Indiana delays Essential Health Benefits decision

2012-10-02T17:45:00Z 2012-10-03T00:56:06Z Indiana delays Essential Health Benefits decisionDan Carden, (317) 637-9078
October 02, 2012 5:45 pm  • 

INDIANAPOLIS | The state's insurance commissioner has told federal health officials that Indiana will not select an Essential Health Benefits plan until a new governor is elected and lingering questions about the Affordable Care Act are answered.

The U.S. Department of Health and Human Services set an Oct. 1 deadline for states to identify a private health plan whose coverages could be used as a minimum benchmark for all health insurance sold in the state starting in 2014.

But in a letter sent Monday to HHS, Indiana Insurance Commissioner Stephen Robertson said federal guidance on choosing an Essential Health Benefits plan has been minimal and conflicting. As a result, he said, Indiana cannot yet make its selection.

"Without this critical information, it is impossible to present any policy options which would enable the current administration to make an informed decision in the best interests of Hoosiers," Robertson said.

He added that Republican Gov. Mitch Daniels, whose term ends in January, solicited advice on Essential Health Benefits from the three candidates for governor but found no consensus.

"Thus, we are left with no other choice but to delay this decision until the new governor is elected," Robertson said.

Under the Affordable Care Act, sometimes called Obamacare, the benchmark insurance plan must cover 10 categories of essential health benefits: ambulance, emergency, hospitalization, maternity, mental health and substance abuse, prescription drugs, rehabilitative care, laboratory, preventative care and pediatric services.

State lawmakers learned last month that no health plan currently sold in Indiana covers all 10 items and that setting minimum coverages for each category would require picking from several health plans.

It's not clear what will happen to benefits currently mandated under Indiana law but not required to be covered by the federal health law, such autism services, physical therapy by personal trainers and some services for the disabled.

There is no apparent penalty for a state that fails to select an Essential Health Benefits plan. On Friday, Illinois chose Blue Cross Blue Shield's Blue Advantage plan for its Essential Health Benefits.

Separately, the Affordable Care Act requires states to expand Medicaid eligibility starting in 2014 to Americans earning up to 133 percent of the federal poverty level. That means an individual earning $14,856 a year or a family of four with income up to $30,657 could receive health coverage under Medicaid.

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