Indiana: Medicaid Buy-In Program

Indiana: Medicaid Buy-In Program

Upshot

  • ·S.B. 384  would expand eligibility for and generosity of MED Works, the existing Medicaid buy-in program in Indiana for qualifying individuals with disabilities ages 16-64.

  • The proposed limit on the types of assets that the Indiana Family and Social Services Administration (FSSA) considers to determine program eligibility would allow a larger number of applicants to become eligible for MED Works.

  • In addition, applicants that previously or currently receive benefits from the federal Social Security Administration (SSA) or the state Medicaid program would not be excluded from MED Works. Beneficiaries of MED Works could also receive home and community-based services to supplement Medicaid buy-in program benefits.

  • The bill failed to advance out of the Committee on Health and Provider Services.

Background

Indiana adopted the ACA Medicaid expansion. Therefore, all adults with an income up to 138 percent FPL are eligible for Medicaid. Indiana attempted to impose work requirements through a Section 1115 waiver approved by the Trump Administration, though it was ultimately withdrawn by the Biden Administration.

Since 2002, Indiana has offered MED Works, a Medicaid buy-in program for individuals who are disabled and employed, as authorized under the federal Ticket to Work and Work Incentives Improvement Act of 1999. Individuals eligible for MED Works are enrolled in Hoosier Care Connect, a Medicaid managed care program. Indiana has contracts with three MCOs to deliver Medicaid benefits – Anthem, Managed Health Services, and United Healthcare.

Summary

While the bill would maintain current income limits for MED Works, it would expand eligibility in three ways: 1) permit applicants to have resources (i.e., assets that can be turned into cash) that exceed federal limits; 2) broaden the criteria for what satisfies the employment requirement; and 3) expressly allow applicants to participate in other public programs.

Under the modified MED Works program, all participants would be required to pay a monthly premium. The bill would remove statutory language that currently permits FSSA to exempt participants with an income less than 150 percent FPL from paying a monthly premium. However, the bill would also lower minimum and maximum monthly premiums on a sliding scale. The bill would also add two situations for when FSSA must adjust an individual’s premium across the sliding scale.

Lastly, the bill would allow participants to receive HCBS through a Medicaid waiver program to supplement Medicaid buy-in program benefits. Examples of HCBS services include health care coordination, home delivered meals, and transportation.