Just about everybody likes Gov. Mike Pence’s Healthy Indiana Plan 2.0. Lots of people have doubts about how well prepared Indiana is to administer an 833 percent increase in Hoosiers receiving subsidized health care.
Later this month, the state will file its request for federal permission to substitute HIP 2.0 for an expansion of Medicaid. A meeting at Ivy Tech Monday was one of nine conversations state officials are having around the state.
As Indiana Health Commissioner William VanNess and Indiana Medi- caid Director Joe Moser fielded questions from about 50 participants, it became clear that the focus of concern was whether anyone has thought through how to get 2.0 off the ground.
We don’t expect major challenges in implementation and enrollment, VanNess said.
This was a tough audience, though; sprinkled with experienced health care workers and administrators, the questions they raised need to be seriously addressed. Among the vital suggestions from Monday’s group:
The application process needs to be simplified.
The state needs to provide an easier way for HIP participants to make their monthly contributions, and a longer grace period for those who miss the deadline.
Arrangements need to be made for non-English-speaking participants.
And the system needs to offer local assistance, not just operators standing by the phones in Indianapolis.
I challenge that you are not ready for this kind of onslaught, Fred Gilbert, a retired welfare caseworker, told VanNess and Moser.
You have no caseworkers, you have no local-office contact, and that is an absolute requirement. Gilbert said. I see document-collection difficulties, I see non-responsiveness in call centers, I see untrained workers.
Gilbert rightly evoked the specter of the train wreck that occurred when the Family and Social Services Administration privatized its registration services during the Daniels administration. FSSA, which oversees HIP and would be in charge of the conversion to the 2.0 plan, often seems to lack a sense of urgency about its work. The most recent example may be the slow-moving pilot preschool program.
However smoothly the 2.0 program is run from an administrative standpoint, it will fail the people it is supposed to reach if something isn’t done to make the payment process easier.
Mary Haupert, chief executive officer of the nonprofit Neighborhood Health Clinics, urged the state to find a way to offer people local offices where HIP participants can pay their required part of their health power account.
The payment will be from $3 to $25, assessed on a sliding scale. But many of those who use HIP don’t have credit cards or checking accounts, Haupert said. Might it be possible that other state offices or private health providers could collect the small fees for HIP 2.0?
It may even turn out that it costs more to collect the monthly payments from some lower-end payers than the revenue it creates. Gov. Mitch Daniels used that argument during his campaign to privatize the Indiana Toll Road, noting that it cost the state more to post collectors at some sites than it was receiving in tolls.
If it’s vital to preserve the monthly contribution system – and VanNess stressed that this is a big reason HIP has succeeded in developing more responsible participants – the state needs to find a way to collect the money easily and efficiently.
Acknowledging all the concerns, Moser pleaded, we only rolled this out three weeks ago.
But Indiana already has lost a year to Pence’s refusal to accept the Obamacare provision that would have allowed Indiana to cover those making too much to be covered by traditional Medicaid and too little to qualify for medical care tax credits.
Granted, the solution the state has fashioned seems in many ways to be an improvement on the Medicaid system.
But choose your analogy – the FSSA privatization meltdown or the Obamacare website fiasco. Health care is too important to let bureaucratic shortsightedness get in the way. If the federal government approves HIP 2.0, the state needs to be ready to make it work.