Medicaid members on certain plans will be required to pay premiums and POWER account contributions starting July 1. Advocates continue to raise concerns about the effect this could have on maintaining coverage for Hoosiers. The Family and Social Services Administration is beginning an outreach effort to inform Medicaid members of the change.
Cost-sharing was temporarily paused during the continuous coverage period where members couldn't be disenrolled due to the COVID-19 public health emergency. Payment requirements are set to resume as part of the state’s “return to normal” plan for Medicaid. The return will impact Children’s Health Insurance Program (CHIP), MED works and the Healthy Indiana Plan members.
Advocates were hoping to prevent the return, saying premiums and POWER accounts cause confusion and get in the way of maintaining coverage.
David Craig, a professor at IUPUI, researches the challenges Medicaid members face. He said POWER accounts frequently came up in conversation.
“POWER accounts are difficult to navigate, especially when you are in poverty and you don't have the money, and you don't have the financial payment structures to do this relatively easily,” Craig said.
POWER account contributions are required by Indiana law for members to receive HIP Plus which includes better coverage, such as vision, dental and chiropractic benefits. The monthly payment can range from $1 to $20 based on a member’s income, and can change throughout the year. Non-payment can result in members being moved to HIP Basic, which includes co-payments for some services.
READ MORE: Despite advocate hopes, federal agency will not prevent return of Medicaid premiums
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When members don’t have a bank account or are confused about the amount they owe and when it's due, their coverage is at risk. Craig said POWER accounts put an additional burden on the relationship between Medicaid members and medical providers.
“The result of that is people are less healthy,” Craig said. “And the cost of their care almost always rises when they get emergency care or delayed care down the road.”
Craig said POWER accounts were meant to add concepts like consumer choice and responsibility into Indiana Medicaid. However, POWER accounts create a barrier where people have to prove they are “worthy” of care, according to Craig.
“And if you don't make that payment, then you're going to have a lesser kind of coverage, which can feel like a form of disciplining people,” Craig said.
Craig said people have had different experiences with Medicaid during the continuous coverage period than members did in prior years. He raised concerns about members losing the coverage they need and losing the “ease of access” that was present during the continuous coverage period.
FSSA said it will work with managed care entities and other stakeholders to make sure members are aware of the return of cost-sharing. It also said it will add information and additional resources to the agency's website.
The outreach efforts will also include “direct communication” from FSSA, managed care entities, and the vendor that receives payments from CHIP and MED Works members. The agency said members will receive “detailed notices 60 days before cost-share resumes and will begin receiving monthly invoices in July.”
The return includes premiums, POWER account contributions and co-payments.
Abigail is our health reporter. Contact them at aruhman@wboi.org.