Feds require state to talk to Native Americans for HIP 2.0 plan

State officials met Tuesday with members of the Pokagon Band of Potawatomi Indians in an effort to satisfy federal regulators who are considering a proposed expansion of the state’s low-income health insurance program.

In a letter dated July 17, the Centers for Medicare and Medicaid Services said the state’s application – which is a request to waive several Medicaid requirements – is considered incomplete until it consults with the tribe about the proposal.

And CMS won’t launch an official review of the application and open the proposal for public comment until it’s deemed complete, wrote Angela Garner, acting director of the agency’s waiver division.

The Indiana Family and Social Services Administration – which administers the state’s Healthy Indiana Plan – is working to address the federal concerns, said agency spokesman Jim Gavin.

Meanwhile, he said state and federal officials are continuing discussions about what the state has dubbed HIP 2.0. The plan would apply to all non-disabled adults ages 19-64, who earn between 23 percent and 138 percent of the federal poverty level. In 2014, that means a maximum income of no more than $16,105 annually for an individual and $32,913 for a family of four.

HIP 2.0 would provide three plans for low-income Hoosiers. The options are meant promote personal responsibility and consumer behavior.

Gavin said FSSA officials remain hopeful that CMS responds quickly to the application so the expanded insurance can begin in early 2015. “We do not anticipate these issues having an impact on the negotiations or the potential start date for the program,” Gavin said.

The state has already sent the HIP 2.0 application to the tribe and received formal feedback that’s been submitted to CMS, Gavin said. The Pokagaon Band – a sovereign Native American tribe with a 10-county service area that includes parts of Northern Indiana and Southwestern Michigan – expressed concerns that its members would be required to participate in HIP 2.0 instead of traditional Medicaid.

In a letter to the state, the Pokagon Band’s medical director said that “would unnecessarily complicate administration of the Medicaid program for both the tribe and the state.” Instead, the tribe proposed that Native Americans be carved out of the proposal, as other states have done.

Gavin noted that federal officials “did not raise tribal consultation as an issue with the three previous HIP waivers submitted including the current waiver submitted in 2013. Furthermore, in August of 2013, CMS had advised the state of Indiana in another matter that that tribal consultation was not required.”

Federal officials have also raised similar concerns about a separate wavier request the state recently made to keep the current HIP program in place, pending the possible expansion.

The Healthy Indiana Plan began in 2008 under a five-year waiver from the federal government and was continued by two one-year waivers granted in 2012 and 2013.

The HIP 2.0 program is meant to replace a Medicaid expansion called for by the federal Affordable Care Act. It’s meant to provide insurance to as many as 350,000 uninsured Hoosiers.