Holcomb’s HIP 2.0 waiver likely to sail through Washington

Last summer, then-Gov. Mike Pence’s administration was battling the Obama administration over how to evaluate HIP 2.0—an expansion of Indiana’s Medicaid program that requires low-income Hoosiers receiving health insurance coverage to have “skin in the game” by contributing to a health management account.

Now, as Gov. Eric Holcomb seeks a waiver from the Centers for Medicare & Medicaid Services to extend the program, a conservative slant to the Medicaid expansion funded by Obamacare, he’ll be dealing with the Trump administration—which, rather than being skeptical of HIP 2.0, appears poised to embrace it as a national model.

Holcomb last week submitted the waiver request, which kicks off an eight-month review process. The current waiver expires at the end of January 2018; the extension would go until 2021.

In a letter to federal officials, Holcomb wrote: “There are now 400,000 members currently enrolled, and our consumer, skin-in-the-game approach has yielded better health outcomes and helped members be better informed and more active participants in their health outcomes.”

Among the reasons the pathway appears smooth are that Pence is now vice president and Trump’s pick for administrator of the Centers for Medicare and Medicaid Services is Seema Verma, who as a health care consultant was instrumental in crafting HIP 2.0 for Gov. Pence.

Verma, who is awaiting confirmation, may foster the introduction of the concepts used in HIP 2.0 into Medicaid expansion plans across the country, said Ed Abel, director of the health care practice at Indianapolis-based Blue & Co., an accounting and consulting firm.

While Trump and Congressional Republicans have vowed to repeal Obamacare, whatever replaces it likely would continue health coverage for many low-income Americans who gained insurance under Obamacare, Abel said. 

According to the Henry J. Kaiser Family Foundation, the number of uninsured nonelderly Americans stood at 28.5 million at the end of 2015, a decrease of nearly 13 million since 2013.

“I don’t think anyone wants to flat-out take those benefits away, but there may be some limitations placed on them,” Abel said.

Holcomb said in a press release that his waiver application “maintains the core elements of HIP 2.0” while providing expanded access for substance abuse treatment. It also would provide new incentives for tobacco cessation, chronic disease management and participation in a job-referral program.