Washington, DC – The U.S. District Court for the District of Columbia vacated the Department of Health and Human Services’ 2020 approval of Indiana’s section 1115 Medicaid waiver project, known as the Healthy Indiana Plan (HIP). The HIP approval permitted Indiana to impose premiums as a condition of Medicaid coverage and eliminate retroactive eligibility and coverage of non-emergency medical transportation (NEMT). The court concluded that HHS violated the Administrative Procedure Act by failing to adequately consider whether the project would promote Medicaid’s central objective of providing health care coverage to low-income individuals. The plaintiffs were represented by the Indiana Justice Project, the National Health Law Program, and the law firm Jenner & Block.
The court described the case as a “sequel” to the three cases challenging HHS’s approval of section 1115 projects that included work requirements and other restrictions on coverage: Gresham v. Becerra (Arkansas), Stewart v. Azar (Kentucky), and Philbrick v. Becerra (New Hampshire). In each of the three cases, the U.S. District Court for the District of Columbia ruled in favor of the plaintiffs, finding that HHS’s approval was arbitrary and capricious.
“Premiums have a documented history in Indiana of causing Healthy Indiana Plan members to receive inferior coverage or no coverage at all,” notes Adam Mueller, Executive Director of the Indiana Justice Project, co-counsel, and one of NHeLP’s Health Law Partnerships. “For the past several years, Indiana has not collected premiums through the Healthy Indiana Plan—with no disruption to services and benefits to Hoosiers. This ruling affirms that HHS has to consider whether waivers like premiums actually promote health coverage.”
“The National Health Law Program is committed to protecting the rights of low-income people to access Medicaid coverage free from unnecessary and illegal burdens and barriers. Since 2011, in the case Newton-Nations v. Betlach, our Litigation & Enforcement team has taken swift legal action to block HHS waiver approvals that threaten people’s access to Medicaid coverage,” says Jane Perkins, Litigation Director at NHeLP. “As this court has held multiple times over the last several years and, yet again, with this Indiana decision, HHS must assess a waiver project’s impact on coverage to determine whether it is consistent with Medicaid’s objectives. NHeLP understands this standard all too well, as it has been voiced by courts repeatedly since we first began challenging improper section 1115 approvals nearly 15 years ago.”
“We are delighted to continue our partnership with NHeLP to ensure access to health care for low-income people,” says Erica Turret, associate at Jenner & Block LLP. “The court’s decision once again emphasizes that Medicaid’s core purpose is to provide coverage to those who cannot afford it, a mission we are committed to protecting.”
The court’s ruling does not prevent Indiana from continuing to implement its Substance Use Disorder/Serious Mental Illness program or alter the status of Medicaid expansion in the State. Indiana’s request to implement HIP is now back with HHS for further consideration.
The National Health Law Program works with state and national partners to challenge unlawful changes to the Medicaid program, including federal approvals that are contrary to the Medicaid Act. Learn more about that fight here and discover the impact of our Health Law Partnerships here.
About the co-counsel:
The National Health Law Program (NHeLP) protects and improves access to health care for low-income and underserved people and works to advance health equity. We believe that everyone should have access to high quality, equitable health care and be able to achieve their own highest attainable standard of health. We enforce health care and civil rights laws; advocate for better federal and state laws and policies; train, support and partner with national, state and local health and civil rights advocates; and use strategic communications to achieve these goals.
The Indiana Justice Project is a non-partisan, non-profit legal advocacy organization. We use all available legal tools to ensure equal justice and opportunity for all Hoosiers. We focus on health equity, economic justice, and providing legal support to communities.
At Jenner & Block, we shape what’s next through experience, vision, and judgment. In the most sensitive and consequential matters our clients face, we are known for finding a clear path forward. We are the litigators behind some of the most significant victories from the trial level to the US Supreme Court; the dealmakers behind landmark corporate transactions transforming industries and markets; the investigators and compliance monitors restoring public confidence following high-profile legal, economic, and reputational threats; and the advocates advancing clients’ interests and shaping policy. We stand out through bold action, intent, and impact.
