Jonathan Ingram is with the Foundation for Government Accountability, a conservative think tank. He said the federal government may be able to help work around previous federal rulings against work requirements. (Abigail Ruhman/IPB News)
Senate Republicans want to overhaul the Healthy Indiana Plan, or HIP, citing concerns about the Medicaid forecast. Lawmakers might need support from the federal government to implement part of the bill — but even with that support, it would likely have no impact on the forecast.
Senate Bill 2 includes a cap on enrollment, a lifetime limit on eligibility and Indiana's previously halted work requirements.
Jonathan Ingram is with the Foundation for Government Accountability, a conservative think tank. He said the federal government may be able to help work around previous federal rulings against work requirements.
“There's no doubt in my mind that Indiana is going to have great partners in the White House, and CMS and beyond,” Ingram said.
Mitch Roob, the new secretary of the Family and Social Services Administration, also spoke in favor of the legislation. He said he hopes federal lawmakers are able to offer support.
“As of this morning, that work requirement is inside of the Freedom Caucus agenda for a process called reconciliation,” Roob said. “We're hopeful that that work passes and clearly gives the secretary of [the U.S. Department of Health and Human Services] the authority to do a work requirement.”
Tracey Hutchings-Goetz is with Hoosier Action. She said even if the federal government allows work requirements, they create harm and they still don’t address fiscal concerns.
“FSSA has made plain on many occasions that the Healthy Indiana Plan did not contribute at all to the Medicaid budget shortfall,” Hutchings-Goetz said.
Hutchings-Goetz said the increased administrative burden might increase the costs of the program in the long run.
“Just because we have more people on the program actually doesn't mean that it is costing the public more money,” Hutchings-Goetz said. “Especially given how much of it, 90 percent, comes from the federal government and it really doesn't come from Indiana's General Fund.”
The legislation would also cap the program at 500,000 people, with everyone else moved to a waitlist. Additionally, Senate Bill 2 would introduce a lifetime limit of 36 months on the program.
Hutchings-Goetz said there isn’t a lot of clarity around how those policies would go into effect.
“One of the most concerning things about this legislation is it is not clear when that clock would start for members, so if this bill would immediately clear everyone from the rolls who has been on HIP for the last three years,” Hutchings-Goetz said. “It is also not clear how people would be selected to be removed from the rolls to meet that 500,000 person new enrollment cap.”
Another significant change within this legislation would affect presumptive Medicaid eligibility.
The goal of presumptive eligibility is to make sure people who appear to be Medicaid-eligible have immediate access to health care by providing short-term health coverage.
SB 2 would introduce stricter standards for hospitals — creating a three-strikes policy for qualified hospitals. Under the bill, any person who was given presumptive eligibility but did not receive Medicaid when they applied would count as a “violation” for the hospital. Any hospital that receives three “violations” within 12 months, would no longer be qualified to determine presumptive eligibility.
Tim Kennedy serves as general counsel for the Indiana Hospital Association. He said the organization is not against a standard, but this standard is incredibly strict and difficult to meet.
“A strict three strikes you're out requirement is not feasible,” Kennedy said. “It could easily result in many hospitals no longer being able to do your presumptive requirements.”
Kennedy suggested lawmakers consider setting a percentage based standard instead.
“You get a certain number of applications you've submitted, if you exceed a particular threshold, maybe that's when you get a strike or maybe that's when there's some penalty or some training requirement,” Kennedy said.
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An earlier section of the bill prohibits the use of self-reporting for determining eligibility. Kennedy asked whether that applied to presumptive eligibility as well.
“The notion of self-attestation, barring it completely, if that's the intent here. I've been told by our folks, would effectively nullify most presumptive eligibility programs,” Kennedy said.
Committee members questioned how hospitals made the determination for presumptive eligibility. Kennedy said patients often come in with nothing that could be used for income verification, so hospital staff have to use their best judgement.
Committee members pushed Kennedy on how he can “lobby” for hospitals committing “unintentional Medicaid fraud.” Kennedy said that wasn’t a fair assessment of how presumptive eligibility works.
“Oftentimes, hospital staff can follow the rules by the book,” Kennedy said. “It just so happens at the end of the day when a full evaluation takes place through no fault of the hospital person ends up not being eligible.”
Sen. Liz Brown (R-Fort Wayne) said this was requiring local businesses to meet standards that the state wasn’t meeting.
“I'm going to take a little bit different approach instead of coming out of the gate about fraud,” Brown said. “I'm looking at it as we're asking you to do the state's job.”
Brown said the hospitals are also doing it while treating patients and asked if hospitals would have access to the state’s data to make those determinations.
“Is the state going to have that information for you or are they actually going to do their job and decide for you who is eligible?” Brown said.
Kennedy also had questions about the lack of clarity around what happens when the state is no longer a “qualified” hospital.
“As we read this language, there is no opportunity for that hospital to regain qualified status to make presumptive eligibility determinations after this third strike,” Kennedy said.
Senate Appropriations Chair Sen. Ryan Mishler (R-Mishawka) — who authored the bill — said he will hold it to make adjustments before presenting the final version to the committee for a vote.
Abigail is our health reporter. Contact them at aruhman@wboi.org.
