CMS Report on HIP 2.0 Finds 'No Systematic Changes' in Health Status

by Lauren Flynn Kelly

As holdout states consider whether to accept the Biden administration's offer of enhanced federal funding to expand Medicaid, a recent evaluation report on Indiana's conservative Medicaid expansion demonstration may hold some lessons learned for states that look to managed care plans to do some of the heavy lifting for such programs.

Under then-Gov. Mike Pence (R), Indiana was among the first states to implement Medicaid expansion by using a section 1115 demonstration waiver. The state in 2015 launched a "2.0" version of its Healthy Indiana Plan (HIP) that features certain "personal responsibility" components such as copayments and requires monthly contributions to health savings-like accounts to promote healthy behaviors and health care consumerism.

In a federal evaluation report released last month by CMS, researchers relied on data from the American Community Survey and the Behavioral Risk Factor Surveillance System to assess the impact of HIP 2.0 on care over time relative to the 2011-2013 (the study pre-period) and "comparison groups" (i.e., other states).

While researchers observed significant improvements in some measures of health care access and affordability, they concluded that relative to other states, "there is little evidence of systematic changes in health care access and affordability, health behaviors, or health status" associated with HIP 2.0.

"In this report the biggest things that we see are that people in Indiana have more access to insurance coverage through 2.0 and better access to care, but we're not seeing the personal responsibility that [Indiana] had hoped to see," which is not unexpected given that these observations were made "just a couple years into the demonstration," says Margaret Scott, an associate principal with Avalere Health.

In many cases, states that use managed care for their expansion rely on the MCOs to "make sure that the beneficiaries understand what's going on and what all of these accounts are for and the reporting requirements," Scott says. As a result, for states considering using managed care for their Medicaid expansion, the biggest takeaway from the report is that "the education should come from the state as much as it comes from the [MCOs], and that the state has to ensure a consistent message is being sent [and] that it is easy to understand."

That flexibility to make program changes is important, says Scott, and illustrates that any expansion demonstration must be improved as states observe "how beneficiaries are reacting…that they're continually reviewing what they're doing and that they’re making appropriate changes going forward."

From RADAR on Medicare Advantage