ANDERSON — After more than 25 years as a certified nursing assistant, Lisa Davidson was suddenly seen as a liability.
It started with a stroke and a seizure on Dec. 28, but when the seizures kept coming a month later, Davidson was deemed a risk to patients at the retirement community where she worked.
Losing her job meant losing her medical insurance, and that meant she had a major dilemma: Davidson couldn’t work because of her seizures, but she couldn’t afford medication to control them without working.
“I didn’t have the money to pay for insurance and then I was like, what do I do?” the Anderson resident said. “I have medical problems I’m dealing with – I’m a diabetic, I’ve got seizures now, which I had in the past but they’d never affected me.
“I started feeling stripped.”
But an expansion of the Healthy Indiana Plan is providing Davidson a second chance.
Healthy Indiana Plan 2.0, or HIP 2.0, is the state’s latest low-cost health insurance program that provides incentives for members to be more health conscious.
Non-disabled Indiana residents ages 19 to 64 years old with a family income of less than 138 percent of the federal poverty level qualify for the insurance program.
HIP 2.0 is a revamp of the original HIP, which was launched in 2008 but had stricter guidelines and a membership maximum, making it difficult for even qualified Hoosiers to be approved.
HIP 2.0 took effect Feb. 1 and has made affordable health care more accessible to Hoosiers while expanding its services, including educational health and addiction counseling programs.
An emphasis with HIP 2.0 is preventative care for long-term health. When people don’t have insurance, they often avoid going to the doctor and end up in the emergency room for issues that should be handled by a primary care physician.
“You can show up in our emergency room and we can treat you, but we cannot give you prescription medicine to treat long-term blood pressure or heart failure or COPD or all those things we see here in Madison County,” said Terri Rinker, reimbursement cycle director at Community Hospital Anderson.
Approved members still contribute financially and have co-pays, but they’re low cost.
The Affordable Care Act enhanced but didn’t establish the federal funding source for HIP, said Jim Gavin, Indiana Family and Social Service Administration (FSSA) director of communications and media.
The federal government currently pays 100 percent of the medical costs and the state pays 50 percent of the administrative costs. In 2017, Indiana will start making contributions to the medical costs and by 2020 the state will contribute 10 percent of the health care costs, while continuing to pay half of the administrative costs.
The HIP expansion means qualified applicants choose between HIP Plus and Hip Basic. Each covers medical expenses such as doctor visits, hospital care, therapies and medications, but Plus also covers vision and dental care.
For Davidson, the Plus plan means she can find relief physically and financially. Some of her teeth broke during her seizures, and the Plus plan means she can afford to go to the dentist.
Being able to pay for essentials is huge for Davidson. She hates having to ask for help and applying for assistance ever since she lost her job earlier this year.
“I always joked around, I was like, yeah, I’m helping (other people) out by working,” she said. But now she’s the one who has to worry about affording to survive.
And she’s not alone.
More than 10,600 Madison County residents were uninsured and had a family income less than 138 percent of the federal poverty level in 2012, the most recent year data is available, according to the FSSA.
Mike Casuscelli, business expansion consultant for Madison County Community Health Center, said a study showed nearly 40,000 Madison County residents were uninsured or underinsured in 2012.
“That’s an incredible number,” he said. “That’s just Madison County. That’s nearly 40,000 people who weren’t being served by health centers.”
According to FSSA, more than 4,000 Madison County residents are HIP 2.0 members as of July, and more than 7,000 have applied for Indiana Health Coverage programs, including but not limited to HIP 2.0.
Elizabeth Ellebracht of Anderson was approved for HIP 2.0 in March, lifting a huge financial burden that had been weighing on her for years.
She came to Anderson in 2009 to treat an eating disorder, but when the program took longer than expected she lost her job – and her insurance – in St. Louis. Knowing that keeping her eating disorder in check was vital to her health, she stayed in Anderson to be near her treatment team.
Suffering from multiple ailments including rheumatoid arthritis and back problems, she used all of her retirement money to pay for her health care, but the money eventually ran out.
As a teacher’s aide, Ellebracht only gets paid when school is in session, so her income is limited any time there’s a school cancellation or a break.
That causes major issues when it comes to paying for prescriptions and procedures that are medically necessary.
“I was basically alternating medications,” Ellebracht said. “I would pay out of pocket for a couple of medications one month and then ration (them out).”
Ellebracht falls into ALICE, or Asset Limited, Income Constrained, Employed, a group of people that are trapped between poverty and prosperity. She makes too much money to qualify for most assistance programs but not enough to spare much when costly situations arise.
Since her income is right at the cutoff line for most programs, she doubted she would qualify even after the state’s HIP changes. When she went to St. Vincent Anderson Regional Hospital to apply, she was surprised to discover she qualified.
“Just to be able to walk into a pharmacy and order what you need and be able to pick it up is fantastic,” Ellebracht said. “I was missing medications that helped slow the progression of the disease. Things you need to stay healthy.”
It also means she doesn’t have to sacrifice her grocery money.
“Which is a big deal for me because in order to stay in recovery I need to eat a balanced diet and do what I need to do nutritionally and not give things up,” she said.
United Way of Madison County Outreach Coordinator Julie Barton said she’s helped on average two people a week this summer apply for HIP 2.0.
Barton said the expanded program enables the community to be healthier and greatly impact individuals.
“The people who need health insurance and HIP 2.0, they’re our neighbors, they’re our cashiers, they’re people we see every day and interact with, and we want to make sure they know this option is available depending on their income,” she said. “Not having health care does lead to other financial problems if you have an emergency or something happens to you.”
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By the Numbers
• 642,000 uninsured Hoosiers estimated prior to the approval of the HIP 2.0 waiver.
• 559,000 non-disabled adults (19-64) who have a family income less than 138 percent of the federal poverty level who the waiver specifically targeted.
• 350,000 of those targeted adults were not previously covered.
• 310,000 members currently in HIP 2.0, some of whom were previously enrolled in the Healthy Indiana Plan or in traditional Medicaid.
• 7,076 Madison County residents have applied for Indiana Health Coverage Programs, including but not limited to HIP 2.0.
• 4,024 Madison County residents are new HIP 2.0 members, as of July.
• 7,916 Madison County residents who have HIP 2.0, as of July.
• 10,612 Madison County residents who, 2012, were uninsured and in the income range to qualify for the current Healthy Indiana Plan.
-According to Jim Gavin, communications director for Indiana Family and Social Services Administration
Places to Apply for HIP 2.0
• Community Hospital Anderson
• Department of Family Resources/FSSA
• Madison County Community Health Center
• Plus One Enterprises
• Pregnancy Plus
• St. Vincent Anderson Regional Hospital
• St. Vincent Mercy Hospital - Elwood
• United Way of Madison County
• For more information about HIP 2.0 and about applying, go to www.in.gov/fssa/hip.