Indiana Medicaid and SCHIP Waivers

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In December 2007, Indiana received approval from the Centers for Medicare & Medicaid Services (CMS) to implement a section 1115 demonstration to operate two distinct health insurance products: Hoosier Healthwise Program for current Medicaid eligible individuals and the Healthy Indiana Plan (HIP) for uninsured adults with incomes up to 200 percent of the federal poverty level (FPL) who are otherwise not eligible for Medicaid. Individuals in Hoosier Healthwise receive Medicaid benefits through managed care. The HIP program provides a high deductible health plan and a Personal Wellness and Responsibility (POWER) Account (similar to a health savings account) valued at $1,100 per adult to pay for initial medical costs. Additionally, HIP provides $500 in “first-dollar” preventive benefits. Members make monthly contributions to the POWER Account based on income level.

Also included in the May 2007 legislation that enacted the HIP program were coverage expansions for pregnant women and children. Following are the details:

  • Medicaid expansion for pregnant women to 200 percent FPL; up from 150 percent FPL. Pregnant women will now have presumptive eligibility.
  • Expand SCHIP to children up to 300 percent FPL; up from 200 percent FPL. This was not implemented due to a restriction by CMS that prevents states from covering children above 250 percent FPL unless the state can meet certain benchmarks.) The State has since applied for a waiver to expand coverage to 250% FPL.