Health care advocates concerned about coverage

By The (Fort Wayne) Journal Gazette

Officials say they're confident the work requirement rules being implemented this year won't jeopardize insurance coverage for Hoosiers qualified for Medicaid benefits under HIP 2.0. The plan here has been structured more cautiously than plans in other states that have already been put on hold by the courts.

Some health care advocates here don't share that confidence.

A federal lawsuit filed this week on behalf of four Indiana residents - one of them a Fort Wayne educator - contends that the health care of thousands of citizens is jeopardized by the state's Gateway to Work requirements.

About 440,000 Hoosiers are enrolled in HIP 2.0. Under the plan designed by the Indiana Family and Social Services Administration, many recipients would be exempt from the paid-or-volunteer work requirements under more than a dozen exemptions, and FSSA SecretaryDr. Jennifer Walthall has said the goal is that no one gets bumped off the program.

"We are building this program unlike any other state in the country, with robust supports and pathways to ensure Hoosiers can easily skill up, volunteer in their community or get a better-paying job while driving towards better health outcomes," Gov. Eric Holcomb said in a statement this week.

"It's disappointing a lawsuit has been filed before the program has had an opportunity to prove its success."

But when should a suit be filed? After the damage some fear comes to pass? Thousands of recipients lost coverage before Arkansas' work requirement was stayed. The suit filed by Indiana Legal Services and the National Health Law Program notes a state-hired actuary estimated 24,000 people would lose benefits by not complying with the work requirement.

As The Journal Gazette's Niki Kelly reported, the lawsuit says one of the low-income Hoosiers whose coverage might be endangered is 54-year-old Mary Holbrock of Fort Wayne, who became eligible for Medicaid after she lost her full-time teaching job during the recession. Now working a fluctuating number of hours each week as a test grader, Holbrock, who has several serious health disorders, is currently classified as "medically frail," which would allow her to remain exempt from the work requirement.

But, the suit says, "her health plan has revoked her medically frail status twice without explanation, even though her health conditions had not improved." If Holbrock should lose that exemption again, according to the lawsuit, her fluctuating weekly hours might prevent her from meeting a required 20-hour-per-week minimum and get her jettisoned from HIP 2.0.

Could people such as Holbrock be given a break under Indiana's more compassionate approach to Medicaid work requirements? Would such recipients be able to stay covered only by navigating an endless sea of red tape?

The Indiana lawsuit, like the challenges in other states, disputes whether the Medicaid law even allows the federal government to sanction work requirements. The link between health care and work requirements cannot be found ineither the law itself or "half a century of administrative policy," the lawsuit contends. That is something for the courts to resolve.

Legalese aside, if it's true some of our neighbors could be denied crucial health coverage because the FSSA determines they don't work the right number of hours each week, will that be OK? Is that the proper role for the state?

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