NEWS & VIEWS

July 4, 2024

Cost-Sharing for HIP Program to Remain Paused

In an announcement on Monday, July 1, the Family and Social Services Administration wrote:

"FSSA is working with its attorneys and consulting with its federal partners at Centers for Medicare and Medicaid Services and will explore all legal remedies regarding the June 27 ruling regarding the lawsuit against the Healthy Indiana Plan.

At this time, cost-sharing for the HIP program, including POWER account contributions and co-pays, will remain paused. MEDWorks and CHIP co-pays will resume effective July 1 as planned.

FSSA is still evaluating the impact for the state and the 762,000 Hoosiers who rely on healthcare coverage through the Healthy Indiana Plan."

CMS Streamlining Rule

On April 2, 2024, the Centers for Medicare and Medicaid Services (CMS) finalized a rule streamlining Medicaid eligibility and enrollment. The Streamlining Rule (“Rule”) will particularly help older individuals and people with disabilities, who have historically been left out of some efforts to simplify Medicaid processes.

 The Rule will, among other things:

• Allow states to streamline the process for individuals living in the community to stay enrolled Medicaid through spend-down and prospective budgeting; and
• Simplify the processes for individuals enrolling in and staying on Medicaid

The Rule will come into effect over time with some parts in effect as of June 2024, while others take effect as late as June 2027.

Routine Immunizations Catch Up Information

Indiana school children going into kindergarten, sixth grade, and 12^th grade are required to receive age-specific immunizations prior to school starting.

There are dozens of immunization clinics in Indiana that provide routine vaccinations for children and teens. The Routine Immunizations Catch Up Map shows where these clinics are, when they are open, and how to schedule an appointment.

Wellness Policy Evaluations

With the new school year approaching, it may be time to update schools’ wellness policies. The Indiana Department of Health’s Division of Nutrition and Physical Activity (DNPA) offers year-round reviews of corporation wellness policies. School districts can submit their corporation’s wellness policy to DNPA for review at any time. DNPA will use the WellSAT 3.0 Quantitative Assessment Tool to score the local School Wellness Policy and then will schedule a consultation to review results and match school districts with support and resources.

Here's What You Need to Know

If Your Child is Being Bullied

Bullying is frightening and traumatic for kids, often leaving parents unsure how to respond. Experts advise ongoing conversations with children and schools, emphasizing calm support and consistent reporting to stop the bullying. Communication is key to addressing these issues. 

Uninsured Rate Expected to Increase

In recently published projections, the Congressional Budget Office (CBO) is predicting the uninsured rate will rise from the current 7.2% in 2023 to 8.9% in 2034. The end of pandemic protections for Medicaid coverage and the end of Marketplace subsidies in 2025 will have the biggest impact on adults aged 19 - 44. Immigration is expected to increase enrollment in employer based coverage as well as increase the number of uninsured.

The CHIRblog post from June 27^th, CBO Projections Are Not Destiny: Policies, ACA Investments Can Change Trajectory, recommends efforts to maintain high insured rates including:

• Making enhanced Premium Tax Cuts for Marketplace permanent
• Investing in Marketplace outreach and enrollment assistance
• Continuous 12 month coverage for Medicaid members especially children
• Reducing paperwork burdens
• Providing affordable coverage options for non-citizens

PathWays and Health & Wellness Waiver Launch

On July 1^st, the Family and Social Services Administration (FSSA) launched PathWays for Aging, a Medicaid managed care program and new waivers. PathWays will serve 123,000 Hoosiers aged 60 and over as a managed care program meant to increase care coordination and make it easier for Hoosiers to stay in their homes.

The Aged and Disabled Waiver is now two waivers – The PathWays Waiver for individuals 60+ and the Health and Wellness Waiver for those 59 and younger. Both waivers have a designated number of slots available with a current waiting list.

• PathWays for Aging Waiver: 39,842 slots, of which 29,268 are filled by Hoosiers already receiving services. 10,574 slots will remain for newly eligible individuals.
• Health and Wellness Waiver: 16,127 slots, of which 13,190 are filled by Hoosiers already receiving services. 2,937 slots will remain for newly eligible individuals

For more information on how individuals on the waiting lists will move to a waiver, please read this FSSA News Release.

Continuity of Care

Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) provided guidance for continuity of care when members transition between different Indiana Health Coverage Programs. New Managed Care Entities (MCEs) must honor existing care plans, previous authorizations, and choice of providers for 90 days to prevent any delay in care. This includes the new Pathways program that launched July 1^st.

FSSA also notes that providers may see an end date of June 30^th for fee-for-service (FFS) members transitioning to an MCE in the Pathways program. 

PathWays Transportation

The PathWays program for Hoosiers 60 and older who are eligible for Medicaid based on age, blindness, or disability, launched on July 1^st. For members previously receiving fee-for-service (FFS) Medicaid that means a change in their transportation broker. PathWays members will need to utilize the transportation broker association with their managed care entity (MCE). As of June 15^th, PathWays MCEs were already scheduling standing order trips for July forward.

Anthem - WellTrans (844-771-6632)

Humana – LCP Transportation (866-274-5888)

UnitedHealthcare - LCP Transportation (800-832-4643)

Help Promote IndianaLegalHelp.org 

It is not uncommon for low-income Hoosier families to need civil legal assistance on issues like safe housing, child custody, and protection from abuse. If you are working with someone who has a legal question or need, directing that person to IndianaLegalHelp.org is a way to connect them to free legal resources and information designed to make the legal process easier to understand and navigate.

From IndianaLegalHelp.org, anyone can search for organizations providing free legal services or clinics by entering their zip code or county. You can access the website from any computer or mobile device, or one of 150 legal kiosks located around the state. 

Know Your Rights

The U.S. Department of Health and Human Services Office for Civil Rights released a new resource to help LGBTQI+ older adults know their rights. This three page document explains rules that protect older LGBTQI+ adults and how to file a complaint if needed.

Latinos in Indiana

The Latino Coalition released a statistical report “Latinos in Indiana”.  Here are some key statistics:

• In 2023, 601,783 Latinos lived in Indiana representing 8.8% of Indiana’s population.
• 32% of Hoosier Latinos live in Marion and the surrounding counties and 24% live in the Northwest corner.
• The counties with the highest Latino population include Marion (134,616), Lake (106,627), Elkhart (42,107), Allen (36,298), St. Joseph (29,740), Hamilton (21,184), and Tippecanoe (19,634). Almost all the counties with a high Latino population have experienced a decline in the percentage of Latinos residing in that county.

Health & Wellness Waiver

Individuals 59 years old and younger who formerly had an Aged & Disabled waiver were switched on July 1^st to the Health & Wellness waiver. For specific information and questions regarding the transition, please visit Medicaid Strategies page.

The Family & Social Service Administration (FSSA) is hosting bi-weekly webinars in July for members and their families affected by the waiver transition. Webinars will be recorded for later viewing. Each webinar is from 3:00 – 3:30 EDT. Registration is not required.

• 6/26/2024 – Planned topics include information on the coordination of waiver services and Medicaid state health plan, specifically Structured Family Caregiving or Attendant Care and Home Health Prior Authorization.
• 7/10/24 – Planned topics include information on what to expect now that the transition has occurred.
• 7/24/24 – Planned topics include information on moving forward and how to find opportunities to stay connected. 

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