Indiana Details Medical Frailty Exemption for HIP Work Requirements
Indiana's Family and Social Services Administration outlined Tuesday how it will determine "medical frailty" exemptions ahead of new work requirements taking effect Jan. 1 for roughly 355,000 Healthy Indiana Program expansion enrollees. Using a customized Milliman Advanced Risk Adjusters (MARA) tool, the state will screen claims data through a diagnosis-based tier and an evidence-based tier; members who don't qualify through either can submit supplemental documentation for review by a three-person clinical team under a third tier. A Sept. 30 test run projected nearly 140,000 people would qualify as medically frail, with about a quarter qualifying based on disabling mental disorders alone, a category with no automated diagnosis-based pathway. The state plans to send frailty determination notices by late November or early December, and frail status will exempt enrollees from work requirements for six-month periods.