Indiana Medicaid bill amended to remove 500,000 cap, but health officials say bill still harmful for recipients

Chicago Tribune

18-03-2025

Susan Brackney, of Columbus, said she's an author and freelancer who is on the Healthy Indiana Plan, the state's Medicaid program. She said she receives care for rheumatoid arthritis, which is a chronic autoimmune disease, and other ailments.
As a self-employed writer, Brackney said her income fluctuates greatly, which has resulted in a lot of conversations with Family and Social Services Administration employees and paperwork to prove her income to remain on the program.
'When I hear about SB 2 and similar bills, it almost feels like some folks don't care whether I live or die. I want you to know that I'm a productive, tax-paying member of society,' Brackney said.
Brackney said she works, volunteers, and takes care of her elderly parents.
'I work really hard. It's because of the Healthy Indiana Plan that I am well enough and stable enough to do the stuff that I do,' Brackney said. 'I just want you to know that I'm not a deadbeat. If it weren't for the Healthy Indiana Plan, I wouldn't be here. It has been lifesaving.'
Senate Bill 2, a major Medicaid bill, was amended Tuesday to remove the 500,000 recipient program cap and will advance to the House Ways and Means Committee to determine its fiscal impact.
The House Public Health Committee voted 8-4, with Republicans in favor and Democrats opposed, on the amended bill. The bill maintains the work requirements, with 11 exemptions.
An amendment to add full-time students in master's and doctoral programs in the work requirement exemptions and to allow for some advertisement of the Medicaid program, like by a nonprofit organization or advocacy group, were briefly discussed.
House Public Health Committee Chairman State Rep. Brad Barrett, R-Richmond, said he wasn't pleased with where the two amendments 'landed,' but the two issues will remain 'under further advisement' as the bill moves forward.
State Sen. Ryan Mishler, R-Mishawaka, who authored Senate Bill 2, said Tuesday that the state has to change its Healthy Indiana Plan following a June 2024 court ruling that Indiana will no longer be able to require monthly payments for HIP. The goal of the state's plan amendment, he said, is to shift the program to a waiver 'so we have more flexibility.'
When the state first established HIP in 2006, there were 40,000 people on the program, Mishler said. Before COVID-19, there were 390,000 on HIP and currently there are more than 700,000 people on the program, Mishler said.
Overall, Medicaid has grown by $5 billion in the last 4 years, Mishler said, and the rate of growth is greater than the state's revenue increase. In the upcoming two-year budget the legislature is working on, Mishler said the majority of new revenue will cover Medicaid costs.
'That's going to take away from other programs and services. I just feel we have to get Medicaid under control. This isn't the cure. I think it's one piece of a bigger puzzle that we have to work on with Medicaid,' Mishler said.
Since the COVID-19 pandemic, Mishler said the state hasn't done a good job monitoring HIP eligibility, which means some HIP recipients could either be better served on other programs or no longer qualify.
Currently, the federal government provides 90% of funding and the state gives 10% — from the state cigarette tax and hospital assessment fees — to fund HIP, Mishler said.
The bill maintains the work requirements, with 11 exemptions including volunteering, receiving unemployment and participating in a substance abuse program. Mishler said for the 20-hour requirement, he would support a combination of what the bill lists, for example, 10 hours worked and 10 hours volunteered.
'We think we have everybody covered that has a legitimate reason to not be able to fulfill the work requirement,' Mishler said.
The bill would prohibit the advertising of Medicaid programs, Mishler said. Companies shouldn't be advertising and making money off of the program, he said.
The bill would also require the Indiana Family and Social Services Administration to submit a report to Medicaid oversight regarding improper payments and fund recovery. Additionally, FSSA will have to report to the budget committee with a five-year look back, Mishler said, which would address instances where 'high net-worth individuals' sign over their assets to their children so that Medicaid pays for a nursing home.
Rep. Maureen Bauer, D-South Bend, said she's concerned about the impacts of Senate Bill 2 because it will cause people to delay their care and then fill emergency rooms when they become very sick. The work requirements would add a lot of red tape to receiving insurance, she said.
Rep. Victoria Garcia Wilburn, D-Fishers, said recent data found that the state pays $667 per person on HIP. Garcia Wilburn also said data has found that 61% of those on HIP are employed.
'So, in essence, it's an investment on each patient at a very minimal cost,' Garcia Wilburn said.
Nearly 30 people testified on the bill, with the majority testifying against the bill even as it was amended to remove the cap.
FSSA Secretary Mitch Roob said the Braun Administration supports the bill as amended. At the federal level, Roob said the Braun Administration would like to keep the 90% federal and 10% state contribution and expand work requirements to 'help the individual to become self-sufficient.'
Jonathan Ingram, with the Foundation for Government Accountability, a conservative think tank, said the organization supports Senate Bill 2 because it will 'move these folks from welfare to work.'
Alison Case, a physician with HealthNet, said the vast majority of the patients she treats are on Medicaid. While the majority of her patients have jobs, they are 'one setback away' from major crises like hunger, poverty or destitution, she said.
Case gave an example of one of her patients, who she called Mary. Even though Mary has a job, she still struggles with high rent and grocery prices, Case said. Mary has diabetes, Chronic Obstructive Pulmonary Disease, among other conditions, and requires multiple medications, Case said.
Mary briefly lost her HIP coverage, Case said, and she stopped taking her medications because she couldn't afford them without HIP. That resulted in multiple emergency room visits, Case said, including a visit where she was treated for life-threatening hyperglycemia, which could've been prevented if she had her medication.
When she wasn't covered by HIP, Case said Mary's job was threatened because she missed work due to illness. While on HIP, Mary was healthy enough to go to work, she said.
'The people I see need this coverage badly. It quite literally keeps them alive,' Case said.
Elizabeth Ferries-Rowe, with the Good Trouble Coalition of Indiana health providers, said the organization opposes Senate Bill 2 because it will not reduce costs for the state. Without Medicaid, more people will go to emergency rooms for medical care, which will actually increase healthcare costs for the state in the long run, she said.
Wade Catt, a medical student in Indiana, said Senate Bill 2 won't prevent people from getting sick, but it will lead them to delay their medical care and go to an already overburdened emergency room when their illness becomes serious.
'Cutting Medicaid does not save money, it just moves the cost around and makes healthcare more expensive for everyone,' Catt said. 'Senate Bill 2 isn't fiscally responsible, it's just short-sighted, harmful, and unjust.'