More than 10,000 low-income Hoosiers now have health insurance, thanks to the Healthy Indiana Plan started this year, but more than a third of those applying are being turned away.

Gov. Mitch Daniels’ top officials are already considering the relative success of the plan, including the possibility of changes in the HIP eligibility requirements, Indiana Family & Social Services Administration Chief Mitch Roob said in a recent interview.

Up to 130,000 Hoosiers can be covered by the HIP plan, which uses cigarette tax income (including the 44 cent-per-pack hike approved by the state Legislature last year) to subsidize coverage.

Roob, one of the chief architects of the plan, stopped short of suggesting he’s not satisfied with the 10,599 residents covered by the plan as of the week of May 16.

At the same time, Roob said, it’s noteworthy that more than 70 percent of those found eligible and added to the program are earning less than 100 percent of the federal poverty guideline (about $10,200 for an individual).

The plan, however, is open to individuals and families making up to 200 percent of the federal poverty level.

Designed as a product for working people whose employers don’t offer health insurance, it’s now unclear whether the eligibility guidelines need to be changed, Roob said.

In particular, Roob cited the fact that if employers offer any kind of health insurance, their employees are no longer eligible for HIP, regardless of how much employees are forced to contribute in premiums.

With certain employers regularly critiqued for making health insurance unaffordable for employees, there needs to be a broad discussion of the point, he said.

“We need to decide what are we going to define as ‘employer-sponsored’ health care — is it any time the employer offers health coverage, regardless of perceived affordability? Because that’s the way it was written into the [law],” Roob said.

“It’s a debate that needs to happen,” he added.

While Indiana’s eligibility criteria are narrower than plans offered in other states, Roob also noted that Indiana’s HIP plan also hasn’t brought the state to the brink of bankruptcy.

“The Legislature acted after a year of discussion. It didn’t anticipate this would be a be-all, end-all solution,” he said. “But other states have rushed headlong into ‘solutions,’ and have rushed headlong into bankrupt solutions.”

Roob remained non-committal on the Daniels administration’s official position on changing HIP eligibility, reiterating that the administration supports “having that discussion.”

The biggest dilemma, he said, remains a factor health policy officials refer to as “crowd out.”

That’s the breaking point when employers begin forcing employees onto state-subsidized health programs.

Under the current HIP program, “crowd-out” doesn’t appear to be a problem. But relax eligibility requirements to enroll more Hoosiers, and crowd-out could appear, Roob explained.

Changes, however, may be inevitable.

The fact remains more Hoosiers have been denied entry into HIP than have actually started the program.

Some of the top reasons for exclusion include failure to provide information, having had health insurance within the past six months, having an income exceeding program criteria, or already having other insurance.

The state received 20,000 applications for HIP coverage in the first month after the program started Jan. 1; as of May 9, the state had received 42,896 applications.

Of those who had applied, the most recent numbers show 10,599 enrolled, 11,444 rejected, 7,295 conditionally approved, and 15,928 applications still pending.

Scott Smith may be reached at (765) 454-8569 or via e-mail at scott.smith@kokomotribune.com



The Healthy Indiana Plan:

• For non-disabled Indiana residents ages 19-64, including U.S. citizens and legal aliens

• Annual income must be below 200 percent of federal poverty level

• Participants must have been without insurance (not counting COBRA coverage) for six months

• Participants must not be eligible for employer-sponsored health insurance

• Anyone interested can call (877) GET-HIP-9 for more information