Ind. lawmakers OK bill to protect state's alternative Medicaid program

INDIANAPOLIS — State lawmakers approved Thursday a bill preventing Indiana’s alternative Medicaid program from being changed without the legislature’s approval.

The bill also says the state’s share of the costs must be restricted, a provision the bill’s author said could potentially limit enrollment, which is in direct opposition to federal Medicaid eligibility rules.

Supporters say the bill, which Gov. Mike Pence is expected to sign into law, will strengthen Indiana’s hand in negotiating with the federal government once the state’s temporary permission for the Healthy Indiana Plan (HIP 2.0) expires in 2018. Negotiations start next year, after studies have been completed on how well its unique features are working.

“What if Mr. (Bernie) Sanders is president? Holy cow!” Rep. Tim Brown, R-Crawfordsville, said during the House floor debate. “Give us the ability to say we negotiate with strength.”

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Opponents said it’s too soon to tell if unique aspects of the 1-year-old program are working and questioned whether the real objective is to prevent a future Democratic governor from making changes.

“It wouldn’t have anything to do with trying to tie the hands of the next governor?” Rep. Charlie Brown, D-Gary, asked shortly before the GOP-controlled House approved the bill by a 65-35 vote.

The Republican-controlled Senate voted 34-16 to send the bill to Pence’s desk.

Pence, who is up for re-election this year, pushed to enshrine the program in state law.

"We will have a new administration in D.C.," Pence said earlier this year. "We want to make sure going forward that the state of Indiana has a solid legal framework."

Joan Alker, executive director of the Georgetown University Center for Children and Families, said instead of additional barriers to coverage, what will persuade the federal government to continue Indiana’s program is evidence that it’s working.

“They’re interested in data-driven results, rather than political statements,” she said of the U.S. Department of Health and Human Services.

A spokesman for the department declined to comment.

Pence negotiated permission from the federal government to receive full federal funding under the Affordable Care Act to expand Medicaid eligibility in Indiana using HIP 2.0. It provides insurance to more than 300,000 Hoosiers earning up to 138% of the federal poverty level.

Other states are looking at implementing a similar program, including requiring monthly contributions of participants.

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The three-year approval the federal government granted last year is supposed to test the program’s effectiveness, such as whether requiring participants to make monthly contributions to a health account that can be rolled over if not used for health care reduces the use of unnecessary care.

New Albany Rep. Ed Clere, one of the few Republicans who opposed the bill, said it’s too early to tell whether all aspects of HIP 2.0 are working well.

“It’s problematic to pronounce after one year that we have all the answers and we’re ready to put it into law and say it can’t be changed,” Clere said.

Sen. Pat Miller, the bill’s author, said the parts of HIP 2.0 she considers essential — including the monthly contributions, penalties for non-payment, and restrictions on when coverage begins — need to be codified to show the federal government how serious Indiana is about keeping them.

An earlier version of the Healthy Indiana Plan, created before the Affordable Care Act expanded Medicaid eligibility, included a participation cap to keep a lid on costs. That's not part of the state’s current waiver. But Miller said the bill's cost-limiting requirement won’t become an issue until after negotiations begin for the waiver renewal because the federal government now covers all costs. After this year, the federal share declines gradually to 90% by 2020.

The Indianapolis Republican said she’s proud she was in on the creation of HIP and that this is her final legislation before retiring from the Senate this year. She added that she’s not saying she would end the program if the state can’t get everything it wants.

“All I’m saying is we need to have the strongest possible position for negotiating,” she said. “We’re keeping the authority within the General Assembly.”

Follow Maureen Groppe on Twitter: @mgroppe