If you did not select an MCE you will be automatically assigned to one. Reduce the number of uninsured residents in the state; Improve statewide access to health care services for low-income residents; Promote value-based decision making and personal responsibility; Prevent chronic disease progression with secondary prevention (treatment, prescriptions); Provide appropriate, and quality or evidence-based, health care services; and. For help making your selection, call 1-877-GET-HIP-9. Managing your account well and getting preventive care can reduce your future costs. To provide you with the most relevant and helpful information, and understand which Pregnancy benefits will end 12 months after your pregnancy ends. The HIP State Plan benefits grant you comprehensive coverage including vision, dental, non-emergency transportation, chiropractic services and Medicaid Rehabilitation Option services. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Once you pay your Fast Track invoice you may not change your MCE/health plan. Your benefit year will be a calendar year running January to December. Medicaid Members: Time is running out! HIP Basic includes all the federally required essential health benefits, but does not provide coverage for vision, dental or chiropractic services, bariatric surgery or Temporomandibular Joint Disorders. HOOSIER HEALTHWISE PLAN A Hoosier Healthwiseis a health care program for pregnant women andchildren. There are no benefit differences between the two HIP State Plan options . Although modeled after a High Deductible Health Plan (HDHP) and HSA, there are key differences between the structure of the HIP and a HDHP-HSA. Learn more about the MHS plans for Medicaid members below. It is the State of Indiana's health care program for children, pregnant women, and families with low income. HIP State Plan Basic offers enhanced benefits such as vision, dental, chiropractic and transportation services. HIP Basic HIP Basic is the fallback option for members with household income less than or equal to 100 percent of the federal poverty levelwho don't make their POWER account contributions. Members will have 60 days to make their POWER account contribution from the start of the HIP Basic benefits. Members who leave HIP and return in the same calendar year will still have their same POWER account and health plan. HIP Plus allows members to make a monthly contribution to your POWER account based on income. Go tohttp://www.in.gov/fssa/dfr/2999.htmto find the closet DFR office near you. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Offering you free services, equipment or supplies in exchange for use of your Hoosier Healthwise or Healthy Indiana Plan number. Accessed May 6, 2016. Members selling or lending their identification cards to people not covered by Hoosier Healthwise or the Healthy Indiana Plan. To avoid a gap in coverage, please tell MHS and theDFR as soon as your pregnancy ends. Call your health plan for details about these options and locations. Call your doctor first if you arent sure. Make sure MDwise always has your correct address and phone number. You can now pay your monthly POWER Account contribution with My Health Pays Rewards! You can also call MDwise customer service at 800.356.1204. Members receive monthly statements that show how much money is remaining in the POWER account. HIP Basic members also receive an opportunity to move to HIP Plus if they earned rollover in the prior calendar year. You will not pay a monthly POWER Account contribution (PAC) while pregnant. It is the State of Indiana's health care program for children, pregnant women, and families with low income. If you are an enrolled HIP member, you should call your health plan (Anthem, CareSource, MDwise or MHS) or go online to their website to research which providers are in that health plan's network. Copayments for non-preferred drugs are $8. Fast Track payments are made to the Managed Care Entity (MCE) or health plan, you select on your application to provide your HIP coverage (Anthem, Caresource, MDwise or MHS). You could also qualify for an additional $85 dollars of My Health Pays rewards. HIP Maternity members will receive vision, dental, chiropractic coverage, non-emergency transportation and access to additional smoking cessation services designed specifically for pregnant women. The HIP waiver renewal application shows progress in meeting each of these goals based on evaluations and analysis performed by the state, Mathematica and Milliman. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. You still have to go through your redetermination process each 12 months. First, the individual has the ability to choose whether or not to participate, and how much to invest, in an HSA in the private market. Members who have incomes below the federal poverty level who do not make their contributions will be moved to the HIP Basic plan. It alsoincludes more benefits like dental, vision, or chiropractic. Evaluation of the adult with hip pain. Do not share your Hoosier Healthwise, Healthy Indiana Plan or other medical information with anyone except your doctor, clinic, hospital or other health provider. You still have to go through your redetermination process each 12 months. Hoosier Healthwise Indiana Medicaid plans covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, surgeries, and family planning at little or no cost to the member or the members family. http://www.uptodate.com/home. You will receive 12-months of HIP Maternity coverage after your pregnancy ends for post-partum coverage. Here are a few key things to look for: -Location of pain: Hip pain is typically felt in the hip joint itself, while sciatica pain is felt along the sciatic nerve. If you have other health insurance, please call 1-800-403-0864 to report this. In teenagers and young adults, hip dysplasia can cause painful complications such as osteoarthritis or a hip labral tear. If these states do not renew their waivers, adults covered by the waivers will lose coverage when they expire. It doesn't offer vision or dental services, bariatric surgery or temporomandibular joint disorders (TMJ). What are the incentives for managing costs and receiving preventive care? POWER account contributions are paid directly to the member's health plan (Anthem, MDwise, CareSource or MHS). If you or your child has other health insurance, you must let us know. You can pay either the $10 Fast Track payment or your POWER account contribution amount. In contrast, POWER Accounts are administered by the managed care plans. Hip pinning uses pins, screws, or plates to help hold broken bones together so they can heal correctly. Poor adults who are not enrolled in the waiver will remain ineligible for Medicaid and they also will be ineligible for tax credits for Marketplace coverage, which begin at 100% FPL. You can also call MDwise customer service. health information, we will treat all of that information as protected health When do HIP members select their health plan? Compared to Indiana's Hoosier HealthWise (HHW) Medicaid population, . You get additional benefits, including transportation to and from your doctor visits, chiropractic services and Medicaid Rehabilitation Option (MRO services) while pregnant. HIP State Plan Basic is for people who have complex medical conditions, mental health disorders, or a substance use disorder. Accessibility View your claims (if applicable to your plan). To enroll in HIP Plus, eligible individuals must make a monthly contribution to their POWER Account to help cover initial health expenses. We can mail you a list of these common services and their estimated reimbursement rates. Anyone who applies for Indiana Health Coverage Programs online will have the opportunity to make a Fast Track payment by credit card when completing the application. The Cost of Not Expanding Medicaid. Income limits are adjusted to account for the number of household members. At the end of her pregnancy, additional pregnancy benefits will continue for another 12 month post-partum period. If you are eligible for HIP and you are a tobacco user, you may have an increased POWER Account contribution (PAC) in your second year of coverage. The ACA Medicaid expansion eliminates the need for states to obtain a Section 1115 waiver to cover adults. Hoosier Healthwise (HHW) is one of the Indiana Medicaid programs. Contribution amounts may be higher for smokers. privacy practices. Box 1810, Marion, Indiana 46952. During this time you will have another chance to choose a new health plan. HIP Basic covers essential health benefits, but has less benefits covered (for example, fewer therapy visits). Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Need information in a different language or format? You must also tell us (or your care manager) if: The other insurance plans are supposed to help pay for your care. Click here to find monthly contribution amounts. On an annual basis, HIP members have the opportunity to switch to another health plan for the following year. As nouns the difference between hip and hips is that hip is the outward-projecting parts of the pelvis and top of the femur and the overlying tissue while hips is plural of lang=en. With HIP State Plan Plus: HIP Basic offers limited benefits and can be more expensive than paying your low monthly HIP Plus POWER Account contribution. http://www.uptodate.com/home. Please note thatalthough these letters may say that payments are due, there are no payments due at this time. If a member does not wish to change health plans, they do not need to take any action and will automatically stay with their current health plan for the new year. Advertising revenue supports our not-for-profit mission. In the absence of the Medicaid expansion, coverage gaps will remain for poor adults in Indiana. The benefits are reduced. Copayments can cost between $4 to $8 per doctor visit or specialist visit. The only exception to this is a charge of $8 if a member goes to the hospital emergency room for a non-emergency. Parents below 22% were eligible for regular Medicaid before implementation of the Healthy Indiana Plan, and continue to receive regular Medicaid coverage. Some members can have HIP Basic coverage even if they dont make their monthly payment, but in HIP Basic they will have to pay a fee every time they go to the doctor or fill a prescription. Carry your member ID card with you at all times. The MDwise Steps to Wellness newsletter provides information on Hoosier Healthwise and HIP benefits. From the date you receive your initial Fast Track invoice you will have 60 days to make a payment to start your HIP Plus coverage. Beginning in January 2008, Indiana began enrolling adults in its new Healthy Indiana Plan (HIP), which was authorized under Section 1115 waiver demonstration authority. If you choose to leave the program early, your contributions not spent on health care costs will be returned to you. Every calendar year, members get a new $2,500 POWER account amount to pay for HIP covered medical expenses. Settings, Start voice information and will only use or disclose that information as set forth in our notice of The member will continue to have a POWER account but will not be required to make payments. CMS extended the plan to not disrupt the coverage currently afforded in Indiana as the state continues to consider its coverage options.1 While this temporarily preserves coverage for many adults currently covered by the waiver, it also leaves many who would be eligible under the ACAs full Medicaid expansion without access to new coverage options. In HIP, your contributions to your POWER account will be yours. When your pregnancy ends, report it to FSSA immediately at 1-800-403-0864. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. The state will pay most of this amount, but the member is also responsible for paying a small portion of their initial health care costs. Based on family income, children up to age 19 may be eligible for coverage. Ensure state fiscal responsibility and efficient management of the program. For example if your POWER account is $15, then your $10 payment will be applied to your first months coverage. It is the State of Indianas health care program for children, pregnant women, and families with low income. If you make a Fast Track payment and are determined to be eligible for HIP then your HIP Plus coverage will begin the first of the month that you submitted your application. As long as members make their required monthly POWER account contributions, they will have no other costs. Monthly POWER account contributions are determined by family income compared to the federal poverty level as shown below. Phone: 866-223-9974 Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. As adjectives the difference between hip and hips Hoosier Healthwise provides standard benefits including coverage for medical expenses such as doctor visits, hospital care, therapies, medications, prescriptions and medical equipment. HIP Basic HIP Basic offers limited benefits and can be more expensive than paying your low monthly HIP Plus POWER Account contribution. It is important to answer their questions to maintain HIP State Plan benefits. HIP Plus provides MORE benefits than the HIP Basic program, including vision, dental and chiropractic services. HIP Plus can be cheaper because you do not pay any other costs or copayments when you visit the doctor, fill a prescription or go to the hospital. Fax: 866-297-3112 You must select a Managed Care Entity in order to make a payment at the time of application. The plan pays for medical costs for members and can include dental, vision and chiropractic. HIP Basic does not cover vision, dental or chiropractic services and could be more expensive. MHS will provide it at no cost to you. CMS has recently issued new regulations related to cost-sharing and it is not clear if they will grant waivers of these limits that would be eligible for enhanced matching funds.16. Parents below 22% FPL who are not eligible for Medicaid because they exceed resource limits ($1,000) are eligible for the Healthy Indiana Plan. Carol Irvin, Healthy Indiana Plan: The First Two Years. At the end of 2008, 37,568 adults were enrolled in HIP. Review your member handbook for important information, Some services need approval from MDwise before you get them. Members in the HIP Basic plan will still use the POWER account to cover their $2,500 annual deductible, but the funds in the account will be contributed entirely by the State. The Children's Health Insurance Program (CHIP) falls under the Hoosier Healthwise program. If they receive recommended preventive care services throughout the year, the discount will be doubled. Similar to the original waiver, under the extension, parents will not be limited by enrollment caps or open enrollment periods, and will have the ability to enroll in HIP provided they make the required contributions (discussed below). HIP Basic can be more expensive than HIP Plus. With HIP Plus, members do not pay every time they visit a doctor or fill a prescription. Members who make POWER account contributions on-time each month participate in HIP Plus where they have better benefits and predictable costs. The Healthy Indiana Plan (HIP) is an affordable health plan for low-income adult Hoosiers between the ages of 19 and 64. Act now to keep your MDwise health coverage. Visit in.gov to learn more. The Healthy Indiana Plan empowers members to make important decisions about the cost and quality of their health care. To participate in HIP Plus, members make affordable monthly contributions into their POWER account based on income. If you have questions or concerns about fraud and abuse, call MDwise customer service. HIP Basic members will be given the opportunity to re-enroll in HIP Plus at the end of their annual cycle, or plan year, defined by their enrollment date. HIP Basic can be more expensive that HIP Plus. Do not ask your doctor or any health care provider for medical care that you do not need. Firestein GS, et al. HIP Plus is the initial, preferred plan selection for all members and offers the best value. Call MDwise customer service right away and confirm your doctor. Because of this, the HIP Basic plan could be more expensive than paying a monthly contribution for HIP Plus coverage. Accessed May 6, 2016. Will my health condition(s) affect the coverage I receive? HIP Plus is the initial, preferred plan selection for all members and offers the best value. Mayo Clinic, Rochester, Minn. May 9, 2016. Call 1-877-647-4848 (TTY: 1-800-743-3333). If you have questions about or changes in your health condition, please contact your health plan directly. HIP State Plan Plus is for people who have complex medical conditions, mental health disorders, or a substance use disorder. Read more on our blog. You will pay a low, predictable monthly cost based on your income. If Indiana implemented the Medicaid expansion, the state could see an additional $17.3 billion, or 24%, increase in federal funds over the 2013-2022 period with small increases in state funding $537 million or a 1.3% increase after accounting for savings due to reduced uncompensated care costs. Once you log in, you can report a change. If you don't have a login, click on the blue "sign up for a new account" button. Examples of member fraud and abuse are: Members selling or lending their identification cards to people not covered by Hoosier Healthwise or the Healthy Indiana Plan. Use our Community Resource Link for local help finding food, housing and other things you might need. Do not give your member ID card or MDwise card number to anyone. Enrollment for childless adults, however, will be capped at 36,500 and limited by open enrollment periods. If annual health care expenses are more than $2,500, the first $2,500 is covered by the member's POWER account, and expenses for additional health services over $2,500 are fully covered at no additional cost to the member (except in the HIP Basic program where the member is responsible for any required copayments). You will receive one (1) letter from FSSA about this change. Your thighbone (femur) meets with your pelvis at your hip joint. Hip and knee pain. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. To change your doctor, please call MDwise customer service. In the HIP Plus program, members do not pay copayments when they go to the doctor or hospital or fill a prescription. October 2013. http://www.kff.org/medicaid/issue-brief/a-look-at-section-1115-medicaid-demonstration-waivers-under-the-aca-a-focus-on-childless-adults/. There is no deadline by which states must determine whether they will implement the Medicaid expansion. The state has since opened enrollment twice, but enrollment has fallen over time through attrition. Cindy Mann, Deputy Administrator and Director of CMCS, Centers for Medicare and Medicaid Services, Waiver Approval Letter, September 3, 2013, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/in-healthy-indiana-plan-ca.pdf, last accessed on October 7, 2013. You can also visit the Indiana Department of Health for more information or to schedule your COVID-19 vaccination. As of January 2014, individuals with incomes above 100% FPL will be eligible for premium tax credits to help purchase coverage through the new Health Insurance Marketplaces established by the ACA. Centers for Medicare and Medicaid Services, Special Terms and Conditions for the Healthy Indiana Plan, pg. If your income is more than this amount, you will need to reapply for coverage to begin HIP. If you are not found eligible for HIP and you have made a Fast Track payment, this payment will be refunded to you by the MCE (Anthem, Caresource, MDwise or MHS) that took the payment. You may have someone make your Fast Track payment on your behalf. HIP Basic does not cover dental, vision or chiropractic services and charges a copayment for each service received. What is the difference between HIP and Hoosier Healthwise? The member contribution amounts are between $1 and $20, but may be higher for members that smoke. Go to FSSABenefits.IN.gov to update your information so you dont lose benefits. If you are a Mayo Clinic patient, this could The filing limit may be extended for newborn claims when the eligibility has been retroactively received by MHS, up to a maximum of 365 calendar days for services provided . Offering you gifts or money to receive treatment or services. Copayments for preferred drugs are $4. HIP Basic is the plan for HIP members who do not make their monthly Personal Wellness andResponsibility(POWER) Account contributionsfor more than60 days.HIP Basic . We will call you back to let you know the estimated reimbursement for that service. If your POWER account contribution amount is less than $10 per month, your $10 payment will be applied to your initial coverage month with the remaining amount applied to future months. Recent analysis finds that some 181,930 poor adults in Indiana could fall into this coverage gap, representing 88% of the states poor uninsured (this analysis assumes that parents with incomes above 24% FPL and childless adults fall into the coverage gap because the waiver provides limited coverage).17 These individuals will not have other alternatives for full coverage and will likely remain uninsured. The only other cost you may have for health care in HIP Plus is a payment of $8 if you visit the emergency room when you dont have an emergency health condition. John Holahan, Matthew Buettgens, and Stan Dorn. The POWER Account is used to pay for the first $2,500 in health care costs. Members can select their health plan when they apply. With the Sydney Health mobile app, you can: Hoosier Healthwise and Health Indiana Plan: Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. If you do, the provider or member will not be told that you called.You also can send an email to our fraud investigation team at SIU@MDwise.org, or leave us an anonymous voice message on our Compliance Hotline, 317-822-7400. The Healthy Indiana Plan (HIP) is a health insurance program for qualified adults. The POWER account is used to pay for the first $2,500 in health care costs. Check your symptoms with our symptom checker. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Health needs screening: Get up to a $30 gift card, Privacy Guidance When Selecting Third-Party Apps - English, Privacy Guidance When Selecting Third-Party Apps - Spanish. The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. If you wait more than 60 days to make a payment and your income is more than the federal poverty level, then your application will be denied and you will have to reapply for HIP coverage. between the HIP 2.0 program and the Hoosier Healthwise (HHW) program has resulted in unequal access to health care services, in accordance with Section IX.8.a of the HIP 2.0 Special Terms and Conditions (STCs). Managing your account well and getting preventive care can reduce your future costs. 2023 HIP provides incentives for members to take personal responsibility for their health. No copays or POWER Account Contributions. If you make your Fast Track payment or first POWER account contribution in July then your HIP Plus coverage will begin July 1. The member pays an affordable monthly POWER account contribution based on income. Dont have dental, vision, or chiropractic benefits? Hoosier Healthwise members remain enrolled in their chosen health plan for a one-year period. All you need to do is complete a Notification of Pregnancy survey. The state of Indiana pays for most of the $2,500 in the POWER account, but the member is responsible for a fixed monthly payment depending on income. Of HIP enrollees not contributing to their accounts, about 13% were parents with no income or already contributing at least 5% of their family income to their childs CHIP coverage. 4th ed. HIP members who are pregnant may keep their HIP coverage for the duration of their pregnancy. Billing or charging for a treatment, service or supply that is different than what you received. This monthly cost is called your POWER Account contribution. You can also make a payment by logginginto your MHS Member Portal Account and clicking onPay Premium. Fast Track allows members to make a $10 payment while their application is being processed. Once the open enrollment period ends, you will stay enrolled in your chosen health plan for the rest of the 12 month period unless you lose your Hoosier Healthwise eligibility. There is no copayment for preventative care, maternity services or family planning services. You may opt-out of email communications at any time by clicking on This type of pain is called referred pain. As a MDwise Hoosier Healthwise member, remember these basic rules: The MDwise member handbookis the best place to go to understand your benefits and services. Download the free version of Adobe Reader. You may change your health plan selection before paying your Fast Track invoice by calling 1-877-GET-HIP-9. Further, the safety net of clinics and hospitals that has traditionally served the uninsured population will continue to be stretched in Indiana. McLaren Health Care and/or its related entity, Commitment to Quality Care | Healthy Indiana Plan, Find a Drug | Healthy Indiana Plan State Plans, Benefits and Services | Hoosier Healthwise, Affordable Connectivity Program | Hoosier Healthwise, Commitment to Quality Care | Hoosier Healthwise, Getting Help with a Problem | Hoosier Healthwise, Renewing Your Coverage | Hoosier Healthwise, Hoosier Healthwise member handbook (English), Hoosier Healthwise member handbook (Spanish), Hoosier Healthwise Member Consent Form (English), Hoosier Healthwise Member Consent Form (Spanish), Care Management/Disease Management Referral Form (English), Care Management/Disease Management Referral Form (Spanish), Congestive Heart Failure Weight Log (English), Congestive Heart Failure Weight Log (Spanish), MDwise list of common medical services and estimated reimbursement rates (English), MDwise list of common medical services and estimated reimbursement rates (Spanish), Nondiscrimination/Accessibility (English), Nondiscrimination/Accessibility (Spanish). MDwise Hoosier Healthwise members can call 1-844-336-2677 to ask about medicines that are covered. Indiana Family and Social Services Administration, Healthy Indiana Plan 1115 Waiver Extension Application (Indianapolis, Indiana: Indiana Family and Social Services, April 12, 2013), http://www.in.gov/fssa/hip/files/April122013HIPWaiverExtensionApp.pdf. Members pay their POWER Account contribution, which is a low monthly payment based on their income. New members get 90 days to decide if they want to stay in the MDwise plan. HIP continues to build on the successes of the original design and lessons learned since initial implementation in 2008. Need help with some of the HIP terms? (Mathematic Policy Research, July, 2010) http://www.in.gov/fssa/files/Presentation_to_Health_Study_Committee_Final_7_13_10.pdf and Rob Damler, Experience under the Healthy Indiana Plan: The short-term cost challenges of expanding coverage to the uninsured (Washington, DC: Milliman, August 2009), http://publications.milliman.com/research/health-rr/pdfs/experience-under-healthy-indiana.pdf. MDwise is an Indiana-based, nonprofit health plan. If you do not pay your monthly contribution on time, you will be moved to HIP State Plan Basic. For more information see the. If you need messages in a different language or format like large print, audio, or Braille, let us help. You must let the Division of Family Resources (DFR) know if you: Go to yourFSSA Benefits Portal. Without implementing the ACA Medicaid expansion, Indiana also will forgo significant amounts of federal financing. Copayments can cost between $4 to $8 per doctor visit or specialist visit. This enrollment lockout will not apply if the member is medically frail or residing in a domestic violence shelter or in a state-declared disaster area. Learn more about the formula shortage and how to keep your baby safe and healthy during this time. Do not let anyone borrow or use your member ID card. Copyright 2023 State of Indiana - All rights reserved. With HIP Plus, members can get 90-day refills on prescriptions and receive medication by mail order. Hip pain is a common complaint that can be caused by a wide variety of problems. To learn more about Fast Track payments, click here. The program covers medical care such as doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost to the member or the member's family. As such, the 2013 waiver extension will decrease HIP eligibility levels from 200% FPL to 100% FPL for both parents and childless adults on April 30, 2014.8 For current HIP enrollees and childless adults on the waitlist, Indiana has a plan to transition those who have incomes between 100% and 200% FPL to Marketplace coverage. Try this guide, complete a form that gives them permission to make this payment (PDF). You can call MDwise or your care manager. Please also call MDwise as soon as you know your new address or phone number. It does not include dental, vision or chiropractic services, or services for bariatric surgery and temporomandibular joint disorders (TMJ).

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