Senators send Medicaid work requirements to governor’s desk

A signature from Gov. Mike Braun is all that remains for a Medicaid work requirements bill to become law, though such a move would require federal approval before it could go into effect.

Under Senate Bill 2, Hoosiers getting their health insurance under the Healthy Indiana Plan would need to log at least 20 work or volunteer hours a week with the overseeing state agency, a move that supporters hope will curb the program’s enrollment numbers. 

“I’d like to remind everybody who Medicaid is for: it is for our poor and our disabled. So every dollar … that is being redirected to somebody who should not be eligible, is taking a dollar away from somebody — some Hoosier — who is poor and or disabled,” said Sen. Chris Garten, R-Charlestown. 

Every other member of the voting Republican caucus agreed: moving the bill forward on a 37-10 vote.

The program, otherwise known as HIP, covers working-age Hoosiers with low-to-moderate incomes and has been in place — in some form or another — since former Gov. Mitch Daniels’ administration. 

But Democrats decried the move, countering the belief that it would decrease costs. Senate Minority Leader Shelli Yoder, D-Bloomington, pointed to a provision that quadruples eligibility checks from an annual process to a quarterly effort.

“My concern is Senate Bill 2 will eventually continue to drive up the costs of administering Indiana’s Medicaid program. So while we’re trying to save money, the way the language sits now … will drive up costs, administrative costs, bureaucracy,” said Yoder. “… Making Indiana’s Medicaid program more complicated will only increase the likelihood of eligible Medicaid members losing their coverage.” 

She also worried that the proposal would have a ripple effect on greater health care access across the state, such as the closure of clinics and longer emergency department waits.

Breaking down budgets: Why Medicaid expenses are growing

Sen. Mike Bohacek, R-Michiana Shores, said his daughter accessed disability services under a Medicaid waiver. 

“You’ll find that those of us that rely on Medicaid are also the most defensive of Medicaid and making sure that those folks that are on the program are eligible … and are being served appropriately,” said Bohacek. “… the path that we’re going on now, it will make the entire program untenable. And this program is way too important for those that quality.”

The Urban Institute and Robert Wood Johnson Foundation estimate that imposing Medicaid work requirements could cull between 102,000-116,000 Hoosiers from the expansion population rolls, far short of the more than 250,000 who would have to be cut in order to meet the 500,000 cap suggested in an earlier version of the bill. 

Though the bill no longer includes an explicit numerical cap, the language allows the Family and Social Services Administration to limit enrollment based on funding, which Sen. Fady Qaddoura called an “appropriation cap.”

“I see this as a policy goal of capping Medicaid enrollment based on appropriations,” said the Indianapolis Democrat. “… there are other solutions. The solution is not to reduce eligibility. The solution is not to reduce appropriations.”

Details

Republicans point to the bill as a way to save much-needed money going into the next two-year budget cycle — though the Healthy Indiana Plan isn’t funded by state dollars. Instead, the federal government pays for 90% of the insurance program while provider and cigarette taxes cover the remainder. 

Several patient and anti-poverty advocates rallied earlier this month to oppose the restrictions proposed under Senate Bill 2, including the Indiana chapter of the American Cancer Society Cancer Action Network. 

Lucy Dagneau, a senior director overseeing the organization’s national Medicaid campaigns, told the Indiana Capital Chronicle that work requirements, specifically, can have a detrimental impact on those with cancer. Such constraints can “impose additional barriers to care and paperwork between cancer patients and their doctors,” Dagneau said.

“I think in a state like Indiana, it seems so unfortunate that the state would take steps backward when the Healthy Indiana Plan has been so successful and such a lifeline for people with cancer and a support in the lives of people who could be diagnosed with cancer,” said Dagneau. 

According to ACS CAN, Medicaid covers the care of an estimated one in ten adults with a history of cancer and one in three children diagnosed with cancer.

“ACS has done a number of studies that show that Medicaid expansion specifically improves cancer survival rates. It reduces cancer mortality (and) it increases the likelihood that cancer patients receive timely treatment and an earlier stage diagnosis,” Dagneau said. “Pretty much across the cancer care continuum, Medicaid expansion makes dealing with cancer, preventing cancer and treating cancer better.”

Though listed exemptions to the bill’s work requirements would likely include someone diagnosed with cancer, “qualifying for and maintaining an exemption can be confusing and onerous,” according to ACS CAN. 

The biggest driver of Medicaid costs is Indiana’s aging population, many of whom rely on it to pay for nursing homes, assisted living facilities, home health aides and other long-term care costs. 

Senate Bill 2 also includes language that would assess the so-called “lookback period,” where regulators assess an individual’s financial assets before determining their Medicaid eligibility. 

“That’s actually how wealthy people get on Medicaid … you can sign all your assets over to a family member and then you have to wait five years and then you go on Medicaid,” said Sen. Ryan Mishler, R-Mishawaka. “We’re just not sure that they’re really waiting five years and we just wanted to … report on what they’re doing to claw back from those violators.”

However, like with the Medicaid work requirements and increased administrative workload, such a provision would need federal approval.