Indiana to impose work requirement for some on Medicaid, get up to $80M for addiction – By Shari Rudavsky (indystar.com) / Feb 2 2018
The Healthy Indiana Plan, which provides low-income Hoosiers with health insurance, has received approval from the federal government to implement sweeping changes, including a work requirement for some, a tobacco surcharge, and up to $80 million a year for addiction treatment.
Friday’s announcement made Indiana the second state in the nation, after Kentucky, to mandate that HIP recipients participate in “community engagement” activities — such as going to school or a jobs training program, working, or volunteering — as a condition of their coverage.
Under the controversial measure, a recipient would have to prove upon re-enrollment each year that he or she was fulfilling this requirement or risk a suspension.
“Today’s announcement is one significant step in a long legacy of innovation in person-centered healthcare,” said Alex Azar, Health and Human Services secretary. “Indiana’s vision and ours goes beyond the provision of quality healthcare. It recognizes that Medicaid can become a pathway out of poverty.”
Proponents of the move argue that those who work enjoy greater well-being than those who are unemployed, so encouraging people to work will improve their overall health. Eleven other states are exploring putting similar programs into place, said Azar, a former Eli Lilly executive who was sworn into his new job earlier this week.
Indiana has a year to iron out details before implementing the community engagement piece.
But not everyone agrees that work requirements will improve health of HIP recipients.
While research supports that employed people are healthier than those who are not, it’s not clear that working leads to health, said Adam Mueller, advocacy director for Indiana Legal Services.
“It’s like saying being in the NBA makes you a taller person,” he said.
In addition, the paperwork associated with proving that a person qualifies for an exemption to the work requirement under one of 12 criteria could prove onerous for recipients, leading them to lose their coverage. Already people who have difficulty paying their premiums often have trouble dealing with the system, Mueller said.
“Adding an extra layer of work requirements will be really pretty tough,” Mueller said. “What we’re talking about is a significant bureaucratic apparatus to run this program and that’s going to lead to folks falling through the cracks and that’s one of our biggest concerns.”
Indiana Legal Services will evaluate the waiver and decide whether to challenge it in court, Mueller said.
The National Health Law Program, in conjunction with WHO, has already filed suit in Kentucky, where an estimated 100,000 people could lose coverage under the requirement. Litigation is also likely in Indiana, the program’s legal director said in a statement released Friday.
Not only do such requirements violate the law, they also have little to do with helping people find work, said Leonardo Cuello, the program’s director of health policy. Instead, they serve as a way to toss up roadblocks for those who need insurance.
“This is not an attempt to help people get or keep jobs. It is a thinly veiled attempt to cut healthcare,” he said. “All roads in this scheme lead to people being terminated from coverage. … It’s patently absurd that you make population healthier by taking away healthcare.”
While about 130,000 of the 442,000 people in the HIP plans do not work, some of those would be exempt from the requirement under one of 12 criteria, said FSSA Secretary Jennifer Walthall.
Those who are pregnant, medically frail, over age 59, caring for a young child or disabled adult, or in treatment for a substance use disorder would all be exempt under the waiver. At this point, FSSA does not know how many people meet one of those criteria, Walthall said.
In the material submitted to the federal government, FSSA noted that it had already tried to encourage recipients to participate in the state’s work referral program. Although 244,000 beneficiaries were unemployed and an additional 58,000 worked fewer than 20 hours a week, only 580 of those attended a Gateway to Work orientation over 15 months.
Almost 90,000 jobs in Indiana are unfilled, said Gov. Eric Holcomb, who appeared at a news conference flanked by Azar and Walthall to announce the three-year waiver renewal.
But the state is also in the grips of an opioid epidemic that incapacitates many who might otherwise be in the workforce.
So the FSSA waiver also includes changes in the Medicaid rules that would open up more treatment beds and therapies for those with substance use disorders. The federal government will now help pay for a range of addiction recovery services, including peer coaches that will translate into as much as an additional $80 million each year for the three years the waiver is in place.
In an effort to whittle away at another poor health indicator — Indiana’s high adult smoking rate — the waiver allows the state to implement a 50 percent surcharge if a recipient smokes. The surcharge will be waived for the first year in which the recipient will have access to a number of cessation programs. About 36 percent of Medicaid recipients smoke.
Indiana would be the first state in the nation to impose such a premium, a measure opposed by the American Lung Association.
“Studies have suggested that tobacco surcharges do not increase tobacco cessation, but rather encourage tobacco users to forgo coverage all together,” said Lew Bartfield, Executive Vice President of the Upper Midwest of the American Lung Association in a statement released Friday afternoon.
But state officials hailed the waiver and its many parts and said that it would result in a healthier Indiana.
“This is not just going to change lives. This in fact will be able to save lives,” Holcomb said.
