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Indiana wraps up Medicaid unwinding, prepares for return of cost-sharing

A stethoscope rests on a white table.
Cost-sharing paused for Medicaid members at the beginning of the COVID-19 pandemic. But it will restart in July for about 1 million Hoosiers in the Healthy Indiana Plan, the Children's Health Insurance Program (CHIP) and the MEDWorks program.

A significant number of Hoosiers lost their Medicaid coverage during a process known as “unwinding,” following the end of the COVID-19 public health emergency. Certain Medicaid members will resume paying premiums as early as July.

Medicaid officials said the state completed its final unwinding renewals in March. As of May, nearly 500,000 Hoosiers were disenrolled.

Indiana still has a couple months in its reconsideration or redetermination period for people who lost coverage at the end of the unwinding period. If someone does not respond to requests for additional information to determine eligibility, the Indiana Medicaid program allows for a 90-day reconsideration period. This allows people to regain coverage if they are still eligible.

During the unwinding, the state found that 21 percent of those who failed to respond to requests for verification regained eligibility during their reconsideration period.

Officials said Indiana processed nearly 1.8 million renewals over the last year — about half of those resulted in a successful renewal. Of those renewals, 78 percent were ex parte renewals. Those are also known as “auto-renewals,” meaning the state has enough information to know the individual is still eligible for Medicaid without needing additional verification.

The federal health insurance marketplace has a special enrollment period for people who lost coverage because of the unwinding.

Nonis Spinner, director of eligibility and member services at the state Office of Medicaid Policy and Planning, said that enrollment period has been extended through November.

“This extends that period until the regular open enrollment opens,” Spinner said. “So it does give them kind of a longer runway to find other coverage if they've found that they are no longer eligible for Medicaid.”

Spinner said most people who lost coverage qualified to have their account transferred to the federal marketplace.

Despite the unwinding, state data showed a net increase in Medicaid enrollment numbers. The most recent enrollment numbers grew about 540,000 over February 2020 enrollment numbers. Medicaid officials pointed to continuous coverage requirements for children younger than 19 as a major contributing factor for that increase.

The continuous coverage requirements are separate from the public health emergency and Medicaid unwinding. If a child is enrolled in Medicaid, they are given 12 months of continuing coverage even if their circumstances change in a way that would make them ineligible. Medicaid officials said this affected Medicaid enrollment numbers, but not the unwinding process.

One of the final parts of the Indiana’s “return to normal” process is the return of cost-sharing, including copayments and premiums.

Cost-sharing paused for Medicaid members at the beginning of the COVID-19 pandemic. But it will restart in July for about 1 million Hoosiers in the Healthy Indiana Plan, the Children's Health Insurance Program (CHIP) and the MEDWorks program.

READ MORE: Despite advocate hopes, federal agency will not prevent return of Medicaid premiums

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Advocates have criticized the return of cost-sharing, specifically the premiums or POWER account contributions associated with the Healthy Indiana Plan and Healthy Indiana Plan Plus.

POWER account contributions are meant to function as “a special savings account that members use to pay for health care.” The state pays for most of the amount in the POWER account, but members are responsible for a monthly payment depending on income. This payment allows them to enroll in HIP Plus, which offers vision, dental and chiropractic coverage.

Many had hope for federal intervention to stop the return, and said POWER accounts are difficult to navigate and make health disparities worse. However, in December, the Centers for Medicare and Medicaid Services decided it would not take action on Indiana’s authority to charge premiums for Medicaid. It said doing so would be too disruptive, but it reserves the right to take action in the future.

Members who pay premiums or POWER account contributions will start receiving invoices in July for the month of August.

Spinner said Healthy Indiana Plan members under the federal poverty level will not lose their coverage for nonpayment.

“They move to a basic program coverage, and then they can buy back up to plus at their next renewal,” Spinner said. “So, not everyone will lose their coverage.”

Members between the federal poverty level and the cap for the program are vulnerable to lose coverage for nonpayment.

Spinner also said Indiana does not have “lockouts'' for Healthy Indiana Plan members. That means if someone loses coverage they can reapply immediately rather than having to wait six months.

Copayments for certain HIP and CHIP members will also resume on July 1.

Abigail is our health reporter. Contact them at aruhman@wboi.org.

Abigail Ruhman covers statewide health issues. Previously, they were a reporter for KBIA, the public radio station in Columbia, Missouri. Ruhman graduated from the University of Missouri School of Journalism.