State Medicaid programs face a number of pressing issues over the next two years, include policy changes, growing demand,
and, of course, financing. Experts agree that even with federal matching funds states cannot realistically cover all their
uninsured residents, nor can they guarantee affordable coverage. A large-scale solution is necessary, but reforms will take
years to develop.
In the meantime, innovation at the state level has created several noteworthy coverage models with the potential for national
implementation. A new subsidized plan in Indiana, designed with bipartisan support, is one to watch.
The Healthy Indiana Plan (HIP), which began enrolling beneficiaries in January 2008, is the first state model that has a consumer-driven
look to it. It includes a high-deductible health plan and health savings account offered to low-income adults who wouldn't
otherwise qualify for Medicaid. HIP is generating interest because:
- It addresses an otherwise underserved population;
- It includes consumer-driven strategies never before applied in Medicaid;
- It incentivizes personal responsibility among members.
Indiana received a five-year, federally approved waiver from the Centers for Medicare and Medicaid Services (CMS) to implement
HIP, which is delivered by two managed care plans: Anthem and the local Medicaid plan, MDwise Inc., based in Indianapolis.
"There was an unforeseen, significant demand for Healthy Indiana," says Charlotte MacBeth, president of MDwise, which covers
more than 10,000 HIP members. "A lot of states have medically needy categories, but Indiana has never adopted a medically
needy program. There was a population of adults who needed medical care who were probably the first ones to sign up. The state
also did an excellent job promoting the program, so that contributed to the initial growth. But it's my understanding the
growth hasn't slowed down. It's continuing to exceed expectations."
According to state data, the program had enrolled nearly 35,000 total members as of Dec. 4, 2008, which amounts to 98 members
per day. More recent data indicates 115 members per day.
New Population
Pent-up demand for HIP is staggering. State officials predict the program will eventually enroll a total of 120,000 adults
earning less than 200% of the federal poverty level. Any low-income adult without access to an employer plan who has been
uninsured for six months is eligible.
As a demonstration project, HIP was designed to open up coverage to low-income adults without children—a unique population
that typically does not have access to state Medicaid programs. More than 22,000 adults without children are now on the rolls;
however, for that subgroup, HIP has a hard enrollment cutoff at 34,000 people.
Based on documented demand, it's almost certain HIP will reach the cap in the first quarter of 2009. At that point, eligible
applicants will be turned away.
Because HIP covers underserved adults—who are often the focus of national coverage reforms—its growing pains over the next
five years might provide lessons for the incoming HHS Secretary and the White House Office on Health Care Reform to observe.
