Indiana will be changing the way it imposes cost-sharing on its Medicaid beneficiaries to decrease fluctuations in what beneficiaries must pay.
As things are now, enrollees in the state's Medicaid program, known as Healthy Indiana 2.0, or HIP 2.0, must make monthly contributions of 2% of their income into a health savings account. Starting Jan. 1, Indiana will switch to a tiered contribution structure based on income.
The goal of the change is to ensure there isn't a frequent change in what an enrollee has to pay if they see modest movements in their income. For instance, people with incomes between 101% and 138% of the federal poverty level will pay a flat $20 contribution per month as long as they stay within that income range.
The cost-sharing changes will also reduce administrative burden for the state, officials said.
Indiana originally sought to make the change via a waiver request, but the CMS sent a letter Dec. 1 to the state indicating one was not required. The notice was posted by the CMS on its website Monday.
"Since the proposed tiers that the state references in its letter are not likely to require any beneficiary to pay more than 2% of household income, we believe the state has the authority … to move forward," said Judith Cash, acting director of the CMS' State Demonstrations Group.
Patient advocates voiced concern about the proposal when it appeared in Indiana's waiver application earlier this year, and say they're generally against imposing cost-sharing on Medicaid beneficiaries.
The current premium structure is complicated and unaffordable for enrollees, according to Families USA, a patient advocacy organization.
Indiana issued a report last year that found more than 90% of HIP 2.0 beneficiaries have been able to make the required HSA contributions, but almost half sometimes, usually or always worried about being able to make those HSA contributions.
"Tiering (cost-sharing) rather than tying them to a percentage of income will not reduce administrative burden in a meaningful way, nor will it address the complexity of the underlying structure of the accounts," Families USA staffers said in a comment letter.