Bookmark and Share

Medicaid, SCHIP, & Federal Authority

  • 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.


High-Risk Pools

  • Indiana’s high-risk pool, the Indiana Comprehensive Health Insurance Association became operational in 1982 and is financed by assessments on insurers. The premium cap for the program is 150 percent of average commercial rates for individual rates. As of June 2006, just over 7,200 persons were enrolled in the program.


Dependent Coverage

  • In May 2007, Indiana Governor Mitch Daniels (R) signed into law House Bill 1678 that requires commercial health insurers and health maintenance organizations to cover dependents up until the age of 24, at the policyholder’s request.

State Specific Strategies

  • Indiana passed legislation in May 2007 that, in addition to the programs listed above, accomplished the following things: 

    • A tax credit to employers that establish a Section 125 plan. For employers who do not offer a fully insured health plan that satisfies Section 125 of the Internal Revenue Service code, the state will provide the lesser of $50 per employee or $2,500 for two years if the employer establishes a Section 125 plan.
    • Offer small employers (2-100 employees) a tax credit up to 50 percent of the cost of a qualified wellness program.
    • Allows certain small employers to join together to purchase health insurance.
    • Expands the definition of 'dependent,' allowing parents to cover their children up until the age of 24 upon policyholder request.