This blog is part of our Working Better Together series and was authored by Adam Mueller, Executive Director at the Indiana Justice Project. This blog series is intended to provide our Health Law Partners with a platform to highlight successes, challenges, and innovative approaches to furthering health access and health equity in the states where they work.
Partnering to Stop Harmful and Illegal Medicaid Work Requirements: 2017-2021
Advocates in Indiana began collaborating with the National Health Law Program (NHeLP) in 2017 when work requirements were proposed for our Medicaid program. At that time, NHeLP formed the Health Law Partnership with Indiana Legal Services. This Health Law Partnership helped us prepare and deliver vital advocacy in several ways. First, NHeLP lent national expertise to our state-based issues. NHeLPers brought strong policy knowledge, a network of skilled litigators, and working relationships with states in a similar position to Indiana. Through monthly meetings, we discussed the intended work requirement rollout, worked on state and federal public comments, and implemented a vast outreach plan to connect to affected Medicaid beneficiaries. As Indiana began to implement the work requirements, we spoke to dozens of concerned individuals. Several of them wanted to take legal action to prevent harm caused by the work requirements and several other aspects of our 1115 waiver project.
In 2019, advocates at Indiana Legal Services, NHeLP, and pro bono attorneys filed the case Rose v. Azar. As a result of the lawsuit, Indiana voluntarily paused the work requirements just a month after filing and without a court order. In the ensuing years, the lawsuit was paused due to the COVID pandemic, and eventually, the work requirements were permanently withdrawn by the federal government. This advocacy would not have been possible without the resources provided through the Health Law Partnership.
Launching Indiana Justice Project and Preparing for Future Advocacy: 2021- Present
In 2021, NHeLP helped launch the Indiana Justice Project (IJP) as the new state-based partner in the Health Law Partnership. Thanks to resources through the partnership, IJP has pushed into the broader advocacy space in health justice in various ways.
First, IJP has played a leading role in advocacy regarding the unwinding of the Covid-19 Public Health Emergency (PHE), which will have profound impacts on Medicaid beneficiaries. This includes helping to convene a loose “All Hands on Deck” coalition of health advocates to prepare for outreach and advocacy once the PHE unwinding begins. In January 2022, IJP organized several partner agencies to publish an op-ed admonishing the state for planning a rushed unwinding process. Thanks partly to IJP’s efforts with other partners, Indiana’s unwinding plan is one of the most transparent nationally. Additionally, through the network of Health Law Partnerships in other states, IJP is contributing to and learning from a growing knowledge base, including advocacy with organizations in similarly situated states.
Thanks to the HLP, IJP continues to play a vital role in advocacy around Indiana’s 1115 demonstration waiver. This includes talking to Medicaid members about concerns regarding administrative hurdles post-PHE unwinding. We have also submitted comments in several state-based forums and provided education to policy and legislative decision-makers on the issue. This issue focuses on the several harms caused by waiver policy—including racial inequity.
Engaging in National Health Advocacy
The Indiana Justice Project also joined NHeLP and all of the Health Law Partnerships, as well as other legal-focused advocacy organizations, to file an amicus curiae brief with the United States Supreme Court in the case Health & Hospital Corporation of Marion County, Indiana v. Talevski.
Additionally, through the partnership, IJP is starting to explore opportunities for health advocacy for non-citizens. This includes providing analysis and education of the federal “Lift the Bar” Act as well as helping to educate non-citizen Hoosiers on the new USCIS Public Charge rule. Using NHeLP templates, webinars, and supporting materials, IJP crafted comments in response to the HHS rule on 1557 nondiscrimination enforcement. These comments reflect ongoing concerns about health disparities for non-citizens in Indiana and how stronger nondiscrimination protections will play a role in reversing inequalities.
NHeLP’s Health Law Partnership works because it is set up to do two things: couple national expertise with local flexibility. On a broad range of issues, from coverage to discrimination to medical debt, NHeLP equips state advocates with the support needed to lead advocacy efforts. Through the course of our HLP, we’ve consulted with likely a dozen NHeLP staff. At the same time, NHeLP trusts its state-based partners to identify partners, issues, and strategies.
Working Better Together Blog Series
The Working Better Together blog series gives our Health Law Partners a platform to highlight successes, challenges, and innovative approaches to furthering health access and health equity in the states where they work. Find other blogs in the series here.
