HIP 2.0 Begins Work Requirement Program

Indiana launched a new work requirement program through Medicaid on the first of the year.  It’s called “Gateway to Work” and is billed as a community engagement opportunity to help connect people with better employment opportunities.

But some worry the changes will result in Hoosiers losing health insurance.

Indiana was one of the first states to apply for a waiver to implement work requirements for the statewide Medicaid expansion program: HIP 2.0. The Centers for Medicaid and Medicare, CMS, in Washington now supports many new state-led Medicaid changes.  

Indiana’s Gateway to Work launched the first of the year.

Jennifer Walthall is the state’s Family and Social Services administration, FSSA, secretary. She says the program is about meeting unmet needs. 

"It’s actually more about connecting people with things they haven’t been connected with before," says Walthall. 

Things like education and transportation. Indiana is only the second state to make the move, and the FSSA set a goal early in the process.

"We’re not going to lose people because of a reporting requirement, or an administrative burden or something along those lines," says Walthall. 

But many worry they will and there is precedent for this worry.

In Arkansas, the first state to implement similar requirements, more than 12,000 lost their health insurance. Many could not easily access the online only reporting system.   

But Walthall says Indiana’s system is easy and user-friendly, and not all online. Members can log work, volunteer or school hours on computer, by phone, and in person – and they don’t have to have documentation.

"They’ll just go in and say, hey I volunteered for 20 hours this week, and it goes right through and gets the job done," says Walthall. "We’re not trying to make this a full time job, we’re actually trying to help people get real full time jobs and we don’t want to get in the way."

The state will work through existing workforce development programs to help people find better employment opportunities. Gateway to Work gives people a list of what it calls "partners" to help them find jobs or volunteer opportunities.

So far there are more than 200 listed on the website.

"We would like to have a cohort of people that are looking for those that have been disenfranchised for a long time and help us do our job better," says Walthall. "We can’t do this by ourselves."

But some partners are skeptical. Maurice Young works with people on Medicaid. He’s an advocate for people experiencing homeless in Indianapolis.  

Every Wednesday he hands out bagged lunches at the Central Library.  

He and his small team also help people navigate health care coverage, for HIP 2.0 and other programs.  

"Kenan over there does Humana for people who are on Medicare and don’t know there are extra benefits they get," says Young. "And then we do some housing."

Young feels like FSSA is relying too much on the partners who work with these communities.

"It’s so funny when you read through the presentation, the partners are supposed to do the work, the partners are the ones that should find the volunteer opportunities," says Young. "OK, I can find some volunteer opportunities, but this is your program, get them some bus tickets."

He’d rather see a carrot than a stick approach.

"If you want to encourage people to do something positive, OK, open it up and offer it, but don’t require it as a quid pro quo for your health, to get your medicine to see your doctor," says Young. 

Not all recipients of HIP 2.0 are subject to the new work requirement restrictions. A majority of the more than 400,000 Hoosiers on HIP 2.0 will be exempt, for a number of reasons including medical frailty, substance use disorder and homelessness. But Young says those categories aren’t clear in real life – homelessness is not clear.

"Institutions have different definitions of homeless, well give me that information," says Young. 

FSSA Secretary Walthall knows it will be hard to reach all of the estimated 70,000 to 80,000 people who may have to comply with the work changes.

"They’ve gone through partners, providers and reached out directly to members through email or letters, to get the word out," says Walthall. "The hardest folks to reach are the most important to reach."

The program has a slow ramp up process.  Members aren’t required to report any hours the first six months, the full 20 hour a week requirement won’t be in place until 2020.