Healthy Indiana Makes Medicaid Enrollees Pay for Additional Coverage

Indiana’s Medicaid program, Healthy Indiana, requires participants to pay a small monthly fee to have advanced coverage (Healthy Indiana Plus). The fees range from $1 to $28, and Medicaid beneficiaries can even get vision and dental coverage, as well.

According to Kaiser Health News, any beneficiaries under the poverty level who do not keep up with payments lose enhanced coverage and face copayments. Enrollees have the option of having free basic coverage or adding dental and vision, Healthy Indiana Plus, which then adds the monthly payment.

Advocates of the program said that by getting the recipients to share financial responsibility, it will reduce unnecessary costs regarding services and emergency room visits. Healthy Indiana has become a possible model for states like Kentucky and Indiana, the article reported.

However, critics worry the complexity of the program could make care even harder for very poor recipients.

“Other states have looked at it, but the Obama administration has made it pretty clear that Indiana is going to be a test case and much evaluation will need to be done before they approve any more like it,” said Matt Salo, executive director of the National Association of Medicaid Directors.

Indiana began expansion in February 2015, and as of February, they have seen an increase of nearly 100,000 enrollees. According to Indiana’s estimates, there are an additional 190,000 adults who are eligible but not enrolled.

“What we heard for years … is that these people won’t pay and don’t have the ability to pay,” said Michelle Stoughton, senior director of government relations for Anthem. “But this has turned those arguments around and been able to show that people do want to be engaged.”

Approximately 75% of Healthy Indiana’s members covered under Anthem visited a dentist and 65% sought vision care within the first 3 months of being covered, according to Stoughton.

State figures show a 42% decrease in emergency room visits in 2015 and approximately 80% of enrollees visited a primary care physician, which is one-third higher than most state programs, according to the article.

Also, 70% of enrollees have been making their required payments for advanced coverage and officials say that 9 out of 10 enrollees are satisfied or very satisfied with their healthcare coverage. However, approximately 2200 people below the poverty level have lost coverage for not paying their monthly fees.

According to Kaiser Health News, both physicians and hospitals support the program because the state increased hospital rates by 20% and doctor pay by 25%. Medicaid has gained more than 5300 providers in the past year.

Some conservative groups and critics say that the program may be more expensive for the state due to advanced coverage and better compensation for providers, while some state that the more complicated structure of the coverage may prevent some from receiving care.