Indiana Medicaid will now cover residential treatment, detoxification and peer recovery services. The federal government approved the expanded coverage earlier this month as part of the Healthy Indiana Plan’s Medicaid waiver extension.
HIP, Indiana’s Medicaid expansion, includes certain unique features, outlined in a so-called “demonstration” waiver that requires periodic approval from the federal government. That approval was announced Feb. 2.
Indiana Family and Social Services Secretary Jennifer Walthall said the intent of the new coverage is to make different types of treatment available for people with different needs, from serious inpatient programs to services for people in long-term recovery.
“We may need to meet people in multiple different areas as they make their way through the recovery process and we want to have all those safety nets in place,” she said.
Even though the measures were approved as part of the HIP waiver extension, she said, they apply to all Hoosier Medicaid enrollees, not just HIP members.
The program already covered other addiction treatment services, including all three medication-assisted treatment therapies: buprenorphine, naltrexone and, most recently, methadone.
The approval of the waiver also grants Indiana exemption from a federal rule that prevents Medicaid from paying for stays in larger inpatient treatment facilities with more than 16 beds.
The “Institutions for Mental Disease” — or IMD — exclusion has been part of the Medicaid program since it was founded in 1965. At the time, the federal government was moving toward supporting community health centers and outpatient treatment in place of large mental institutions.
However, in recent years, the opioid crisis has fueled a push for Medicaid coverage of inpatient treatment, especially in states such as Indiana that lack sufficient accomodations to treat people with addiction.
“When we look across the state of Indiana for capacity ... it’s one thing to say we’ll pay for it and it’s another to have access,” Walthall said. “It’s a whole different issue to meet the needs of people where they are.”
Walthall said that as a result of Indiana’s IMD exemption exclusion, 21 larger facilities will be immediately able to accept Medicaid patients.
“There’s a huge number, and you can see that they’re geographically distributed across the state already,” Walthall said.
The facilities first need to agree to accept Medicaid reimbursement. Walthall says she has faith they’ll quickly jump on board.
The newly-approved HIP waiver also includes a provisions that have come under fire from advocates who say they could act as a barrier to recovery.
For instance, certain HIP enrollees will be required to work to maintain coverage.
According to the FSSA, people in addiction treatment will be exempt from that work requirement.
Another change to the program: Healthy Indiana Plan enrollees who fail to renew coverage could now be subject to a six-month suspension period.
The measure drew criticism from Covering Kids and Families Diretor Mark Fairchild, who said many people on HIP are transient, in some cases because they suffer from addiction. That could make renewing coverage — and receiving treatment — difficult.
“We're not in favor of any policy for locking somebody out for something that could be a logistical issue,” he said earlier this month.
According to the waiver application, the state estimates approximately 81,000 Healthy Indiana Plan members have substance abuse disorder.
This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.