Health insurers in the Midwest are coping with the recession by laying off employees, holding the line on pricing and adjusting benefit design to allow employers to take advantage of additional cost-shifting. The HMO market continues to lose stature in Ohio, Kentucky & Indiana with a shift from fully insured to self-insured designs for those remaining in the more tightly managed accounts. The public sector is taking the slack with an example being the Health Indiana Plan, a Medicaid-expansion program in Indiana that is now allowing more adults to join the program by purchasing benefits on their own through the program. On the Medicare side, the number of Medicare Advantage vendors continues to contract, but the market in the Midwest is vibrant enough to attract a large number of zero-premium plan designs. Insurers launched new programs to better manage member health and costs – Anthem Blue Cross and Blue Shield in Indiana believes its Community Resource Centers can reduce unnecessary visits to hospital emergency rooms; while Kaiser Permanente in Ohio has introduced an obesity program targeting children. Finally, Ohio's Medicaid program has moved dozens of drugs used to treat mental illness into a category that requires prior authorization.