Common use of PROGRAM DESCRIPTION AND OBJECTIVES Clause in Contracts

PROGRAM DESCRIPTION AND OBJECTIVES. This section 1115(a) demonstration provides authority for the state to offer two distinct health care coverage benefit packages to specified populations. The Hoosier Healthwise (HHW) Program supplements state plan benefits for Medicaid eligible children and those otherwise eligible adults who are not aged, blind or disabled. The HIP provides health care coverage for uninsured adults not otherwise eligible for Medicaid through a high deductible managed care health plan and an account styled like a health savings account called a Personal Wellness and Responsibility (POWER) Account. Separate from this demonstration, Indiana offers the Indiana Select Program which includes case management services to supplement state plan benefits offered through Medicaid Select managed care programs for current Medicaid eligible adults who are aged, blind or disabled. Indiana began the Hoosier Healthwise program in 1994, when it initially mandated managed care enrollment for all section 1931 children and adults through a waiver granted by the Secretary under the authority of section 1915(b) of the Social Security Act (the Act). By July 1997, the program was implemented statewide using a combination of managed care organizations (MCOs) and a Primary Care Case Management (PCCM) delivery system. Effective December 2005, all Hoosier Healthwise enrollees are served exclusively by MCOs. Effective January 1, 2008, the authority for the Hoosier Healthwise program was provided solely through this demonstration. The HIP provides a high-deductible health plan and an account styled like a health savings account called a POWER Account to uninsured adults including low-income custodial parents and caretaker relatives of Medicaid and Children’s Health Insurance program (CHIP) children and uninsured non-custodial parents and childless adults. Participation in HIP is voluntary, but all enrollees will be required to receive medical care through the high deductible health plans and POWER Accounts. Enrollees must also make specified contributions to their POWER Accounts as a condition of continued enrollment. These accounts will be used by enrollees to pay for the cost of health care services until the deductible is reached; however, preventive services up to a maximum amount will be exempt from this requirement. Once the deductible has been met, the health plan will provide coverage for medical services up to an annual maximum amount. Eligible individuals who have certain high-risk conditions will be enrolled in the Enhanced Services Plan (ESP), a separate care delivery mechanism managed by the Indiana Comprehensive Health Insurance Association (ICHIA), the state’s high-risk pool. HIP offers the following coverage: 1) A basic commercial benefits package once annual medical costs exceed $1,100; 2) A Personal Wellness and Responsibility (POWER) Account valued at $1,100 per adult to pay for initial medical costs. The POWER Accounts provide incentives for participants to utilize services in a cost-efficient manner. HIP members make monthly contributions to their POWER Accounts depending on their income level; and 3) $500 in “first dollar” preventive benefits at no cost to HIP members. Under this demonstration, Indiana expects to achieve the following to promote the objectives of title XIX:  Access: Ensure availability of necessary health services for Medicaid enrollees while offering health coverage to thousands of uninsured individuals;  Prevention: Encourage individuals to stay healthy and seek preventive care;  Personal Responsibility: Give individuals control of their health care decisions and incentivize positive health behaviors;  Cost Transparency: Make individuals aware of the cost of health care services; and  Quality: Encourage provision of quality medical services to all enrollees. Encourage quality, continuity, and appropriate medical care. The following populations will participate in the Hoosier Healthwise (HHW) component of the demonstration. The three populations derive their eligibility through the Medicaid state plan.

PROGRAM DESCRIPTION AND OBJECTIVES. This The HIP section 1115(a) demonstration provides authority for the state State to offer operate two distinct health care coverage benefit packages to specified populations. The insurance products: the Hoosier Healthwise (HHW) Program supplements state plan benefits for current Medicaid eligible children persons, and those otherwise eligible adults who are not aged, blind or disabled. The the HIP provides health care coverage for uninsured adults not otherwise currently eligible for Medicaid through a high deductible managed care health plan and an account styled like a health savings account called a Medicaid. HIP offers the following coverage: 1) A basic commercial benefits package once annual medical costs exceed $1,100; 2) A Personal Wellness and Responsibility (POWER) AccountAccount valued at $1,100 per adult to pay for initial medical costs. Separate from this demonstrationThe POWER Accounts provide incentives for participants to utilize services in a cost-efficient manner. HIP members make monthly contributions to their POWER Accounts depending on their income level; and 3) $500 in ―ifrst dollar‖ preventive benefits at no cost to HIP members. Indiana currently requires managed care enrollment for most Medicaid eligibles. Section 1931 children and adults are served under the Hoosier Healthwise program, Indiana offers while the Indiana Select Program which includes case management services to supplement state plan benefits offered through aged, blind, and disabled are served under the Medicaid Select managed care programs for current Medicaid eligible adults who are aged, blind or disabledProgram. Indiana began the Hoosier Healthwise program in 1994, when it initially mandated managed care enrollment for all section 1931 children and adults through a waiver granted by the Secretary under the authority of section 1915(b) of the Social Security Act (the Act). By July 1997, the program was implemented statewide using a combination of managed care organizations (MCOs) and a Primary Care Case Management (PCCM) delivery system. Effective December 2005, all Hoosier Healthwise enrollees are served exclusively by MCOs. Effective January 1, 2008, the authority for the Hoosier Healthwise program was is provided solely through this demonstration. The Medicaid Select program began in 2002, when Indiana began enrolling the aged, blind and disabled into managed care through a PCCM delivery system. Authority for this program continues to be provided under the authority of section 1915(b) of the Act. On October 1, 2007, an enhanced PCCM system called Indiana Care Select was phased in to provide care management services to the aged, blind, and disabled enrolled in Medicaid Select. All aspects of care delivery and financing of Medicaid Select and Indiana Care Select are separate and apart from this demonstration. The HIP provides a high-deductible health plan and an account styled like a health savings account called a POWER Account to uninsured adults including low-income custodial parents and caretaker relatives of Medicaid and Children’s Health Insurance program (CHIP) children and uninsured non-custodial parents and childless adults. Participation in HIP is voluntary, but all enrollees will be required to receive medical care through the high deductible health plans and POWER Accounts. Enrollees must also make specified contributions to their POWER Accounts as a condition of continued enrollment. These accounts will be used by enrollees to pay for the cost of health care services until the deductible is reached; however, preventive services up to a maximum amount will be exempt from this requirement. Once the deductible has been met, the health plan will provide coverage for medical services up to an annual maximum amount. Eligible individuals who have certain high-risk conditions will be enrolled in the Enhanced Services Plan (ESP), a separate care delivery mechanism managed by the Indiana Comprehensive Health Insurance Association (ICHIA), the stateState’s high-risk pool. HIP offers the following coverage: 1) A basic commercial benefits package once annual medical costs exceed $1,100; 2) A Personal Wellness and Responsibility (POWER) Account valued at $1,100 per adult to pay for initial medical costs. The POWER Accounts provide incentives for participants to utilize services in a cost-efficient manner. HIP members make monthly contributions to their POWER Accounts depending on their income level; and 3) $500 in “first dollar” preventive benefits at no cost to HIP members. Under this demonstrationDemonstration, Indiana expects to achieve the following to promote the objectives of title XIX:  Access: Ensure availability of necessary health services for Medicaid enrollees while offering health coverage to thousands of uninsured individuals;  Prevention: Encourage individuals to stay healthy and seek preventive care;  Personal Responsibility: Give individuals control of their health care decisions and incentivize positive health behaviors;  Cost Transparency: Make individuals aware of the cost of health care services; and  Quality: Encourage provision of quality medical services to all enrollees. Encourage quality, continuity, and appropriate medical care. The following populations will participate in the Hoosier Healthwise (HHW) component of the demonstrationDemonstration. The three populations derive their eligibility through the Medicaid state State plan.

PROGRAM DESCRIPTION AND OBJECTIVES. This section 1115(a) demonstration provides authority for the state to offer two distinct health care coverage benefit packages to specified populations. The Hoosier Healthwise (HHW) Program supplements state plan benefits for Medicaid eligible children and those otherwise eligible adults who are not aged, blind or disabled. The HIP provides health care coverage for uninsured adults not otherwise eligible for Medicaid through a high deductible managed care health plan and an account styled like a health savings account called a Personal Wellness and Responsibility (POWER) Account. Separate from this demonstration, Indiana offers the Indiana Select Program which includes case management services to supplement state plan benefits Demonstration Approval Period: January 1, 2014 through December 31, 2014 Page 1 of 38 offered through Medicaid Select managed care programs for current Medicaid eligible adults who are aged, blind or disabled. Indiana began the Hoosier Healthwise program in 1994, when it initially mandated managed care enrollment for all section 1931 children and adults through a waiver granted by the Secretary under the authority of section 1915(b) of the Social Security Act (the Act). By July 1997, the program was implemented statewide using a combination of managed care organizations (MCOs) and a Primary Care Case Management (PCCM) delivery system. Effective December 2005, all Hoosier Healthwise enrollees are served exclusively by MCOs. Effective January 1, 2008, the authority for the Hoosier Healthwise program was provided solely through this demonstration. The HIP provides a high-deductible health plan and an account styled like a health savings account called a POWER Account to uninsured adults including low-income custodial parents and caretaker relatives of Medicaid and Children’s Health Insurance program (CHIP) children and uninsured non-custodial parents and childless adults. Participation in HIP is voluntary, but all enrollees will be required to receive medical care through the high deductible health plans and POWER Accounts. Enrollees must also make specified contributions to their POWER Accounts as a condition of continued enrollment. These accounts will be used by enrollees to pay for the cost of health care services until the deductible is reached; however, preventive services up to a maximum amount will be exempt from this requirement. Once the deductible has been met, the health plan will provide coverage for medical services up to an annual maximum amount. Eligible individuals who have certain high-risk conditions will be enrolled in the Enhanced Services Plan (ESP), a separate care delivery mechanism managed by the Indiana Comprehensive Health Insurance Association (ICHIA), the state’s high-risk pool. HIP offers the following coverage: 1) A basic commercial benefits package once annual medical costs exceed $1,100; 2) A Personal Wellness and Responsibility (POWER) Account valued at $1,100 per adult to pay for initial medical costs. The POWER Accounts provide incentives for participants to utilize services in a cost-efficient manner. HIP members make monthly contributions to their POWER Accounts depending on their income level; and 3) $500 in “first dollar” preventive benefits at no cost to HIP members. Under this demonstration, Indiana expects to achieve the following to promote the objectives of title XIX:  Access: Ensure availability of necessary health services for Medicaid enrollees while offering health coverage to thousands of uninsured individuals;  Prevention: Encourage individuals to stay healthy and seek preventive care;  Personal Responsibility: Give individuals control of their health care decisions and incentivize positive health behaviors;  Cost Transparency: Make individuals aware of the cost of health care services; and  Quality: Encourage provision of quality medical services to all enrollees. Encourage quality, continuity, and appropriate medical care. The following populations will participate in the Hoosier Healthwise (HHW) component of the demonstration. The three populations derive their eligibility through the Medicaid state plan.