10:36p ET
Indiana
Premiums return for Indiana's HIP, CHIP Medicaid enrollees • Indiana Capital Chronicle
For the first time in years, certain Indiana Medicaid beneficiaries will start paying premiums again — a concern for advocates who say that enrollees are unprepared and point to federal concerns about the rule’s effectiveness.
The state waived the cost-sharing requirement, otherwise known as POWER Accounts, in early 2020 during the COVID-19 pandemic. During that time, the state’s Medicaid rolls swelled as the federal government incentivized states not to cut off coverage during an unprecedented public health emergency.
But on July 1, Medicaid beneficiaries in the Healthy Indiana Plan (HIP), Children’s Health Insurance Program (CHIP) and MedWorks will get a bill — many of them for the first time if they enrolled during or after the pandemic.
Adam Mueller, one such advocate, pointed to surveys finding beneficiaries didn’t understand the premiums, which can fluctuate monthly and sometimes are rolled over to other months. Even those who tried to do everything right could fall short due to an external factor, he said.
“If you’ve ever put $1 in a vending machine, and you see the bag of chips and it comes in halfway and just stops. You’re like, ‘What do I do? That was the only dollar I had. How do I get my chips?’ But in this case, it’s health care. The whole system could trip up based on whether you paid $1 or not,” said Mueller.
“It’s really, really scary to me that people could lose access to coverage — life-saving coverage, life-sustaining coverage — over paperwork errors.”
Lawsuit and FSSA response
Former Gov. Mitch Daniels first introduced the consumer-driven, cost-sharing approach in 2007 when the state expanded Medicaid to moderate income workers. Then Gov. Mike Pence developed the program even further.
Mueller is an attorney with the Indiana Justice Project, a nonprofit currently suing the federal government for approving several waivers that allowed the Family and Social Services Administration (FSSA) to tailor specific aspects of its Medicaid program.
In particular, the U.S. Department of Health and Human Services approved waivers to impose the work requirements, require premiums, strike retroactive coverage and bar payment for certain non-emergency medical transportation. Plaintiffs represented by Mueller’s group revived the lawsuit in January after a pandemic pause, when premiums were suspended.
In June 2021, the federal government removed work requirements, which were dropped from the case, but left the other three waivers in place during a review published in December 2023.
The presiding judge is under no deadline to decide the case, though the state government filed to dismiss in April.
FSSA says that Indiana law requires the agency to implement cost-sharing across the three programs, which ranges from $1 to $187 for single enrollees depending on household income.
Instead, the agency pointed to its advertising campaign in multiple languages as evidence of its efforts to educate members about the premiums restart.
“FSSA has used a robust outreach plan to ensure that members, their families and friends, and stakeholders are aware of the cost-share restart and when, how, and where to pay,” an agency spokesperson said in a statement.
“FSSA has equipped them with tools in multiple languages that are designed to raise overall awareness, help members easily transition into cost-share and help third parties that want to pay contributions on behalf of members,” the agency continued. “This has included multiple stakeholder meetings, an advertising campaign, a 9-week social media toolkit designed for stakeholder use and guides for how to pay.”
Notably, Hoosiers who make enough money to purchase an insurance plan on the federal marketplace don’t pay any premiums.
Details about cost-sharing
For a new enrollees first month, qualifying beneficiaries will have conditional coverage, meaning their coverage will be “active” once they make their first payment, FSSA’s Nonis Spinner shared in an April meeting detailing the reintroduction of premiums.
Paying immediately or when you apply is the surest way to maintain coverage, Spinner said, but each plan offers additional options.
“If they don’t make the payment within 60 days … those with over 100% (of the Federal Poverty Level income, or $31,200 for a family of four) will be disenrolled and they won’t have coverage. However, there is no lockout — they can reapply at any time,” Spinner said.
For those making under that threshold, they’ll be put on a “basic” coverage plan with the option to choose a different plan during their renewal period.
“The main difference between basic and plus is that in basic coverage, you pay co-payments at the time of service for most of your services. And in the plus coverage, you pay a monthly contribution instead,” Spinner summarized.
The state has some exceptions for someone who is determined to be medically frail or pregnant. Additionally, tobacco users are subject to a premium surcharge starting in 2026.
Hoosier Medicaid recipients report higher program dissatisfaction than peers
The General Assembly approved continuous eligibility for children in 2023, meaning that even if parents don’t make the payment, Hoosiers under 19 will still be covered for a full year.
After a full year without payments, those children can be locked out for up to three months until coverage can be reactivated — potentially disrupting crucial health care for the state’s youngest Hoosiers.
Meanwhile, someone with a disability covered by the MedWorks plan can be locked out for two years due to nonpayment if they make 150% of the federal poverty level, or $46,800 for a family of four.
But Mueller pointed to some evidence, first heard from enrollees, about the ineffectiveness of premiums and documentation about the added programming expenses.
“… we started to see a lot of people lose coverage for what I would describe as … paperwork reasons. They were still eligible (and) they thought they had paid their power account. Some people didn’t know they had a power account,” Mueller said.
These anecdotes were later confirmed by reports documenting the confusion of enrollees and administrative burden on the private entities overseeing HIP, further complicated because third-party nonprofits or churches often paid part or all of the premiums on behalf of beneficiaries.
FSSA reported that third parties paid for 11,000 members in 2019 alone but Mueller and others noted that the network of aid has dissolved during the COVID-19 pandemic pause.
The Centers for Medicare and Medicaid Services (CMS) has their own concerns about the cost-sharing tool, as detailed in a December letter allowing the state to continue to practice.
“Evidence on the effects of premiums in Medicaid … suggest that premiums beyond those authorized under Medicaid statute may reduce access to coverage and care among the population that Medicaid is designed to serve,” read the letter from CMS to FSSA’s Medicaid Director Cora Steinmetz. “Beneficiaries who are subject to premiums appear to experience greater disruptions in Medicaid coverage and exhibit lower initial rates of enrollment.”
CMS Letter to Indiana 12.22.23
Ultimately, the agency allowed the state to continue with POWER Accounts over these concerns, noting that disenrollment issues disproportionately impact Black Hoosiers, in order to minimize disruptions to FSSA’s other projects.
Mueller additionally added that FSSA and the private entities administering the programs ultimately reported saving money during the COVID-19 pandemic, even as enrollment swelled and the state paused premiums collections.
“So many people that are on HIP right now have never had to pay POWER Accounts, that’s going to be a foreign process to them,” Mueller said. “And then a lot of the workers — both at some of the managed care organizations and also at FSSA — have not have to administer this as well. We already know that they’re overworked and their caseloads are high and there’s a lot of turnover there as well.”
As for the argument that enrollees need “skin in the game” to incentivize them to make healthier choices, Mueller pointed to their participation as evidence of their conviction.
“People are on this program because they care about their health care. So, clearly, they already have ‘skin in the game,’” Mueller said. “I don’t know what else you need from somebody other than that.”
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Indiana
California man who had $42K seized at Indiana FedEx facility gets money back after legal fight
LOS ANGELES (KABC) — Millions of packages move across the country every single day. Many of those go through the FedEx facility in Indianapolis. That’s where they can get taken – not by thieves but by local law enforcement.
“I am just totally stunned that this can happen in America,” California jewelry wholesaler Henry Cheng told Eyewitness News about how he had tens of thousands of dollars seized by another state.
He didn’t want to be identified on camera because he says robbers often target him to steal his merchandise. In this case, he sold items to a client in Virginia. The client sent him $42,000 in a FedEx package. It was stopped in Indianapolis.
“The next thing I know is the police and the prosecutor is forfeiting my money, saying that based solely on suspicions, they didn’t even name the crime that I’ve committed, because I know I have not committed any crime,” Cheng said.
The practice of civil forfeiture is legal and common. It allows local governments to seize property suspected to be involved in criminal activity. Property can be seized without a conviction or charges.
Cheng called police and the prosecutor’s office in Indianapolis and says they wouldn’t give him a reason why the money was taken. He showed authorities the receipt for the sale. He was told it didn’t matter.
“You can get your money back, but you got to go to court,” Cheng said he was told.
A public interest law firm called the Institute for Justice took up the case and filed a lawsuit.
“Civil forfeiture really is one of the greatest threats to property rights in the nation today,” said Sam Gedge, a senior attorney at the Institute for Justice. “It lets governments across the nation take people’s cash, their cars, their homes, without ever convicting them of a crime, without charging them with a crime.”
The Indianapolis FedEx hub is the second largest in the United States, and attorneys claim law enforcement in Indiana is using that to profit because it can keep a large part of the money.
In the affidavit for probable cause, it states one of the reasons the parcel was deemed suspicious and pulled for inspection is simply because it was shipped to California.
“So they describe California as a quote, a source state, a source state for drugs,” Gedge said.
The affidavit in this case adds several other reasons for the package being suspicious: the seams were secured with tape, it was dropped off at a FedEx shipping center. It also states that it contained $100 bills, $50 bills and $20 bills. It claims those denominations are consistent with illegal activities.
“They simply say that there’s been, quote, a violation of a criminal statute. They don’t tell you what criminal statute. They don’t tell you what violation and really it is just a numbers game,” Gedge said.
A numbers game that adds up to a lot of money. Gedge says the prosecutors’ office in Marion County, Indiana has stopped more than 130 packages over the last two years and seized about $2.5 million.
“Oftentimes, to travel to Indiana, if you live in California, to try to litigate a civil forfeiture action, it may very well cost more to hire a lawyer to defend yourself than the amount of money at stake,” Gedge said.
Now after several lawsuits and questions from Eyewitness News and others, Cheng is getting back his money.
“The state came back and said ‘OK, now that we know the full story we’re willing to give the money back,’” Gedge said.
Gedge adds that the government always knew the full story. Nothing changed in the last few months. He said the evidence was always there.
“For people who are willing to lawyer up and spend months filing in the courts and incurring all this time and resources trying to defend their property, sometimes the government just gives up, but of course, a lot of people can’t afford to do that,” Gedge said.
“A lot of people don’t have the good fortune to have free lawyers, and for those people, the government tends not to be quite as ready to give people’s property back,” he added.
Attorneys say the return of the money will not end the case. They counter-sued with a class action lawsuit over the constitutionality of the process used to seize and forfeit assets.
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Indiana
Will Indiana beat Ohio State? Can Oregon State upset Washington State? Our Week 13 CFB picks
As the college football regular season winds down, the intrigue in some of the Week 13 matchups turns way up.
- WATCH: Stream most of this week’s top college football games live for FREE with Fubo (free trial) or with DirecTV Stream (free trial).
In the Big Ten, undefeated Indiana tries to keep rolling toward a berth in the Big Ten championship game when the fifth-ranked Hoosiers visit No. 2 Ohio State. The one-loss Buckeyes are 11-point favorites.
Meanwhile, No. 4 Penn State, which also remains alive in the chase to face top-ranked Oregon in the conference title game, faces a potentially tough road game against the Minnesota Golden Gophers. The Nittany Lions are favored by 11.5 points.
In the Pac-12, Oregon State will look to end its losing streak when the Beavers play host to Washington State. The Beavers have lost five in a row and are 11.5-point underdogs, but can they put a complete game together against the Cougars?
Check out this week’s college football odds and score predictions for all the Big Ten and Pac-12 games from the CFB coverage team at The Oregonian/OregonLive.
Purdue (1-9, 0-7) at Michigan State (4-6, 2-5)
Game details: 5 p.m. PT Friday at Spartan Stadium in East Lansing, Michigan
TV channel and live stream: Fox and Fox Sports Live
Latest line: Michigan State by 13.5
Over/under: 47.5
Predictions
Ryan Clarke: Michigan State 31, Purdue 17
James Crepea: Michigan State 28, Purdue 14
Nick Daschel: Michigan State 31, Purdue 27
Aaron Fentress: Michigan State 31, Purdue 20
Joe Freeman: Michigan State 30, Purdue 15
Sean Meagher: Michigan State 34, Purdue 17
Joel Odom: Michigan State 31, Purdue 10
Bill Oram: Michigan State 28, Purdue 13
Washington State (8-2) at Oregon State (4-6)
Game details: 4 p.m. PT Saturday at Reser Stadium in Corvallis
TV channel and live stream: The CW
Latest line: Washington State by 11.5
Over/under: 57.5
Predictions
Ryan Clarke: Washington State 30, Oregon State 7
James Crepea: Washington State 35, Oregon State 14
Nick Daschel: Washington State 38, Oregon State 17
Aaron Fentress: Washington State 27, Oregon State 17
Joe Freeman: Washington State 32, Oregon State 17
Sean Meagher: Washington State 42, Oregon State 21
Joel Odom: Washington State 38, Oregon State 14
Bill Oram: Washington State 38, Oregon State 23
No. 5 Indiana (10-0, 7-0) at No. 2 Ohio State (9-1, 6-1)
Game details: 9 a.m. PT Saturday at Ohio Stadium in Columbus
TV channel and live stream: Fox and Fox Sports Live
Latest line: Ohio State by 11
Over/under: 52.5
Predictions
Ryan Clarke: Ohio State 37, Indiana 34
James Crepea: Ohio State 42, Indiana 35
Nick Daschel: Ohio State 31, Indiana 29
Aaron Fentress: Ohio State 38, Indiana 25
Joe Freeman: Ohio State 28, Indiana 27
Sean Meagher: Indiana 38, Ohio State 35
Joel Odom: Ohio State 31, Indiana 21
Bill Oram: Ohio State 26, Indiana 24
No. 25 Illinois (7-3, 4-3) at Rutgers (6-4, 3-4)
Game details: 9 a.m. PT Saturday at SHI Stadium in Piscataway, New Jersey
TV channel and live stream: Peacock
Latest line: Rutgers by 1
Over/under: 47.5
Predictions
Ryan Clarke: Illinois 22, Rutgers 14
James Crepea: Illinois 28, Rutgers 14
Nick Daschel: Illinois 24, Rutgers 20
Aaron Fentress: Illinois 23, Rutgers 20
Joe Freeman: Rutgers 24, Illinois 23
Sean Meagher: Illinois 28, Rutgers 24
Joel Odom: Illinois 27, Rutgers 17
Bill Oram: Illinois 28, Rutgers 14
Iowa (6-4, 4-3) at Maryland (4-6, 1-6)
Game details: 9 a.m. PT Saturday at SECU Stadium in College Park, Maryland
TV channel and live stream: Big Ten Network and Fox Sports Live
Latest line: Iowa by 3.5
Over/under: 43.5
Predictions
Ryan Clarke: Iowa 28, Maryland 20
James Crepea: Iowa 28, Maryland 21
Nick Daschel: Iowa 20, Maryland 14
Aaron Fentress: Iowa 33, Maryland 18
Joe Freeman: Iowa 27, Maryland 20
Sean Meagher: Iowa 21, Maryland 17
Joel Odom: Iowa 34, Maryland 13
Bill Oram: Maryland 35, Iowa 21
No. 4 Penn State (9-1, 6-1) at Minnesota (6-4, 4-3)
Game details: 12:30 p.m. PT Saturday at Huntington Bank Stadium in Minneapolis
TV channel and live stream: CBS and cbssports.com
Latest line: Penn State by 11.5
Over/under: 44.5
Predictions
Ryan Clarke: Minnesota 27, Penn State 24
James Crepea: Penn State 35, Minnesota 21
Nick Daschel: Penn State 24, Minnesota 23
Aaron Fentress: Penn State 31, Minnesota 17
Joe Freeman: Penn State 31, Minnesota 21
Sean Meagher: Penn State 30, Minnesota 24
Joel Odom: Penn State 28, Minnesota 16
Bill Oram: Minnesota 28, Penn State 18
Wisconsin (5-5, 3-4) at Nebraska (5-5, 2-5)
Game details: 12:30 p.m. PT Saturday at Memorial Stadium in Lincoln, Nebraska
TV channel and live stream: Big Ten Network and Fox Sports Live
Latest line: Nebraska by 1
Over/under: 41.5
Predictions
Ryan Clarke: Nebraska 24, Wisconsin 7
James Crepea: Nebraska 24, Wisconsin 17
Nick Daschel: Nebraska 20, Wisconsin 14
Aaron Fentress: Wisconsin 24, Nebraska 23
Joe Freeman: Wisconsin 23, Nebraska 20
Sean Meagher: Wisconsin 28, Nebraska 27
Joel Odom: Wisconsin 20, Nebraska 17
Bill Oram: Nebraska 21, Wisconsin 14
Northwestern (4-6, 2-5) at Michigan (5-5, 3-4)
Game details: 12:30 p.m. PT Saturday at Michigan Stadium in Ann Arbor
TV channel and live stream: FS1 and Fox Sports Live
Latest line: Michigan by 10.5
Over/under: 36.5
Predictions
Ryan Clarke: Michigan 31, Northwestern 10
James Crepea: Michigan 17, Northwestern 10
Nick Daschel: Northwestern 21, Michigan 20
Aaron Fentress: Michigan 29, Northwestern 10
Joe Freeman: Michigan 24, Northwestern 10
Sean Meagher: Michigan 21, Northwestern 14
Joel Odom: Michigan 16, Northwestern 13
Bill Oram: Michigan 33, Northwestern 17
USC (5-5, 3-5) at UCLA (4-6, 3-5)
Game details: 7:30 p.m. PT Saturday at the Rose Bowl in Pasadena, California
TV channel and live stream: NBC and Peacock
Latest line: USC by 5
Over/under: 51.5
Predictions
Ryan Clarke: UCLA 38, USC 31
James Crepea: USC 35, UCLA 28
Nick Daschel: UCLA 28, USC 27
Aaron Fentress: USC 31, UCLA 26
Joe Freeman: USC 30, UCLA 24
Sean Meagher: UCLA 33, USC 28
Joel Odom: USC 36, UCLA 30
Bill Oram: UCLA 49, USC 47
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