Latest news with #GeorgetownUniversityCenterforChildrenandFamilies
Yahoo
27-05-2025
- Business
- Yahoo
How Medicaid Cuts Could Impact Early Intervention for Young Children
The first warning sign Rebecca Amidon spotted was when her 1-year-old daughter wasn't walking on her feet. 'She would only walk on her knees, and her coordination seemed really off,' Amidon recounted. Then physical therapists noticed tremors, a sign of a neurological condition that affects balance and coordination. Medicaid covered a brain MRI, which led to a proper diagnosis as well as orthotic ankle braces and weekly physical therapy appointments at the local hospital to support her development. 'Medicaid is there to catch us all when we fall,' said Amidon, who lives in Manistee, Michigan. 'It's not just for people who've always needed it; it's for people like my family as well, who never thought that we would be in a position to rely on it. Without Medicaid and these early intervention services, our family would be facing a much different reality.' Get stories like this delivered straight to your inbox. Sign up for The 74 Newsletter As plans for cutting hundreds of billions of dollars in Medicaid take shape in Congress and President Donald Trump's proposed budget, parents and child health advocates are warning about collateral damage. Namely, the healthy development of young American children. Nationwide, 31 million children rely on Medicaid, and experts such as Julie Kashen, senior fellow and director for women's economic justice at The Century Foundation, have sounded the alarm, saying, 'Reductions in coverage could worsen the health of those children and their communities.' While Congressional debate is largely focused on cutting coverage for low-income adults and limiting states' ability to raise taxes for healthcare spending, the impact could well cause children to lose services and access to health care. 'There's not a lot of fat to cut in Medicaid,' Elisabeth Wright Burak, senior fellow at the Georgetown University Center for Children and Families said on a recent webinar. 'Cuts would put states in a very difficult position of making hard decisions between spending more or rolling back existing coverage or services.' Medicaid, a state-federal partnership, supports American families in many different ways. The health coverage it provides to low-income children has been shown to improve health and boost educational attainment. Nearly three in 10 child care workers are covered by Medicaid, and it is a major funder of community health workers. Medicaid also helps fund part C of the Individuals with Disabilities Education Act (IDEA), which provides early intervention screening and services. Established by Congress in 2004, the program is designed 'to enhance the development of infants and toddlers with disabilities, to minimize their potential for developmental delay and to recognize the significant brain development that occurs during a child's first three years of life.' The program provides early intervention screening and services with resources that vary by state. Nationwide, about 540,000 children under age 3 receive Part C services, and about half of them are enrolled in Medicaid, according to a report from the Infant and Toddler Coordinators Association. Part C saves taxpayers money by minimizing long-term costs for children with disabilities, promoting school readiness and reducing the prevalence of severe disabilities in adulthood. These benefits have been extensively documented: These services are proven to support outcomes for infants and toddlers with developmental delays. As a result of early intervention services, 42% of young children served did not need special education by the time they reached kindergarten. Infants and toddlers with disabilities who receive services under Part C demonstrate improved social-emotional skills, knowledge and behaviors — with two-thirds substantially improving and about one half catching up to a level appropriate for their age. Every state has different Medicaid policies and protocols, which can limit the support that children receive. In Texas, 75% of the state's Medicaid enrollees are children, said Adriana D. Kohler, policy director of Texans Care for Children, a children's advocacy nonprofit. About 2.8% of the state's children under age 3 receive Part C services compared to 7% nationwide, the latest data show 'It's pretty complicated for the early intervention providers,' Kohler said. 'We leverage over a dozen different funding sources, and Medicaid is a critical source of funding.' Related Owing to drastic cuts in Medicaid that Texas lawmakers enacted in 2011, the number of early intervention providers dropped from 58 to 40, while enrollment in the Part C program dropped by 20% to 30% in some areas, according to Kohler. 'You had to be a more severe case or have higher needs in order to qualify,' she said. 'These programs are having to do more with less.' Texas is also one of 10 states that has not agreed to the Medicaid expansion approved in the Affordable Care Act, meaning that uninsured adults living under the poverty line cannot access Medicaid unless they are pregnant, gave birth in the past year, have a disability or live in a nursing home. Burak underscored the particular risks for children's health care in states that did not expand Medicaid and rely on taxing managed care organizations to pay for services. A proposal now before Congress would prohibit such provider taxes, meaning states like Texas would likely be forced to cut back on coverage or services for kids.
Yahoo
16-05-2025
- Health
- Yahoo
Nearly a third of pregnant rural Arkansans rely on Medicaid, study shows
(Getty Images) Pregnant Arkansas women living in rural areas will face even greater challenges obtaining obstetric care if Congress approves proposed cuts in Medicaid, according to health policy experts who discussed a new report Thursday. Arkansas as a whole has the 10th highest share of women of childbearing age covered by Medicaid in rural areas, according to a Georgetown University Center for Children and Families study presented during a webinar Thursday. The report also highlighted 20 U.S. counties where approximately half of their women of childbearing age are covered by Medicaid. One of those counties is in Arkansas, according to the study. Eastern Arkansas' Lee County has about 8,100 residents and a nearly 39% poverty rate, according to the U.S. Census. Medicaid is a significant source of health coverage for women of childbearing age, especially for those living in small towns and rural communities, the report found. The study defines these communities as non-metropolitan counties with urban areas of fewer than 50,000 residents. Bills to improve Arkansas maternal health, change ballot initiative process head to Sanders' desk 'It's absolutely critical for maternal and infant health that women have access to affordable, comprehensive healthcare before, during and after they get pregnant,' said Joan Alker, Georgetown University Center for Children and Families director and lead author of the report. Women in rural areas face greater challenges to accessing care because of a shortage of providers, hospital closures and the loss of labor and delivery units and obstetrical capacity, Alker said. Nationally, 23.3% of women of childbearing age (19 to 44 years old) in rural areas are covered by Medicaid, compared to 20.5% of women in metropolitan areas, according to the report. Louisiana and New Mexico have the highest share of Medicaid-covered women, with just over 40% each. Nearly 28% of women of childbearing age are covered by Medicaid in rural Arkansas. For many Arkansas women, especially those living in rural areas with low-income families, Medicaid may be the only health insurance source to keep them healthy throughout pregnancy, Arkansas Advocates for Children and Families Health Policy Director Camille Richoux said in an interview. 'For me, it's a great thing that we have Medicaid ensuring that women throughout the state have coverage options,' Richoux said. 'It also means that we have more at stake whenever there are threats to Medicaid…this report really makes that case of how any kind of threats or cuts around Medicaid could have the potential to be devastating to a lot of women in the state and especially in a state that has so many challenges in maternal health.' Arkansas has one of the highest maternal mortality rates in the nation and the third-highest infant mortality rate, according to the Arkansas Center for Health Improvement. Access to Medicaid could change under proposed federal legislation. A U.S. House panel approved a plan Wednesday that would reduce federal spending on Medicaid by $625 billion over the next decade. The proposal includes a provision for work requirements. Arkansas implemented a work-reporting requirement in 2018 that led to 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working. A federal judge later ruled the program was illegal. Arkansas officials submitted a request for a new work requirement earlier this year. 'The first time didn't work': Georgia and Arkansas scale back Medicaid work requirements Rural communities have a lot at stake with the congressional Medicaid debate, Alker said, because the loss of Medicaid revenue would place 'additional pressure on a very strained system.' Nearly half of all births in rural areas are covered by Medicaid, and less access to obstetrical care leads to worse outcomes to moms and their babies, she said. According to one study, 293 rural hospitals stopped providing obstetric care between 2011 and 2023. Another study found that more than 52% of rural hospitals did not provide obstetric care by 2022. Arkansas ranks sixth in terms of states with the highest percentage of maternity care deserts, according to the March of Dimes, which defines maternity care deserts as areas with no birthing facility or obstetric clinician. Nearly 51% of Arkansas is a maternity care desert, according to the organization's 2024 report. 'If we see more hospital closures and loss of labor and delivery units, all women living in rural areas are at risk of losing out on the care they need, regardless of who is their insurer, if that care is just not available,' Alker said. 'So these communities will not be able to grow and thrive without a robust system to support women and families.' Beyond reducing healthcare access for all rural community residents, not just those insured through Medicaid, Richoux noted hospital closures can hurt an entire community, especially when it's the area's largest employer. 'Not everybody can just leave…to move out of an area is an easy thing to say, a lot harder to do,' she said. 'And people shouldn't have to be forced to leave their small, rural town because their hospital is unnecessarily closed.' The full Georgetown University report is available here. SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
02-03-2025
- Health
- Yahoo
Proposed Medicaid cap, work requirements in Indiana bill a cause for concern, researchers say
The cap on enrollment and work requirements are the two most concerning parts of a Medicaid bill that the Indiana legislature is considering, said two public health researchers. At the federal level, Medicaid doesn't have work requirements or a cap on those who can enroll in the program, Leo Cuello, a research professor with the Georgetown University Center for Children and Families. 'That leads you to two ways in which this bill would propose to make some significant changes,' Cuello said. Sen. Ryan Mishler, R-Mishawaka, authored Senate Bill 2 which would place restrictions on Medicaid, like work requirements on an insurance program for Hoosiers with a medium income and between the ages of 19 to 64. The bill also creates a program cap, which threatens access for hundreds of thousands of Hoosiers. The bill includes 11 exemptions for the work requirement, including volunteering, receiving unemployment, or participating in a substance abuse program. Mishler called Senate Bill 2 the 'right size' for Medicaid, which has grown exponentially in recent years. In the last four years, Medicaid costs have grown by $5 billion, he said. Meanwhile, since COVID, Medicaid participants have nearly doubled — from 390,000 to 750,000. 'We're spending more on Medicaid alone than the percentage of our total revenue,' Mishler said. 'You're going to see that when we do the budget that Medicaid and the Department of Child Services are going to suck up most of our revenue and we're not going to have a lot left to do other programs.' Under Senate Bill 2, the Healthy Indiana Plan can't be advertised and the program is 'arbitrarily' capped at 500,000, Sen. Rodney Pol, D-Chesterton, said. 'We haven't seen the data that demonstrates why it should be 500,000 people or how that is ultimately going to reduce costs. We know that every action has a reaction and our worry is that we're going to end up paying for it,' Pol said. Medicaid is a healthcare program operated under a federal and state partnership, Cuello said. Meaning, Medicaid was created under federal law but each state chooses if it wants to participate — which all states have chosen to participate — and the two government entities share in the cost. 'As the state spends money on Medicaid health services, it qualifies for federal matching funds, fairly generous federal matching funds. The federal government is always paying half or more than half of the bill. The state retains control over how the program is administered,' Cuello said. The federal government has a list of minimum requirements for states to meet to receive the funds, Cuello said. But Medicaid looks different across the country because states get to control how the program works, he said. In Indiana, the federal government pays 65% and the state pays 35% of the bill for standard Medicaid services, Cuello said. For the Medicaid expansion group, which includes adults 19-64 years old earning up to $1,800 a month for a single person or slightly above the poverty line, the federal government pays 90% and the state pays 10% of the bill, Cuello said, which is the case for all 50 states. As of 2023, 21.8% of Indiana residents are covered through Medicaid, according to Georgetown University data. Lake County has a rate higher than the state, with 24% of county residents covered by Medicaid, and Porter County has a lower rate than the state average, with 19.2% of residents covered by Medicaid, according to the data. For Indiana's non-elderly adults, which most closely resembles those on the Medicaid expansion program, Cuello said, the state coverage rate is 17.6%, according to the data. In Lake County, 19.6% of non-elderly adults are on Medicaid, and in Porter County 16% of non-elderly adults are on Medicaid, according to the data. At the federal level, Republicans in Congress are considering massive cuts to Medicaid. If the federal government decreases its contributions to the Healthy Indiana Plan and the state doesn't step in to fund the program, about 366,000 Hoosiers would be left without health insurance, according to a study from the Urban Institute and the Robert Wood Johnson Foundation. '(Indiana's) legislation could be totally irrelevant based on what happens in the federal legislative process,' Cuello said. When it comes to work requirements, Cuello said it leads to termination and suppressed enrollment for workers. Hardworking families, who are struggling to pay bills and juggling their children's lives, will have to provide monthly documentation of their employment to have health insurance, he said. 'What this thing does is it creates red tape for working families and many of them don't get through,' Cuello said. 'We know the majority of Medicaid enrollees are in working families. The data shows that the ones who aren't working usually have a very good reason, they have a disability or they are in school. The whole thing is trying to solve a problem that doesn't exist.' Arkansas and Georgia are the only two states that have implemented work requirements, Cuello said, and the results were concerning. During President Donald Trump's first administration, roughly a dozen states, including Indiana, requested and got approved for work requirements under Medicaid, Cuello said. The HealthWell Foundation and state partners filed lawsuits against the work requirements, and they won the lawsuits, he said. Arkansas was able to implement work requirements before the lawsuits were filed, Cuello said, and stopped the practice after the state lawsuit was resolved. But, when the work requirements were in effect for about six months, roughly 18,000 people in Arkansas were kicked off Medicaid, he said. About 18 months ago, Georgia implemented a work requirement, Cuello said, which resulted in 6,503 people enrolling in Medicaid, which is a microscopic fraction of the people eligible. In contrast, North Carolina, a state comparable in size to Georgia, started its Medicaid expansion program after Georgia without a work requirement and has enrolled more than 600,000 people, Cuello said. 'The work requirement basically, if you dump this onto the Indiana program, what it's going to do is it's going to take people who are currently enrolled and terminate a whole bunch of them and it's going to really throttle new people getting on to the program. It's going to have that suppressive effect,' Cuello said. In Arkansas, the data showed further that the work requirements didn't result in more people working, Cuello said. In fact, in many cases, Medicaid helps people continue to work, Cuello said, pointing to a case where a worker, who lost Medicaid, then lost their job because they could no longer afford their lung disease medication. 'The work reporting requirements don't help anyone work. They create that red tape, including for workers, and then when people fail to report their insurance gets taken away,' Cuello said. 'The data tells the reason that people don't work. It's childcare, it's transportation, lack of jobs or job training, and sadly, in a rural state like Indiana, dealing with the fallout of opioid addiction. Work reporting requirements don't help with any of those problems.' Kosali Simon, associate vice provost for Health Sciences at Indiana University's Paul H. O'Neill School of Public and Environmental Affairs, said hospitals will be impacted if people don't have coverage under Medicaid. 'It's not that only insured people come to a hospital,' Simon said. In 2005, Tennessee disenrolled 190,000 people from its Medicaid program, Simon said, which resulted in a reduction in mammograms and an increase in personal bankruptcies and eviction filings, among other things. 'People thought, in Tennessee, maybe when you cut people's health insurance they'll want to go work and find a new job, but research papers just aren't showing that people in Tennessee went to find new jobs,' Simon said. For any program, Simon said the administrative costs of requiring people to file paperwork, like a work requirement, are very expensive, she said. 'Anytime costs are being cut it's got to be done very carefully in a way that ensures the state doesn't end up paying in some other way,' Simon said. Medicaid is an entitlement program where eligible people have the right to enroll in, Cuello said, so placing caps on it could likely lead to legal action against the state. It's also unclear how the state will decide which people to kick off the program, he said. 'The legislature should steer totally clear of any kind of numerical cap on who should enroll in the program. It's just going to cause themselves a lot of headaches,' Cuello said. Capping Medicaid 'is leaving a bunch of money on the table,' Cuello said, because the federal government helps pay for the program. If federal funding is reduced, the state would be left alone to pay for those hospital care costs when people seek treatment, Cuello said. 'It's nonsensical that the state wouldn't take that deal and would cap itself and limit the federal dollars that it can leverage to solve a problem it has,' Cuello said. 'The state has a phenomenal thing going and to upend it for politics is terrible, terrible policy.' akukulka@
Yahoo
02-03-2025
- Health
- Yahoo
Proposed Medicaid cap, work requirements in Indiana bill a cause for concern, researchers say
The cap on enrollment and work requirements are the two most concerning parts of a Medicaid bill that the Indiana legislature is considering, said two public health researchers. At the federal level, Medicaid doesn't have work requirements or a cap on those who can enroll in the program, Leo Cuello, a research professor with the Georgetown University Center for Children and Families. 'That leads you to two ways in which this bill would propose to make some significant changes,' Cuello said. Sen. Ryan Mishler, R-Mishawaka, authored Senate Bill 2 which would place restrictions on Medicaid, like work requirements on an insurance program for Hoosiers with a medium income and between the ages of 19 to 64. The bill also creates a program cap, which threatens access for hundreds of thousands of Hoosiers. The bill includes 11 exemptions for the work requirement, including volunteering, receiving unemployment, or participating in a substance abuse program. Mishler called Senate Bill 2 the 'right size' for Medicaid, which has grown exponentially in recent years. In the last four years, Medicaid costs have grown by $5 billion, he said. Meanwhile, since COVID, Medicaid participants have nearly doubled — from 390,000 to 750,000. 'We're spending more on Medicaid alone than the percentage of our total revenue,' Mishler said. 'You're going to see that when we do the budget that Medicaid and the Department of Child Services are going to suck up most of our revenue and we're not going to have a lot left to do other programs.' Under Senate Bill 2, the Healthy Indiana Plan can't be advertised and the program is 'arbitrarily' capped at 500,000, Sen. Rodney Pol, D-Chesterton, said. 'We haven't seen the data that demonstrates why it should be 500,000 people or how that is ultimately going to reduce costs. We know that every action has a reaction and our worry is that we're going to end up paying for it,' Pol said. Medicaid is a healthcare program operated under a federal and state partnership, Cuello said. Meaning, Medicaid was created under federal law but each state chooses if it wants to participate — which all states have chosen to participate — and the two government entities share in the cost. 'As the state spends money on Medicaid health services, it qualifies for federal matching funds, fairly generous federal matching funds. The federal government is always paying half or more than half of the bill. The state retains control over how the program is administered,' Cuello said. The federal government has a list of minimum requirements for states to meet to receive the funds, Cuello said. But Medicaid looks different across the country because states get to control how the program works, he said. In Indiana, the federal government pays 65% and the state pays 35% of the bill for standard Medicaid services, Cuello said. For the Medicaid expansion group, which includes adults 19-64 years old earning up to $1,800 a month for a single person or slightly above the poverty line, the federal government pays 90% and the state pays 10% of the bill, Cuello said, which is the case for all 50 states. As of 2023, 21.8% of Indiana residents are covered through Medicaid, according to Georgetown University data. Lake County has a rate higher than the state, with 24% of county residents covered by Medicaid, and Porter County has a lower rate than the state average, with 19.2% of residents covered by Medicaid, according to the data. For Indiana's non-elderly adults, which most closely resembles those on the Medicaid expansion program, Cuello said, the state coverage rate is 17.6%, according to the data. In Lake County, 19.6% of non-elderly adults are on Medicaid, and in Porter County 16% of non-elderly adults are on Medicaid, according to the data. At the federal level, Republicans in Congress are considering massive cuts to Medicaid. If the federal government decreases its contributions to the Healthy Indiana Plan and the state doesn't step in to fund the program, about 366,000 Hoosiers would be left without health insurance, according to a study from the Urban Institute and the Robert Wood Johnson Foundation. '(Indiana's) legislation could be totally irrelevant based on what happens in the federal legislative process,' Cuello said. When it comes to work requirements, Cuello said it leads to termination and suppressed enrollment for workers. Hardworking families, who are struggling to pay bills and juggling their children's lives, will have to provide monthly documentation of their employment to have health insurance, he said. 'What this thing does is it creates red tape for working families and many of them don't get through,' Cuello said. 'We know the majority of Medicaid enrollees are in working families. The data shows that the ones who aren't working usually have a very good reason, they have a disability or they are in school. The whole thing is trying to solve a problem that doesn't exist.' Arkansas and Georgia are the only two states that have implemented work requirements, Cuello said, and the results were concerning. During President Donald Trump's first administration, roughly a dozen states, including Indiana, requested and got approved for work requirements under Medicaid, Cuello said. The HealthWell Foundation and state partners filed lawsuits against the work requirements, and they won the lawsuits, he said. Arkansas was able to implement work requirements before the lawsuits were filed, Cuello said, and stopped the practice after the state lawsuit was resolved. But, when the work requirements were in effect for about six months, roughly 18,000 people in Arkansas were kicked off Medicaid, he said. About 18 months ago, Georgia implemented a work requirement, Cuello said, which resulted in 6,503 people enrolling in Medicaid, which is a microscopic fraction of the people eligible. In contrast, North Carolina, a state comparable in size to Georgia, started its Medicaid expansion program after Georgia without a work requirement and has enrolled more than 600,000 people, Cuello said. 'The work requirement basically, if you dump this onto the Indiana program, what it's going to do is it's going to take people who are currently enrolled and terminate a whole bunch of them and it's going to really throttle new people getting on to the program. It's going to have that suppressive effect,' Cuello said. In Arkansas, the data showed further that the work requirements didn't result in more people working, Cuello said. In fact, in many cases, Medicaid helps people continue to work, Cuello said, pointing to a case where a worker, who lost Medicaid, then lost their job because they could no longer afford their lung disease medication. 'The work reporting requirements don't help anyone work. They create that red tape, including for workers, and then when people fail to report their insurance gets taken away,' Cuello said. 'The data tells the reason that people don't work. It's childcare, it's transportation, lack of jobs or job training, and sadly, in a rural state like Indiana, dealing with the fallout of opioid addiction. Work reporting requirements don't help with any of those problems.' Kosali Simon, associate vice provost for Health Sciences at Indiana University's Paul H. O'Neill School of Public and Environmental Affairs, said hospitals will be impacted if people don't have coverage under Medicaid. 'It's not that only insured people come to a hospital,' Simon said. In 2005, Tennessee disenrolled 190,000 people from its Medicaid program, Simon said, which resulted in a reduction in mammograms and an increase in personal bankruptcies and eviction filings, among other things. 'People thought, in Tennessee, maybe when you cut people's health insurance they'll want to go work and find a new job, but research papers just aren't showing that people in Tennessee went to find new jobs,' Simon said. For any program, Simon said the administrative costs of requiring people to file paperwork, like a work requirement, are very expensive, she said. 'Anytime costs are being cut it's got to be done very carefully in a way that ensures the state doesn't end up paying in some other way,' Simon said. Medicaid is an entitlement program where eligible people have the right to enroll in, Cuello said, so placing caps on it could likely lead to legal action against the state. It's also unclear how the state will decide which people to kick off the program, he said. 'The legislature should steer totally clear of any kind of numerical cap on who should enroll in the program. It's just going to cause themselves a lot of headaches,' Cuello said. Capping Medicaid 'is leaving a bunch of money on the table,' Cuello said, because the federal government helps pay for the program. If federal funding is reduced, the state would be left alone to pay for those hospital care costs when people seek treatment, Cuello said. 'It's nonsensical that the state wouldn't take that deal and would cap itself and limit the federal dollars that it can leverage to solve a problem it has,' Cuello said. 'The state has a phenomenal thing going and to upend it for politics is terrible, terrible policy.' akukulka@
Chicago Tribune
02-03-2025
- Health
- Chicago Tribune
Proposed Medicaid cap, work requirements in Indiana bill a cause for concern, researchers say
The cap on enrollment and work requirements are the two most concerning parts of a Medicaid bill that the Indiana legislature is considering, said two public health researchers. At the federal level, Medicaid doesn't have work requirements or a cap on those who can enroll in the program, Leo Cuello, a research professor with the Georgetown University Center for Children and Families. 'That leads you to two ways in which this bill would propose to make some significant changes,' Cuello said. Sen. Ryan Mishler, R-Mishawaka, authored Senate Bill 2 which would place restrictions on Medicaid, like work requirements on an insurance program for Hoosiers with a medium income and between the ages of 19 to 64. The bill also creates a program cap, which threatens access for hundreds of thousands of Hoosiers. The bill includes 11 exemptions for the work requirement, including volunteering, receiving unemployment, or participating in a substance abuse program. Mishler called Senate Bill 2 the 'right size' for Medicaid, which has grown exponentially in recent years. In the last four years, Medicaid costs have grown by $5 billion, he said. Meanwhile, since COVID, Medicaid participants have nearly doubled — from 390,000 to 750,000. 'We're spending more on Medicaid alone than the percentage of our total revenue,' Mishler said. 'You're going to see that when we do the budget that Medicaid and the Department of Child Services are going to suck up most of our revenue and we're not going to have a lot left to do other programs.' Under Senate Bill 2, the Healthy Indiana Plan can't be advertised and the program is 'arbitrarily' capped at 500,000, Sen. Rodney Pol, D-Chesterton, said. 'We haven't seen the data that demonstrates why it should be 500,000 people or how that is ultimately going to reduce costs. We know that every action has a reaction and our worry is that we're going to end up paying for it,' Pol said. Medicaid is a healthcare program operated under a federal and state partnership, Cuello said. Meaning, Medicaid was created under federal law but each state chooses if it wants to participate — which all states have chosen to participate — and the two government entities share in the cost. 'As the state spends money on Medicaid health services, it qualifies for federal matching funds, fairly generous federal matching funds. The federal government is always paying half or more than half of the bill. The state retains control over how the program is administered,' Cuello said. The federal government has a list of minimum requirements for states to meet to receive the funds, Cuello said. But Medicaid looks different across the country because states get to control how the program works, he said. In Indiana, the federal government pays 65% and the state pays 35% of the bill for standard Medicaid services, Cuello said. For the Medicaid expansion group, which includes adults 19-64 years old earning up to $1,800 a month for a single person or slightly above the poverty line, the federal government pays 90% and the state pays 10% of the bill, Cuello said, which is the case for all 50 states. As of 2023, 21.8% of Indiana residents are covered through Medicaid, according to Georgetown University data. Lake County has a rate higher than the state, with 24% of county residents covered by Medicaid, and Porter County has a lower rate than the state average, with 19.2% of residents covered by Medicaid, according to the data. For Indiana's non-elderly adults, which most closely resembles those on the Medicaid expansion program, Cuello said, the state coverage rate is 17.6%, according to the data. In Lake County, 19.6% of non-elderly adults are on Medicaid, and in Porter County 16% of non-elderly adults are on Medicaid, according to the data. At the federal level, Republicans in Congress are considering massive cuts to Medicaid. If the federal government decreases its contributions to the Healthy Indiana Plan and the state doesn't step in to fund the program, about 366,000 Hoosiers would be left without health insurance, according to a study from the Urban Institute and the Robert Wood Johnson Foundation. '(Indiana's) legislation could be totally irrelevant based on what happens in the federal legislative process,' Cuello said. When it comes to work requirements, Cuello said it leads to termination and suppressed enrollment for workers. Hardworking families, who are struggling to pay bills and juggling their children's lives, will have to provide monthly documentation of their employment to have health insurance, he said. 'What this thing does is it creates red tape for working families and many of them don't get through,' Cuello said. 'We know the majority of Medicaid enrollees are in working families. The data shows that the ones who aren't working usually have a very good reason, they have a disability or they are in school. The whole thing is trying to solve a problem that doesn't exist.' Arkansas and Georgia are the only two states that have implemented work requirements, Cuello said, and the results were concerning. During President Donald Trump's first administration, roughly a dozen states, including Indiana, requested and got approved for work requirements under Medicaid, Cuello said. The HealthWell Foundation and state partners filed lawsuits against the work requirements, and they won the lawsuits, he said. Arkansas was able to implement work requirements before the lawsuits were filed, Cuello said, and stopped the practice after the state lawsuit was resolved. But, when the work requirements were in effect for about six months, roughly 18,000 people in Arkansas were kicked off Medicaid, he said. About 18 months ago, Georgia implemented a work requirement, Cuello said, which resulted in 6,503 people enrolling in Medicaid, which is a microscopic fraction of the people eligible. In contrast, North Carolina, a state comparable in size to Georgia, started its Medicaid expansion program after Georgia without a work requirement and has enrolled more than 600,000 people, Cuello said. 'The work requirement basically, if you dump this onto the Indiana program, what it's going to do is it's going to take people who are currently enrolled and terminate a whole bunch of them and it's going to really throttle new people getting on to the program. It's going to have that suppressive effect,' Cuello said. In Arkansas, the data showed further that the work requirements didn't result in more people working, Cuello said. In fact, in many cases, Medicaid helps people continue to work, Cuello said, pointing to a case where a worker, who lost Medicaid, then lost their job because they could no longer afford their lung disease medication. 'The work reporting requirements don't help anyone work. They create that red tape, including for workers, and then when people fail to report their insurance gets taken away,' Cuello said. 'The data tells the reason that people don't work. It's childcare, it's transportation, lack of jobs or job training, and sadly, in a rural state like Indiana, dealing with the fallout of opioid addiction. Work reporting requirements don't help with any of those problems.' Kosali Simon, associate vice provost for Health Sciences at Indiana University's Paul H. O'Neill School of Public and Environmental Affairs, said hospitals will be impacted if people don't have coverage under Medicaid. 'It's not that only insured people come to a hospital,' Simon said. In 2005, Tennessee disenrolled 190,000 people from its Medicaid program, Simon said, which resulted in a reduction in mammograms and an increase in personal bankruptcies and eviction filings, among other things. 'People thought, in Tennessee, maybe when you cut people's health insurance they'll want to go work and find a new job, but research papers just aren't showing that people in Tennessee went to find new jobs,' Simon said. For any program, Simon said the administrative costs of requiring people to file paperwork, like a work requirement, are very expensive, she said. 'Anytime costs are being cut it's got to be done very carefully in a way that ensures the state doesn't end up paying in some other way,' Simon said. Medicaid is an entitlement program where eligible people have the right to enroll in, Cuello said, so placing caps on it could likely lead to legal action against the state. It's also unclear how the state will decide which people to kick off the program, he said. 'The legislature should steer totally clear of any kind of numerical cap on who should enroll in the program. It's just going to cause themselves a lot of headaches,' Cuello said. Capping Medicaid 'is leaving a bunch of money on the table,' Cuello said, because the federal government helps pay for the program. If federal funding is reduced, the state would be left alone to pay for those hospital care costs when people seek treatment, Cuello said. 'It's nonsensical that the state wouldn't take that deal and would cap itself and limit the federal dollars that it can leverage to solve a problem it has,' Cuello said. 'The state has a phenomenal thing going and to upend it for politics is terrible, terrible policy.'
