Putting Indiana's work requirement for HIP 2.0 coverage on hold was a wise move. Waiting until a lawsuit filed in September is resolved to move against those who fail to comply with the new provision at least avoids adding to the uncertainty. And there's always the hope that the legal fight will lead policymakers to reconsider whether adding another level of complexity to the health care coverage gauntlet is a good idea to begin with.
The lawsuit filed by Indiana Legal Services and the National Health Law Program on behalf of four plaintiffs, including a Fort Wayne woman, contends that thousands of Hoosiers could be dropped from coverage. But officials of the Indiana Family and Social Services Administration, which has been ramping up the new requirements since the beginning of the year, say their goal is to encourage clients to better their situations, not to disqualify them from health care.
The department has been rolling out the regulations in stages. The goal is to allow HIP 2.0 recipients time to determine whether they qualify for an exemption – you can be excused from the work requirement for a wide range of reasons, including illness or the need to care for a family member – and to allow those who will be affected to get used to reporting the hours they worked to the state.
But the reality is that facing another layer of paperwork and regulations can be overwhelming for some who seek or receive assistance. Someone with language barriers, reading disabilities or limited computer literacy may find it hard to comply with what might seem to others to be simple procedures.
“I am concerned about that requirement,” Steve Hoffman, president/CEO of Brightpoint, said Monday. The worry is that “there are a lot of people out there who can't work” because of particular circumstances that could cause gaps in their coverage. “People don't fit into the bucket every time,” he said.
“I know that we have been spending time educating patients at the center about the requirements,” Angie Zaegel, president/CEO of Neighborhood Health in Fort Wayne, said in an interview Friday. “We are concerned that some people may lose coverage.” But, she said, state officials in a session she attended several months ago seemed confident the system would work smoothly.
“The message I got,” Zaegel said, “is that they felt like it would only affect the people who were just not paying attention at all.”
The simple truth is that many need help navigating the complexities of existing health care rules. For instance, a new report shows funding delays and confusion about changing Affordable Care Act requirements led to an increase in the percentage of uninsured children, nationally and in Indiana. But among Neighborhood Health's clients, the numbers are going in the opposite direction.
“In 2017, 45.73% of our pediatric patients were uninsured,” Zaegel said. “In 2018, 36.9% of our pediatric patients were uninsured.” A team led by Neighborhood Health's outreach and enrollment coordinator, Liz Craker, appears to have made the difference by helping patients sort through the options. Even if a low-income family earns too much to qualify for HIP 2.0 coverage, Craker said, children may still be eligible for coverage under the Children's Health Insurance Program.
During the Affordable Care Act open-enrollment period that began last week, counselors at Neighborhood Health and Brightpoint are also helping clients in slightly higher income categories choose plans on the insurance Marketplace. “We figure out what they are eligible for, then try to put them in the best plan we can,” Hoffman said.
Some HIP 2.0 participants are already availing themselves of resources offered under the state's Gateway to Work, including job training and help finding a job. That kind of assistance makes sense not only as part of a holistic health plan, but as part of Indiana's struggle to develop a strong workplace.
What doesn't make as much sense is the coercion factor – more bureaucracy, more red tape for those least able to negotiate it, more counseling time, more lawsuits, more possibilities that someone in need will go without health treatment. It's amazing how much effort and how many resources Indiana is willing to expend to make sure some undeserving person somewhere isn't getting a free checkup. Why not call a truce on the lawsuit and pour those resources into making the voluntary work-assistance program for HIP 2.0 recipients as attractive as possible?
Anyone with problems navigating the healthcare system can get help from Brightpoint, at 423-3546.
Families looking for information on how to enroll their children in Medicaid or CHIP may call 877-KIDS-NOW or visit insurekidsnow.gov.