Gateway to Work logo
Photo courtesy of state of Indiana website

A work requirement has begun in Indiana as the state of Kentucky’s effort remains entangled in litigation.

The Gateway to Work program requires eligible members of the Healthy Indiana Plan, known as HIP, to work or do other qualifying activities, such as attending college or volunteering, for 20 hours a month from July through September.

Those hours will gradually increase until the person reaches the maximum requirement of 80 hours a month in July 2020.

Gateway to Work chart
The number of hours that have to be completed as part of Gateway to Work will increase gradually. | State of Indiana website

“As of this month, about 72,000 of the approximately 400,000 HIP members without an exemption are required to perform a certain number of qualifying activities each month,” said James Gavin, a spokesman for the Indiana Family and Social Services Administration, via email.

“Gateway to Work connects HIP members to ways to look for work, train for jobs, finish school and volunteer,” Gavin added. “So there are a number of options (not just employment).”

But there has been some pushback against the program, which recently drew protestors to Indianapolis, according to news reports.

Indiana Legal Services, the statewide civil legal aid provider, also has heard some concerns, said Adam Mueller, the organization’s director of advocacy.

“For many people enrolled in HIP, there’s a lack of understanding about how the work requirement will be implemented and how it will affect them,” Mueller said via email.

“It’s been our experience that when it comes to HIP,” he added, “often folks find out they’ve lost health coverage when they try to get a prescription refilled or visit the doctor only to be told their insurance is not active. That can be very scary.”

Gavin said Indiana has made extensive efforts to inform HIP members about Gateway to Work.

“When we surveyed HIP members back in March, 94% had heard about Gateway to Work and 83% said they knew their status,” he said.

“The current priority focus of our communications and outreach is ensuring that the members know how to report their hours through our online portal or by calling their health plan,” he said. “No paperwork is required to be submitted.”

Gavin said Indiana recruited organizations around the state to serve as partners and the new Gateway to Work website can connect members to nearby resources.

Work or “community engagement” requirements have been embraced by the Trump administration as a way to make “able-bodied” Medicaid recipients more self-sufficient and to “put beneficiaries in control with the right incentives to live healthier, independent lives,” as was stated last year by Seema Verma, the administrator of the U.S. Centers for Medicare & Medicaid Services.

But the requirements have been criticized by advocates for the poor as thinly veiled attempts to kick people off Medicaid and have been fraught with issues in some parts of the country. For example, about 18,000 people lost their Medicaid coverage after Arkansas began implementing its work requirement in June 2018.

Work requirement notice in New Hampshire
This notice about New Hampshire’s work requirement was recently posted on the website of that state’s Department of Health and Human Services.

This week, New Hampshire announced that its work requirement would be delayed after issues arose with noncompliance, and experts have estimated that hundreds of thousands of people could lose coverage if work requirements were to be implemented across nine states.

Kentucky’s proposed Medicaid overhaul, Kentucky HEALTH, includes an 80-hour-a-month work requirement but hasn’t been implemented partly because of court battles initiated by Medicaid recipients, who’ve been successful twice in the U.S. District Court. The latest ruling in their favor is being appealed by the state of Kentucky and the federal government.

CMS approved the current version of Gateway to Work in February 2018 as part of a Section 1115 Medicaid waiver, the month after the Trump administration first approved Kentucky HEALTH.

Hoosiers can receive exemptions for various reasons, including being homeless, medically frail, pregnant, a caregiver of a dependent child under age 7 or having a substance use disorder. Those age 60 and older don’t have to participate.

No one will lose coverage for noncompliance until January 2020, Gavin said.

Indiana will look back to see whether the person has met the requirement eight out of 12 months of 2019. They receive credit automatically for the first six months of this year, Gavin said.

Indiana State Rep. Ed Clere
Indiana State Rep. Ed Clere. | Courtesy of

Indiana state Rep. Ed Clere said he has confidence in Jennifer Walthall, secretary of the Indiana Family and Social Services Administration, and hopeful statements by her regarding Gateway to Work.

“She and her team have designed a work requirement that has a long list of exemptions and options for fulfilling the work requirement,” said Clere, a New Albany Republican. “… I believe Secretary Walthall when she says that she is committed to making sure no one loses coverage as a result of the work requirement.”

But he also views Gateway to Work as an administrative burden and questions whether it and other HIP requirements will lead to better health outcomes, namely healthier Hoosiers. “Conceptually, I remain a skeptic,” he said.

Mueller said people with questions or concerns about Gateway to Work can call Indiana Legal Services at (317) 829-3174.

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Darla Carter
Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.