On Friday, Feb. 2, the Department of Health and Human Services (HHS) approved the Healthy Indiana Plan requiring some 130,000 state residents on Medicaid who aren’t already in compliance to work, enroll in school, undergo job training or volunteer for at least 20 hours a week over eight months each year.


HHS Secretary Alex Azar

The plan follows closely on the heels of a similar program instituted by Kentucky three weeks ago, shortly after HHS issued guidance on requiring work for Medicaid for the able-bodied.

Exemptions abound, however, including people who are pregnant, some caregivers, the frail, students, people at least 60 years old and those being treated for substance abuse problems.

“Today’s announcement is one significant step in a long legacy of innovation in person-centered health care,” said new HHS Secretary Alex Azar, speaking at an Indiana hospital event on the occasion of the implementation. “Indiana’s vision and ours goes beyond the provision of quality health care. It recognizes that Medicaid can become a pathway out of poverty.”

Indiana Gov. Eric Holcomb, a Republican, called his state’s plan “the gold standard for the nation.”

Democrats and Affordable Care Act (ACA) proponents were quick to denounce the work requirement, with Sen. Ron Wyden (D.-Ore.) saying, “Policies that lock people out of the health-care system for months at a time or place onerous barriers in the way of coverage do not make Medicaid better at providing health care.”

Indiana  also offers a “HIP Plus” Medicaid account for those who voluntarily contribute to a form of a health savings account going by the acronym of POWER (Personal Wellness and Responsibility Account). HIP Plus offers enhanced benefits, including dental, vision and chiropractic coverage.

The plan, set to commence next year, will also impose higher fees on smokers.

Three years ago, Indiana submitted a similar plan to the Obama HHS, but it was rejected.