is gone. HIP Plus provides MORE benefits than the HIP Basic program, including vision, dental and chiropractic services. Healthy Indiana Plan (HIP) Medicaid | MHS Indiana Home Find a Provider Portal Login Events Careers Contact Us Contrast a a a For Members Wellcare by Allwell Ambetter from MHS Healthy Indiana Plan Hoosier Care Connect Hoosier Healthwise For Providers Login Behavioral Health Providers Clinical & Payment Policies Coronavirus Information Disabling mental disorders, including serious mental illness; Physical, intellectual or developmental disabilities that significantly impair the ability to perform one or more activities of daily living; or. While making a Fast Track payment can help ensure you get enrolled in HIP Plus as quickly as possible, you are NOT required to make a Fast Track payment. To enroll in HIP Plus, eligible individuals must make a monthly contribution to their POWER Account to help cover initial health expenses. You will receive a Fast Track invoice from the Managed Care Entity (MCE) you selected to provide your health coverage. In the HIP Plus program, members do not pay copayments when they go to the doctor or hospital or fill a prescription. Eligibility is not impacted by availability of employer coverage. Accessibility Comprehensive . The $10 payment goes toward your first POWER account contribution. With HIP Plus, members can get 90-day refills on prescriptions and receive medication by mail order.
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