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Category: Medicaid

Does the Healthy Indiana Plan 2.0 have national aspirations?

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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For the last six years, the Healthy Indiana Plan (HIP) has delivered quality care, encouraged the use of preventive services, and received measurable results. By incorporating the essence of a high deductible health plan and health savings account (HSA), the Medicaid expansion project became the first in the nation to adopt – and successfully demonstrate – the linkage of personal responsibility with subsided health protection to low-income individuals.

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Trump Administration releases guidance on Medicaid work requirements

Matt Cummings

Solutions Architect at Softheon
Matthew is a Solutions Architect at Softheon. He works closely with Product and Development teams to design products and solutions to help Health Plans and other entities to excel in the marketplace. He received his bachelor's degree in Applied Psychology and Business Management from Stony Brook University in Stony Brook, New York.

What happened?  

In a major shift that could affect millions of low-income people receiving benefits, The Trump Administration announced Thursday, January 11, that it will open the door for states to require work requirements for Medicaid recipients.  

The guidance was published in a letter from CMS Deputy Administrator Brian Neale to State Medicaid Directors Thursday morning. In the letter, Deputy Administrator Neale stated that the move would help “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” 

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At a Glance: Kentucky’s Medicaid Managed Care System

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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The Affordable Care Act (ACA) opened the door to an improved Medicaid Managed Care system. However, while the health law fundamentally transformed the health insurance policy landscape, the Commonwealth Fund concludes that state Medicaid programs still carry a heavy burden, since the Medicaid population is poorer and faces high health risks. Because of these risks, the likelihood for challenges such as reaching medically underserved communities, unstable eligibility and enrollment, developing effective payment incentives, organizing coverage, aligning managed care with health, education, and social services, as well as those relating to information technology (IT) is likely. In this blog, we examine the impact of Medicaid Expansion in the state of Kentucky, its current reform initiatives (e.g. 1115 Waivers), and recommendations to resolve common challenges faced by MCOs across the country.  

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Graham-Cassidy: A Closer Look

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

There is a major effort in Washington to push healthcare reform through before the end of the September.

The new bill drafted by Sen. Lindsey Graham (R-SC) and Sen. Bill Cassidy (R-LA) is appropriately known as the Graham-Cassidy bill. It is lauded by its sponsors as a proposal to return power to the states after the centralization of the ACA. Under the Graham-Cassidy bill, money made available for Medicaid Expansion effort and health plan subsidies would be pooled and allocated to states as block grants, which the states can then use to build their own health care plans. The block grants will be based on the number of individuals with incomes between 50-138% of the Federal Poverty Line (FPL) in the state, but this is only initially. Starting in 2024, enrollment levels will also be factored in to determine the level of funding available through the grants. Block grants are only provisioned through 2026, though, with nothing legislated to take their place after that year.

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Partial Medicaid Expansion; How Would It Impact Arkansas Works?

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Medicaid waivers have historically allowed states to experiment with delivery reform and coverage expansion, but increased in popularity in 2012 following a United States Supreme Court decision. This decision was related to the states’ choice on whether to expand their Medicaid programs to cover individuals with incomes of up to 138% of the federal poverty level.

During the Obamacare Administration, states’ requests for waivers were denied. This included those which:

  • would have conditioned Medicaid eligible for some beneficiaries on their ability to find work;
  • waivers that would have terminated coverage for beneficiaries with incomes below the poverty level if they failed to make out-of-pocket payments for medical care; and
  • state requests to partially expand their Medicaid programs to enroll beneficiaries with incomes up to 100% of the poverty level, but not those between 100% and 138%.

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Analysis: HIP 2.0 Serving as Model for National Medicaid Reform

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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Vice President Mike Pence and CMS Administrator Seema Verma both had a significant role in shaping the way Indiana has structured and increased access to Medicaid through Healthy Indiana Plan 2.0. The program, which is up for renewal, may be used as a model for other states as they look to utilize waivers to individualize their programs.

For the last six years, the Healthy Indiana Plan (HIP) has delivered quality care, encouraged the use of preventive services, and received measurable results. This Medicaid expansion project became the first in the nation to adopt and successfully demonstrate the linkage of personal responsibility with subsided health coverage to low-income individuals. It accomplished this by incorporating the concepts of a high deductible health plan with the concepts of a health savings account (HSA).

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View: HIP 2.0 – A Model for States Looking Toward Medicaid Expansion

Matthew Schumpf

Matthew is the Director of Business Solutions. He is responsible for identifying industry-wide challenges and designing new products or processes in healthcare landscape. In his long tenure with Softheon, Matt worked on a number of projects, including those with private health plans as well as those with State Governments. He received his bachelor’s degree in business administration at the State University of New York at Albany. Prior to Softheon, Matthew was a sales analyst at a wholesale florist.

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Indiana’s Medicaid reform was conducted under Healthy Indiana Plan (HIP), an innovative waiver program designed to drive consumer engagement. Here, Matthew Schumpf of Softheon describes the path for integrating a health plan into the HIP 2.0 Medicaid reform program.

Following the passage of the Affordable Care Act (ACA), states have taken different approaches to Medicaid reform and expansion. To date, 26 states have expanded Medicaid, while another six have expanded under alternative models (1115 Waivers) to meet their state-specific goals [1].

As one of the six, Indiana elected an alternative model for Medicaid reform to build upon the state’s reform success. The program became known as Healthy Indiana Plan (HIP) [2].

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