Latest news with #MitchRoob
Yahoo
30-05-2025
- Business
- Yahoo
FSSA secretary: Braun administration ‘inherited a mess'
FSSA Secretary Mitch Roob addresses a crowd at the Indiana Fiscal Policy Institute's 2025 Policy Summit on May 30, 2025 to discuss the agency and Medicaid policy. (Whitney Downard/Indiana Capital Chronicle) When it comes to the Family and Social Services Administration — which oversees Medicaid alongside other state programs like child care subsidies — Gov. Mike Braun 'inherited a mess,' FSSA Secretary Mitch Roob said Friday. Roob is taking his second turn leading the agency, which has the single largest budget due to its federal funding. Previously, he led FSSA under former Gov. Mitch Daniels. Donning his now-standard 'Make Medicaid Boring Again' hat, Roob said the state had 'no other choice' than to make the program more sustainable and fiscally sound. He spoke at the Indiana Fiscal Policy Institute's 2025 Policy Summit in Indianapolis. 'Very few people wear — other than (President) Donald Trump — wear their job description on their hat, but I do,' said Roob. 'That is our task for the next four years.' House GOP overwhelmingly votes to impose Medicaid work requirements Under Daniels, Roob launched the earliest version of the Healthy Indiana Plan, which covers moderate-to-low-income Hoosiers but has grown since its first iteration. HIP 3.0, on the other hand, would return to its roots and 'inject personal responsibility for able-bodied adults again,' Roob said, putting it into alignment with federal discussions on work requirements for the Medicaid program. Also in his first term, Roob said the agency conducted monthly finance reporting and other fiscal checks to tamp down on spending. He said departing from that norm in subsequent administrations is when the program went awry, pointing specifically to cost growth for applied behavior analysis therapy and attendant care. The former is a treatment sought by some parents with autistic children while the latter is a program that previously allowed parents to be paid as caregivers for their children with complex medical needs. '… that lack of accountability, that lack of paying attention to the dollars is why we had ABA therapy growing at a pace that we did. It's why we had attendant care growing at the pace that it did,' said Roob. 'It's very difficult to put that genie back in the bottle here because, in both of those cases, we had created, inadvertently, a dependency.' He never specifically named former Gov. Eric Holcomb in his criticism. In 2019, Indiana's Medicaid program spent $120 million on ABA therapy, but the program ballooned to $639 million by 2023. In response, Braun established a panel to consider cost controls earlier this month. 'If you think this is sustainable, you're budgeting at the federal level,' quipped Roob. 'Because this will bankrupt Indiana.' Similarly, attendant care costs for parents of disabled children grew rapidly during that time span. Roob said the agency spent $11 million monthly in July 2020 but the number soared to $84 million each month by May 2024, when the agency diverted parents to a structured family caregiving program that paid at a lower rate. Combined, Roob said those numbers contributed to a December 2023 state forecast determining Indiana was $1 billion short in its Medicaid budget. Providers, seniors continue to experience challenges under PathWays program 'Many folks look at the Medicaid program and they go, 'How did you get in debt a billion dollars?' Well, it's because you have so many more people receiving care and help. Because we are paying so much more for very discrete parts of the agency,' Roob said. Another program that transitioned care for elderly Hoosiers from state oversight to a contract with insurers — known as managed care entities — would 'never' be something he would pursue, said Roob. 'I have been quite clear this program … I never would implement (it),' said Roob. 'Because it's very difficult for managed care companies to manage the care of individuals who are in nursing homes. What is the value?' Early pitches said the PathWays to Aging program would deliver savings because the state would pay a flat fee for Hoosiers and private companies would manage their care, rather than Indiana paying piecemeal for every cost. However, the transition to get there 'is very difficult,' Roob said. 'We have not, today, seen the results that we are hoping for,' said Roob, adding that the state will pay $300 million extra to the companies in cost overruns this year. '… it's been painful for everybody involved so far and that pain shows signs of easing — but only signs.' Roob didn't limit his criticisms of previous administrations solely to health care programs, also saying there was 'a lack of planning' when it came to the state's child care options. Roughly 75,000 children currently receive some form of child care through the agency, an increase initially funded by federal pandemic dollars, Roob said. 'Their plan was in April of this year simply to take children off of the child care program with no particular warning,' asserted Roob. 'Gov. Braun and the legislature felt that was probably not the best answer, so they have allowed us to create a slope to slowly dr0p people from the child care program. 'That doesn't minimize the fact that we're losing over 20,000 daycare slots for the children of men and women who make below 127% of the poverty level,' continued Roob. CONTACT US Additionally, the 'lack of planning and forethought by our predecessors' meant that there would be even fewer options for parents seeking child care for infants or one year olds. Part of the problem with Indiana's Medicaid spending can be attributed to the state's high health care costs, an explicit priority for Braun. Since his tenure under Daniels, Roob said the disparity between what Hoosiers pay and what they receive has worsened. 'When Gov. Daniels was in office, I used to tell people that Indiana residents were buying a Cadillac and getting a Chevrolet,' Roob said. 'Unfortunately, today, we're no longer driving Chevrolet. We are driving a used Kia.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
17-02-2025
- Health
- Yahoo
Indiana instituted waitlists to curb soaring Medicaid budget. Will they ever go away?
As Indiana lawmakers debate how to tackle the ever-rising cost of Medicaid, more than 10,000 Hoosiers in need of institutional-level care remain on waitlists for certain waiver services. There's little sign Indiana lawmakers will legislate this problem away in the short term. The legislation directly targeting the waitlists won't make it out of committee before Monday's deadline, and the House's state budget proposal does not include a fix. "That's hard to say," Rep. Jeff Thompson, R-Lizton and chair of the Committee on Ways and Means, said Friday about the odds of negotiating any relief. "A lot of discussion between now and April." These waitlists restricting access to home and community-based care, like assisted living facilities, were enacted last year as a cost-cutting measure after the Medicaid office discovered it had underbudgeted by about $1 billion. More: Hoosier seniors on Medicaid waiver waitlist file class-action lawsuit against Indiana The main argument against the waitlists, besides the delayed care to people on them, is that they are self-defeating in terms of saving money: Those who can't get into assisted living when they need more advanced care might go to a nursing home instead, which is more costly. The new FSSA Secretary Mitch Roob ― reprising a role he held during the Gov. Mitch Daniels administration ― said he subscribes to that argument. 'I think the previous administration, candidly, in a panic, decided to do this because they needed what was a quick fix," he told the House ways and means committee in January. "And it is a quick fix, but it's probably not the best longterm fix.' Republican Rep. Brad Barrett had introduced a bill to prohibit waitlists for assisted living facilities and require FSSA to petition the government for more waiver slots. House Bill 1592 had a hearing, but hasn't passed committee and isn't on the schedule before Monday's deadline. So rather than legislate away the waitlists, the prevailing strategy is to go through an exercise of finding inefficiencies in Medicaid and scrutinizing eligibility ― through another piece of legislation, Senate Bill 2 ― in the hope that the cost savings will negate the need for them. "I hear everybody talk about waitlists," Sen. Ryan Mishler, R-Mishawaka, told the Senate appropriations committee Thursday. "Well, until we rightsize it and figure out who should be on it, we're going to have waitlists." Senate Bill 2 also proposes that the state negotiate with the federal government to cap enrollment in the Healthy Indiana Plan ― a Medicaid program for adults who don't qualify for traditional Medicaid ― which could very well create yet another waitlist, Democrats argue. "Waitlists are not solutions; they are state-sanctioned neglect," Indianapolis Sen. La Keisha Jackson said. "And now with SB 2, Indiana is poised to push even more families into this black hole of unmet needs." The waitlists also affect children with medically complex conditions who need institutional care. Some of them used to be able to get cared for by their parents for an hourly wage, before one of FSSA's cost-cutting measures shifted that system to a daily stipend program and limited who could provide the care. The House unanimously passed a bill last week encouraging FSSA to seek permission from the federal government to go back to allowing parents to provide that care, and to add a higher-pay tier of reimbursement for people requiring extraordinary levels of care. House Bill 1689 says the FSSA shall report to an advisory council about its efforts to do so. There are some actions FSSA is taking to minimize the waitlists' impact in the meantime, Roob said. Less than half the people invited off the waitlist are actually getting onto the Medicaid waiver, he said, either because they don't respond to FSSA's letters or because they're not actually eligible. After that notification, a person had 360 days to decide whether to get covered. In the meantime, others still wait on the waitlist. So the agency has already decided to shrink that period to 180 days. It also plans to increase the amount of financial and health information it collects before people get on the waitlist. "There are people on that waitlist who will not be invited off until April, May, June, who honestly won't make it," he said. "We should be adjudicating this more quickly. We should have a higher threshold for getting on the waitlist." Contact IndyStar state government and politics reporter Kayla Dwyer atkdwyer@ or follow her on X, formerly Twitter, @kayla_dwyer17. This article originally appeared on Indianapolis Star: Indiana's waitlists for Medicaid waivers may be around for a while
