posted Apr 10, 2015, 6:23 PM by Barbara Thompson
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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% FPL | HIP 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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