HIP Workforce Bridge is a program that designed to assist Hoosiers to transition from HIP Medicaid to commercial coverage that have entered into the workforce. This program will allow thousands of outgoing HIP participants to continue to use up to $1,000 from their POWER accounts for up to 12 months to pay premiums, deductibles, copayments and coinsurance during this transition.
The program was designed and proposed by FSSA on July 25, 2019 after direction from Governor Eric J. Holcomb to support his Next Level agenda and find a way to help Hoosiers maintain coverage and avoid potential negative consequences from advancing in the workforce. After a few revisions, it was approved by CMS on May 20, 2020 under the project of section 1115 demonstration project entitled, “End Stage Renal Disease (ESRD)” (Project Number 11-W-00237/5), in accordance with section 1115(a) of the Act.
This assistance will be offered to individuals as soon as they become ineligible for HIP due to earning higher incomes. Indiana becomes the first state to establish such an innovative approach to eliminating the gap in health coverage that can prevent HIP members from pursuing meaningful employment. Implementation of Gateway to Work is expected to increase employment and income among Healthy Indiana Plan members. HIP members who earn income over the HIP income limit will need to transition to commercial coverage. The HIP Workforce Bridge Account (Account) is designed with the goal of supporting continuity of coverage and addressing the coverage cliff between HIP and commercial coverage. The HIP Workforce Bridge Account will provide $1,000 of support for HIP members’ who need to transition to commercial insurance. This account will be available for up to 12-months when a HIP member is no longer HIP-eligible solely due to income and will be funded with remaining POWER Account dollars. Providers may directly bill the Account for services, and individuals may request premium reimbursement from the Account. No benefits are provided once the Account is exhausted. To align with the full implementation of the Gateway to Work program, and the first enforcement of the requirement, the HIP Workforce Bridge Account was to begin in 2020. Due to the public health emergency, FSSA is not currently disenrolling members of any health coverage program, but with CMS’s approval, HIP Workforce Bridge will be in place to support members immediately once the governor’s executive order expires. In addition to the HIP Workforce Bridge Account, this amendment request includes changes to Gateway to Work exemptions. It requested an exemption for members of federally recognized tribes and to change the exemption for caretakers of dependent children to exempt HIP members from the Gateway to Work requirement when they are a caretaker of a dependent child under the age of 13.
HIP members facing disenrollment due to an increase in income will be notified of their option to participate in the HIP Workforce Bridge program. Individuals who have been most recently disenrolled for failure to meet conditions of eligibility, such as payment of premiums, will not qualify.
This program will be available to no more than 8,000 eligible individuals. Since this is a capped program, individuals who are eligible, once notified, must opt-in to the Workforce Bridge Account program. To opt-in to the Workforce Bridge Account, the eligible individual must acknowledge to the state, by phone or mail, an interest in participating. Individuals will have 30 days once notified to opt-in to the account. As part of this 30 day opt in process, individuals will be given the opportunity for a referral to a “health care navigator” who will be able to inform individuals about their health care options and provide choice counseling.
Once individual’s opt-in, the amounts associated with the Workforce Bridge Account will be available for 12 months or until the full amount has been expended, whichever comes first. Individuals are only allowed to use the account for premiums, cost-sharing or for the direct cost of services received within 12 months and once the 12 months is finished, individuals will not be able to access the Workforce Bridge Account. Reimbursement for health insurance premiums will be paid to the individual or at the request of the individual enrolled in a Marketplace health plan the state will pay for the premiums directly on behalf of the individual to the health plan. In addition, beneficiaries of this program will receive an insurance card that will contain information for providers on how to submit a claim to the Bridge Account for reimbursement of cost-sharing linked to the enrollee’s primary insurance or direct billing for enrollees who have not yet completed enrollment in primary insurance coverage. The card can also be used for the direct payment for the costs of most Medicaid coverable section 1905(a) services that would be otherwise available to Medicaid beneficiaries. In order to receive reimbursement for these services, the services must be rendered by a Medicaid enrolled provider.
“The HIP Workforce Bridge program will be especially important during our state’s recovery from the COVID pandemic and as Indiana’s economy evolves,” Governor Holcomb said in a news release on June 3, 2020. “As Hoosiers skill up, go back to school and go back to work, HIP Workforce Bridge will make that transition from HIP to marketplace insurance or employer-based coverage easier to navigate and afford.”