Codifying HIP 2.0: Premature Or Purposeful?

INDIANAPOLIS -- During this past legislative session, lawmakers voted to codify the state’s new health insurance program for low income Hoosiers, also known as HIP 2.0.  The move helps solidify the initiative but it may also pose restrictions for some health centers like the Raphael Health Center in Indianapolis. 

The center is undergoing a 5,000 square foot expansion that will more than double the number of dental examination rooms. CEO Dee Roudebush says they’re integrating services to provide more holistic care for their patients who may recieve primary, mental and dental care in one visit. 

The center is one of the 27 Federally Qualified Health Centers in Indiana that serve low income Hoosiers. And Roudebush says the Affordable Care Act, and more specifically HIP 2.0, has enabled their expansion.  In the past year, their percentage of self-payed patients dropped from 50 percent to 14 percent. 

She says insurance gives patients a sense of security and pride. "Now they have so much more self-confidence because they know they have insurance and they know they can pay us and that means a lot to a patient they want to be a part of their care and they have a vested interest."

HIP started in 2011 under Gov. Mitch Daniels' administration, and in the first two years expanded coverage for nearly 62,000 low-income Hoosiers not eligible for Medicaid.  HIP 2.0 was established in 2014 under Gov. Mike Pence as an approved alternative to Medicaid expansion with the Affordable Care Act. 

One of the core ideas of the program has always been the health savings account.

Republican State Sen. Patricia Miller says HIP supporters want to keep features like the POWER Account in play.

"Putting into the statute some of those things we had negotiated early on like skin in the game, where individuals would pay some type of payment for their insurance policy even if it were minuscule, we felt they had to have some personal responsibility," Miller says. 

Lawmakers voted to put HIP 2.0 into the state statue last session. It offers two levels of coverage, with HIP Basic, there’s no dental.

Currently, HIP 2.0 is fully covered by federal funds, but that amount will decrease to 90 percent over the next few years, if the waiver is renewed in 2017 when changes may need to be negotiated.

Miller says codifying the program sends a message.

"We think by having it in the statute, if the federal government wants to modify they will see we feel very strongly about it here in Indiana," Miller says.

Since HIP 2.0, an estimated 350,000 low income Hoosiers are now covered.   Democrat State Sen.Tim Lanane says no one is arguing that that isn’t a good thing.  He says the big concern with codification is the lack of flexibility.

"When the federal government approved this program and made it clear to us that they had some skepticism about some of the features whether it was the POWER Account requirement or the lock out period and the fact that you could get downgraded to a lesser plan," Lanane says. 

Members who fail to pay into their POWER Account every month can be bumped down to Basic HIP, losing some benefits and may be locked out of HIP Plus for a six month period.  Lanane says he understands why the current state administration and supporters wanted to lock these features.

"But what if the federal government doesn’t agree," Lanane says."Then where will we be at that time?"

At that time the Medicaid waiver will be up for renewal and specifics of the program will likely be renegotiated.  It could also mean it would head back to the legislature to modify the code.  The Family Social Services Administration administers the plan, and it is able to change parts of the program that are not set in the statute – maybe increasing the amount of dental coverage – and that could help more patients at the Raphael Health Center in Indianapolis.

Dee Roudebush says many of her patients are in need of extensive dental care. "We need to get their teeth fixed. It’s going to save money in the long run medically, and it’s going to make these people healthy and happy," Roudebush says. "They’re going to get jobs because they have teeth. They’re eating better. They’re healthier."

The federal and state reviews will be in next year when the current Medicaid extension waiver runs out.