New Medicaid Rules Nix Administrative Maze For Pregnant Hoosiers

Black and white photo of a pregnant stomach with hands holding an ultrasound.

Photo: A. (Flickr)

Providers say the old system created problems for women, especially those who are managing opioid addiction with medication.

New changes to Indiana’s Medicaid program may make it easier for women to keep continuous health coverage during pregnancy.

Under the old rules, if a woman had to renew her Medicaid coverage during pregnancy, she would be required to switch to a different program.

Now, instead of leaving HIP when pregnant, these members will remain covered by the program, under a track called HIP Maternity. “As previously, there will be no cost sharing and enhanced benefits for pregnant members,” said FSSA Spokesman Jim Gavin in an email.

“Previously, pregnant women would transition between HIP and Hoosier HealthWise during their pregnancy,” said Gavin, referring to the special Indiana program for pregnant women and children. “After the pregnancy [was] over, following a 60 day period, the woman would then move back to HIP.”

Providers say the old system created problems for women, especially those who are managing opioid addiction with medication. That’s because when a patient changes insurance plans, their insurer needs to approve the meds before getting it filled at the pharmacy, a process called prior authorization. The approval process sometimes creates a gap in care and can even lead the women to relapse.

Dr. Tara Benjamin, an OB-GYN at Indiana University Health in Indianapolis, said her patients often run into problems postpartum, when the risk of a relapse is highest.

“Without the patient knowing all of a sudden their insurance has switched and nobody notifies them of this… They’ll go to the pharmacy one day and they’ll say you don’t have insurance or your prior authorization didn’t go through,” she said.

“You can imagine if you’re an opiate-dependent person that has been on [addiction treatment] Subutex and are nice and stable for two months, and all of a sudden there’s a requirement for another prior authorization,” said former American Society of Addiction Medicine President Dr. Louis Baxter, “That can be very problematic.”

After giving birth, women will receive coverage under HIP Maternity. Sixty days into the postpartum period she will seamlessly transition back to their original HIP plan.

The new policy has been in effect since Feb. 1.

This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.

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