Healthy Indiana patients are being dumped into lower-tier plan

More than half of Indiana's alternative Medicaid recipients didn't make payment required for top service

By Maureen Groppe
IndyStar, May 8, 2017

More than half the low-income people who qualified for Indiana’s alternative Medicaid program failed to make a monthly payment required for the top tier of service — a key feature of the program Vice President Mike Pence insisted on as a condition to expanding the health care program when he was Indiana’s governor.

That's according to a new evaluation of the Healthy Indiana Plan, a program designed by Indiana health care consultant Seema Verma, who — as the new administrator for the Centers for Medicare and Medicaid Services — can now grant other states permission to impose similar monthly fees.

Opponents say the department of Health and Human Services should not allow other states to do this, because this study and other research has shown requiring poor people to pay is a barrier to care.

Verma, along with HHS Secretary Tom Price, already have told states they want to be as permissive as possible.

Of the 590,315 Hoosiers determined eligible for Medicaid during the 22 months after Indiana expanded eligibility, 55 percent either never made the first payment or missed one while on the program.

Nearly nine in 10 ended up in the lower-tier plan as a result, according to an evaluation done for the state and submitted to the federal government.

“The evaluation makes clear that Healthy Indiana's complicated use of premium payments is not working,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “More than half of the enrollees have missed a payment at some point, and as a result are bouncing around in and out of coverage sources or no coverage at all. These are very poor people for whom premiums are a hardship.”

Pence insisted on including monthly payments as a condition for expanding Medicaid through the Affordable Care Act. He argued the payments promote personal responsibility and better decision making by patients who have “skin in the game.”

It's a sentiment shared by Verma. “The Healthy Indiana Plan is about empowering individuals to take ownership for their health,” Verma said during her confirmation hearing.

The insurance companies which offer the Medicaid plans say Indiana’s payment requirements and two-tiered system is more costly to administer.



By Don McCanne, M.D.

Although we’ve covered this topic before, this report provides new evidence that the Healthy Indiana Plan is providing a disservice to eligible Medicaid beneficiaries by shifting most of them into the lower-tier plan where they lose dental and vision benefits, have more limited drug coverage, and are exposed to copayments. Since most of these individuals have no discretionary income, many do without these important services. This is the opposite of what a program designed to provide low-income individuals with affordable access to health care should be doing.

One of the major problems with our health care financing system is that we pay hundreds of billions of dollars for outrageous administrative waste. Now the insurers report that the Healthy Indiana Plan is even more costly to administer than traditional Medicaid. Just exactly what we need - more administrative waste!

Recently-appointed CMS Administrator Seema Verma worked with then Governor Mike Pence to establish this ideologically-driven but cruel policy, and now she wants to work with HHS Secretary Tom Price to expand this concept to other states. Enough! We do not need more inefficiency and impaired access to care. We need a single payer national health program - an improved Medicare for all so that all of us can have the care that we need, when we need it.