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HIP 2.0 - What You Need to Know

posted Apr 10, 2015, 6:23 PM by Barbara Thompson   [ updated Apr 20, 2016, 1:45 PM ]
This is an overview. For answers to specific questions contact the FSSA through their live chat feature or by phone 1-877-GET-HIP-9 (1-877-438-4479) 


Governor Pence announced on January 27, 2015 that the Federal Government has approved HIP 2.0, Indiana’s alternative to traditional Medicaid expansion. This announcement opened the door for 350,000 Hoosiers, previously ineligible for Medicaid, to access affordable health insurance. Coverage for this new group became available on February 1, 2015. Hoosiers can enroll at any time by visiting HIP.IN.gov, or by visiting a local DFR (Division of Family Resources) Office.

What is HIP 2.0?

Unlike traditional Medicaid, HIP 2.0 gives members a POWER Account, similar to a Health Savings Account (HSA), and a High Deductible Health Plan (HDHP). POWER accounts will be pre-funded from the first day of enrollment, and funds will be immediately available for members to use for their qualified health expenses. If a member’s annual expenses are more than the amount in their POWER Account, their HDHP will cover the additional health expenses. In lieu of paying a monthly premium for health insurance, HIP 2.0 members are asked to make a monthly contribution to their POWER Account equal to 2% of their monthly income.

Who is Eligible?

Qualified Hoosiers ages 19 to 64 with incomes of up to $16,436.81 annually for an individual, $22,246.25 for a couple, or $33,865.13 for a family of four are generally eligible to participate in HIP 2.0. All HIP members must have their eligibility renewed every 12 months.


Medically Frail Designation

The Code of Federal Regulations defines "medically frail" as including "individuals with disabling mental disorders, individuals with serious and complex medical conditions, and individuals with physical and/or mental disabilities that significantly impair their ability to perform one or more activities of daily living." Individuals designated as "medically frail" do not need to meet the federal and/or state standard for disability.

Hip 2.0 enrollees who are designated as "medically frail" will be exempt from any lockout of coverage and will have access to dental coverage, vision coverage, and non-emergency medical transportation, regardless of whether POWER Account contributions are made. In order to benefit from this status, it is very important to report any history of mental illness and/or substance abuse when filling out the application.

NAMI anticipates that many of our members (or the family members of our members) who have applied for and been denied disability benefits in the past will be designated as “medically frail” due to history of mental illness. The enhanced benefits and exemption from the six-month lock-out will be a great benefit to these members.

Cost

HIP 2.0 enrollees will be asked to pay a monthly premium into their POWER Account equal to 2% of their monthly income. For example, an individual with an income of $950/month would be required to pay $19 a month ($950 x .02 = $19). Members who do not make this monthly contribution may be required to pay co-pays at time of service.

HIP Plus

HIP Plus is an enhanced benefits package for those members who pay their monthly POWER Account contributions. HIP Plus benefits include dental and vision coverage, and HIP Plus members are not required to pay co-pays for doctor’s visits or prescriptions.

HIP Basic

Hoosiers living at or below 100% FPL who fail to make their monthly POWER Account Contribution (within a 60-day grace period) will be placed into HIP Basic coverage. This benefits package does not include dental and vision coverage and requires members to pay co-payments for service (ex. $4 for outpatient services, $75 for inpatient services, $4 for preferred drugs, $8 for non-preferred drugs).

Six-Month Lockout

Hoosiers with an income between 100-138% FPL are NOT ELIGIBLE for HIP Basic. These individuals will be LOCKED OUT of coverage for failing to make their monthly POWER Account contributions, unless they are designated as Medically Frail* or section 1931 parents and caregivers beneficiaries.


 Federal Poverty Limit (FPL)Make Monthly Contribution Do Not Make Monthly Contribution 
Between 100-138% FPL HIP Plus SIX MONTH LOCKOUT 
 Below 100% FPLHIP Plus  HIP Basic
 Medically Frail
(0-138% FPL)

HIP Plus Benefits + Non-Emergency Medical Transport 

HIP Plus Benefits +

Non-Emergency Medical Transport

Co-Pays Required for Service

(those above 100% FPL will receive bills for POWER Account Contributions until they are no longer delinquent)  


Annual Renewal (Redetermination Process)

By law, all HIP members must have their eligibility renewed every 12 months through what is called the redetermination process. At this time you will be able to renew your insurance coverage or upgrade to the HIP Plus. You will receive notices in the mail with guidance on how to renew.


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