The Medicaid program has served as an invaluable champion in ensuring millions across the country have the health coverage and care they need, thanks in large part to federal protections put in place during the COVID-19 public health emergency (PHE). Nowhere is this more apparent than in Indiana, where, on top of suspending disenrollments during the PHE, the state has also temporarily suspended burdensome Medicaid premiums. As a result of the elimination of these administrative hurdles, Medicaid has been operating smoothly with Indiana Medicaid enrollees reporting positive experiences with their coverage. This praise of Indiana’s Medicaid coverage will likely be undone by the state’s improper planning for the end of the PHE that could lead to more than 277,000 disenrolled.  

There are several factors that could lead to heightened disenrollments in Indiana. As is the case in several other states, Indiana’s legislature has attempted to limit the governor’s administrative authorities and prematurely end the state’s PHE. There have also been examples of the legislature attempting to stifle the Medicaid agency’s ability to address enrollees’ needs during the pandemic. One such example includes a new bill introduced earlier this year that would impractically force state agencies to eliminate a rule every time they create a new rule that contains restrictions, penalties or fines. This could pose challenges in adequately responding to developments in the PHE because Indiana’s state legislature only meets part-time and if passed, this bill could impact the timeliness and way Indiana’s Medicaid program gets things done. 

Hoosier Action a homegrown, independent community organization based in rural and small-town Southern Indiana and led by members across Indiana, has been engaging the state on this topic. This blog details several of Hoosier Action’s strategies to pressure Indiana to develop comprehensive, equitable plans for addressing the end of the PHE.  

Has Indiana’s Medicaid agency communicated their plans for the end of the PHE with stakeholders and the general public?  

In the December 2021 Medicaid Advisory Committee (MAC) meeting, Indiana’s Family and Social Services Administration (FSSA) attempted to lay out their end of the PHE preliminary plans during the last 10 minutes of the meeting. This resulted in public outrage as people sought more detailed answers, and subsequently caused the meeting to be extended by 30 minutes. It was clear from these preliminary plans, however, that the agency had no plans to provide outreach in languages other than English or to adequately outreach to people with disabilities, an issue that has occurred in the past when FSSA did not provide materials in Braille or electronic documents readable via special software for people who are blind.  

Additionally, the state has indicated it will rely exclusively on mail, such as a series of five postcards to remind people to update their addresses and redetermination notices once the end of the PHE is announced. This is a cause for concern because Indiana is among the states with the highest rates for eviction. Throughout the pandemic, people have not been required to report address changes in order to maintain their Medicaid coverage. So, it is unlikely that the increased number of people who have faced housing insecurity due to economic hardships throughout the pandemic have reported their address, and as a result, will not receive the agency’s mail notices. 

Notably, the state has failed to mention to enrollees that not only are address changes required, but also that people will be required to start paying premiums to maintain coverage. There is currently a whole set of people who are experiencing Medicaid coverage for the first time and may be unaware of Indiana’s former policies around premiums, and there is another set of people who may have forgotten that premiums had been a feature of Indiana’s Medicaid program. Hoosier Action has published this op-ed that convincingly argues for Indiana to permanently eliminate Medicaid premiums once and for all, especially now as unprecedented numbers of Medicaid enrollees’ coverage are at risk.  

It is critical for Indiana to consider these dynamics when developing outreach plans that communicate important messages for people to maintain their Medicaid coverage as well as how to equitably plan for normal operations.   

How has Hoosier Action and other stakeholders put pressure on the state to develop more thoughtful and comprehensive plans for the unwinding of PHE protections? 

  • Be involved in Medicaid Advisory Committee meetings. Hoosier Action and other stakeholders were able to understand the state’s plans (albeit to a limited degree) for the end of the PHE and push for more considerations for how to best communicate with enrollees (i.e., languages other than English, different formatting for people with disabilities) by attending these meetings. And in Indiana, where these meetings have now been posted on YouTube, these forums become public record as folks were able to share their questions in the YouTube comment section, further holding state officials accountable.  

  • Publicize the issue through media outlets. Hoosier Action’s op-eds have been an opportunity to not only hold state officials accountable to create plans for the end of the PHE in an expedited way, but also inform the general public of reporting address changes now or risking missing out on important Medicaid communications.  

  • Emphasize the importance of Medicaid to state officials. Hoosier Action has built strong relationships with several state officials who could put additional pressure on the state’s Medicaid program to develop equitable plans. The organization has also provided Medicaid trainings to these officials to highlight how Medicaid has allowed people to access critical health care and provided evidence of the administrative costs associated with churn, particularly through enforcing Medicaid premiums.   

Why is it so important to start pressuring state officials to develop plans for unwinding PHE protections now?  

If states fail to be proactive and develop comprehensive, equitable plans now, 15 million people around the country will be at risk of losing their Medicaid coverage once the PHE ends. Furthermore, both enrollees and Medicaid agencies will experience the strain as call centers will likely become overwhelmed with questions and concerns about how to maintain coverage. These concerns can be avoided, or at least reduced, if states build out plans now. 

A special thank you to Tracey Hutchings-Goetz from Hoosier Action for sharing their strategies to understand Indiana’s plans for unwinding PHE Medicaid protections! 

How is your state planning to unwind PHE protections? Email me at rrosales@communitycatalyst.org to let me know.