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FSSA receives HIP 2.0 guidance from the Treasury and CMS

By Brian Leichty

Based on guidance recently received from the U.S. Department of the Treasury and the Centers for Medicare & Medicaid Services (CMS), Indiana FSSA is updating information for low-income Hoosiers who currently have health coverage through the federal Marketplace (HealthCare.gov) but now, with the approval of HIP 2.0, will be eligible for the Healthy Indiana Plan (HIP) based on their income.

Specifically, an Indiana resident who is currently receiving Advance Payments of the Premium Tax Credit (APTC) to help purchase a Marketplace plan and who will be eligible for HIP 2.0 will not face a tax penalty solely because he or she does not apply for HIP 2.0 in 2015. This remains the case so long as the individual has not been determined eligible for HIP or a Medicaid plan by Indiana FSSA, as explained below. Please note this is different than previously released guidance due to new federal guidance.

If an individual is determined eligible for HIP or a Medicaid plan in 2015 by Indiana FSSA, he or she will lose eligibility for the tax credit for the months after the HIP or other Medicaid determination. Accordingly, individuals should end their Marketplace coverage with APTC as soon as they receive a final determination of eligibility for HIP or other Medicaid from Indiana FSSA. The tax filer(s) in the APTC beneficiary’s household will be liable to repay APTC received while the beneficiary is eligible for HIP or other Medicaid starting the first day of the month following the HIP or other Medicaid eligibility determination.

To find out if an individual who is currently receiving Marketplace coverage with APTC is newly eligible for Medicaid (including the Healthy Indiana Plan), individuals should go to the Marketplace and “Report a Life Change” to their existing Marketplace application and click through the application. Individuals should also report any changes such as income, household, or other relevant life changes that may impact their eligibility. In addition, individuals may learn that they are eligible for Medicaid or HIP by applying for coverage directly at Indiana Medicaid.

Note: If individuals do not report changes to the Marketplace, they may have to repay some portion of the APTC received for reasons other than eligibility for Medicaid or HIP, such as if the individual’s actual household income for 2015 exceeds the projected amount of household income on the application (on which the individual’s APTC was based). Returning to the Marketplace to update application information triggers a redetermination of eligibility and thus may also result in the applicant being found newly eligible for Medicaid or HIP.

The following guidance applies to any Indiana resident who is enrolled in a Marketplace plan and receiving the benefit of APTC, and who chooses to apply for HIP coverage:

  • If you are determined eligible for HIP by Indiana FSSA:
    • You will get information about your eligibility and then may choose a health plan (Anthem, MDWise or MHS) to manage your health care services. If one of these companies is providing your current Marketplace plan, it may also contact you directly about your possible eligibility for HIP.
    • You will receive a bill from your health plan for your monthly POWER account contribution. Paying this bill as soon as possible will guarantee you access to comprehensive coverage, without a gap in coverage.
    • You should visit the Marketplace to end your coverage with APTC as soon as you receive a final determination of HIP eligibility from Indiana FSSA. Otherwise, the tax filer(s) in your household may be liable to repay APTC received starting the first of the month following your HIP eligibility determination. Clickhere for instructions fromHealthCare.gov on ending a Marketplace plan when you get Medicaid (including HIP).
  • If you are not determined eligible for HIP by Indiana FSSA:
    • You will receive a denial notice and you will keep the health insurance coverage you purchased on the Marketplace.
    • You will not face a tax penalty related to APTC and HIP eligibility because you are not eligible for HIP.

FSSA is not planning additional outreach to Marketplace members at this time, but may reach out to them with more information when the next Marketplace open enrollment period begins in November of this year.

Please direct any questions toHIP2.0@fssa.in.gov

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Indiana State Association of Health Underwriters

Indiana State Association of Health Underwriters