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Cost-Share Restart

Cost-sharing for HIP program to remain paused at this time

July 1, 2024

FSSA is working with its attorneys and consulting with its federal partners at Centers for Medicare and Medicaid Services and will explore all legal remedies regarding the June 27 ruling regarding the lawsuit against the Healthy Indiana Plan.

At this time, cost-sharing for the HIP program, including POWER account contributions and co-pays, will remain paused. MEDWorks and CHIP co-pays will resume effective July 1 as planned.

Indiana strongly disagrees with the ruling and believes the actions have unintended consequences. The implications of the decision handed down are far-reaching. FSSA is still evaluating the impact for the state and the 762,000 Hoosiers who rely on healthcare coverage through the Healthy Indiana Plan. HIP was designed to provide healthcare coverage to non-disabled adults ages 19-64, empowering them to become engaged and active consumers of their health care.

At this time, individuals on the Healthy Indiana Plan remain covered, but there is uncertainty as to what services are included in that coverage.

While the lawsuit took aim at HIP’s POWER account contributions or premium-like payments, the June 27 decision revoked the entire 10-year waiver approval granted to Indiana in 2020 to operate HIP – creating uncertainty regarding which services are covered for HIP members and removing authority for certain administrative aspects of the program’s operation. The ruling also has implications that conflict with state law.

During the federal COVID-19 public health emergency, Indiana paused cost sharing to keep health coverage open for our members. This pause will end July 1, 2024, and Indiana will restart cost sharing for Medicaid, including the Children’s Health Insurance Program (CHIP); and the MEDWorks program for employed individuals with a disability.

No cost sharing for Healthy Indiana Plan (HIP) members will resume. For more information, see BT202461.

CHIP members may owe copayments for certain services starting July 1. Most copayments are under $10. CHIP or MEDWorks will receive their invoices from the premium vendor. Benefits may be reduced or terminated if they are not paid.

View Cost Share FAQs here

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Who has to pay a cost share?

If you are or have a child in CHIP or if you receive MEDWorks coverage and are required to pay premiums, you will receive a bill from the premium vendor in July.

No cost sharing for Healthy Indiana Plan (HIP) members will resume.

If you are in a health coverage category that has a cost sharing requirement, you will receive a letter from FSSA 60 days before you have to start paying. You will receive a post card from your health plan to remind you to look for an invoice around a month before you have to start paying, then, you will receive an invoice in the month before your first payment is due.

Medicaid members can check their status online in their benefits portal account (fssabenefits.in.gov) to determine if they are required to pay monthly contributions/premiums. Eligibility notices from FSSA and for CHIP and MEDWorks members, monthly invoices will also be provided by the premium vendor to keep members informed.

How do I pay my cost share?

To learn about the difference options available how to pay costs share please consider downloading the reference guide below or click on a specific health plan:

How much is my cost share?

The specific amount of the cost that members will need to contribute will vary as the amount is based on the members’ income.

Checking one's status online at fssabenefits.in.gov will provide personalized information about monthly contribution/premium amounts. Members can find more information on copay amounts by calling the “member services” number on the back of their Medicaid card.

Members may also review the charts below to see CHIP/MEDWorks Premium tiers by family size and dollar income.

No cost sharing for Healthy Indiana Plan (HIP) members will resume.

2024 CHIP Premiums by Federal Poverty Level

Single CHIP Child in Family$22$33$42$53
Household Size 151% 175% 176% 200% 201% 225% 226% 250%
1 $1,895.05 $2,196.25 $2,196.26 $2,510.00 $2,510.01 $2,823.75 $2,823.76 $3,137.50
2 $2,573.04 $2,982.00 $2,982.01 $3,408.00 $3,408.01 $3,834.00 $3,834.01 $4,260.00
3 $3,249.52 $3,766.00 $3,766.01 $4,304.00 $4,304.01 $4,842.00 $4,842.01 $5,380.00
4 $3,926.00 $4,550.00 $4,550.01 $5,200.00 $5,200.01 $5,850.00 $5,850.01 $6,500.00
5 $4,602.98 $5,334.58 $5,334.59 $6,096.66 $6,096.67 $6,858.74 $6,858.75 $7,620.83
6 $5,279.97 $6,119.17 $6,119.18 $6,993.34 $6,993.35 $7867.51 $7,867.52 $8,741.68
7 $5,956.95 $6,903.75 $6,903.76 $7,890.00 $7,890.01 $8,876.25 $8,876.26 $9,862.50
8 $6,633.93 $7,688.33 $7,688.34 $8,786.66 $8,786.67 $9,884.99 $9,885.00 $10,983.33
Multiple CHIP Children in Family $33 $50 $53 $70

2024 MEDWorks Premiums by Federal Poverty Level

Single MEDWorks Member in Home$48$69$107$134$161$187
Household Size 150% 175% 176% 200% 201% 250% 251% 300% 301% 350% 351% or higher
1 $1,882.50 $2,196.25 $2,196.26 $2,510.00 $2,510.01 $3,137.50 $3,137.51 $3,765.00 $3,765.01 $4,392.50

$4,392.51 
or higher

Married Couple Both on MEDWorks $65 $93 $145 $182 $218 $254
Note: Only the income of the individual counts when determining MEDWorks eligibility; spouse income is added back in to determine premium amounts only; there is no income limit for spouse income when the spouse is not on MEDWorks.

Stakeholder meeting

Timeline/Key dates

  • February 2024: An updated insert was included in eligibility notices
  • April/May: 60-day notification to members of cost share restart
  • July: Invoices will be sent in the first half of July for CHIP and MEDWorks for the month of August
  • July: Co-pays active in CHIP

Sample Member Communications

The notices listed below are samples of the letters members will receive to inform them of their cost-share status.

  1. No cost sharing for Healthy Indiana Plan (HIP) members will resume.
  2. MEDWorks CHIP w/ Premiums
  3. Non- Special Income Limit for Aged, Blind, Disabled and Miscellaneous

Outreach

Indiana is duplicating its redetermination outreach strategy and outreach materials currently being developed include a media campaign, social media toolkits, specific outreach materials for our partners to help share the message.


Social Media Tool Kit

To help raise awareness, the Indiana Family and Social Services Administration has created a nine-week social media campaign toolkit, which includes graphics and text for each week of the campaign.

We ask you please consider downloading and sharing the information on your social media channels to help ensure Medicaid members are aware of the upcoming changes.

Download the toolkit here


Monthly Contributions Are Returning - YouTube videos



Sample member communication

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