A House committee amended controversial legislation that will reintroduce previously halted work reporting requirements to Indiana's Medicaid expansion program. Among other things, the committee made changes to who is exempt from the work reporting requirements.
Senate Bill 2 would require employment as a condition of enrollment in the Healthy Indiana Plan, or HIP. Lawmakers originally included 11 exceptions, such as being physically or mentally unable to work, in a substance use recovery treatment program and pregnant.
The House Ways and Means Committee made several changes to the list, including adding a completely new exception.
Rep. Brad Barrett (R-Richmond) said full-time students enrolled in an accredited education program will now also be exempt. He said this was carried over from conversation in the House health committee.
“This is really the best option for unloading of Medicaid services,” Barrett said. “Someone that is going to school to learn a career and then be able to move towards independence.”
Lawmakers also adjusted the exceptions to include caregivers of any person with a serious medical condition or disability — not just caregivers of a dependent child.
Despite the exceptions, Medicaid advocates and members continue to raise concerns about work reporting requirements causing fewer people to be covered and a higher cost for Indiana to run the program. Medicaid experts said most people on Medicaid already work, but administrative issues can lead to people losing coverage — even if they would otherwise meet the requirement.
The committee also amended the bill's Medicaid advertising and marketing ban. SB 2 included language to codify the policy set by Gov. Mike Braun administration back in January.
Some Medicaid advocates raised concerns about the lack of clarity around what that ban includes. The original language was broad. It prohibited advertising and marketing of the Medicaid program from state agencies, people with a contract with the Family and Social Services Administration under the Medicaid program, health providers, law firms and “any other person or entity.”
In the House health committee, one advocate was worried the informational videos his organization makes could qualify. This week at a rally, an advocate with Hoosier Action shared a similar concern about the buttons Medicaid advocates and members wear. The buttons said “Ask me about Medicaid” and “Protect Medicaid.”
The committee softened the language to no longer apply to health providers, law firms and the broadest category of “any other person or entity.” This means that state agencies and people with a contract with FSSA under Medicaid are the only groups not able to advertise “except to indicate their participation in the program.”
The committee also introduced language aimed at addressing concerns associated with the presumptive eligibility section of the bill.
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 and create a three-strikes policy for qualified hospitals.
The Indiana Hospital Association said this policy is too strict and would ultimately result in no one conducting presumptive eligibility.
Barrett said to address these concerns lawmakers will include 30 days of retroactive coverage.
“The patient's coming to a point of service for care, and so they would like to see their care delivered,” Barrett said. “The hospital is providing services rendered in good faith. And so, as confounding as that process can be, that's where I look at the retroactive eligibility to be the bridge that says, ‘hey, if it takes two weeks to get that figured out, there is a look back. There's a 30-day safety net.’”
Retroactive coverage comes into play once someone is enrolled in Medicaid, this means a hospital can provide services in good faith and not get the reimbursement the way it would with presumptive eligibility. But lawmakers this session said presumptive eligibility costs Indiana money it can’t get back.
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Several lawmakers on the committee raised concerns about the FSSA’s ability to implement the increased monitoring of Medicaid member eligibility.
Medicaid members are required to go through a yearly redetermination process. SB 2 would add checks on certain eligibility criteria either monthly or quarterly.
FSSA Secretary Mitch Roob said this will be handled electronically and will not require any additional staff.
Rep. Cherrish Pryor (D-Indianapolis) said she’s concerned this will repeat what happened in 2006. Indiana implemented an automated eligibility system run through a third party. The goal was to streamline the applications and identify fraud. She said the system cost people their coverage.
"I don't have confidence,” Pryor said. “Having been here when we had the IBM debacle, and there were so many issues — where people were sending in their information. Their information got lost. People were getting kicked off, disqualified.”
Pryor said she has a lot of reservations because of that.
Indiana canceled its $1.3 billion contract with IBM just three years into its implementation. The legal battle that ensued concluded in 2019, with IBM ordered to pay the state tens of millions of dollars.
Barrett said it’s been almost 20 years since the contract and a lot has changed.
“We have a new governor's office,” Barrett said. “We have a new agency, essentially from top to bottom.”
However, Roob was also the FSSA secretary in 2006, helping to implement the system Pryor referenced.
“To me, it's not about the convenience of the agency. To me, the important thing is, are we serving people?,” Pryor said. “The agency, to me, it has no consideration. The most important thing is to the people.”
Barrett said FSSA reassured him they will be able to implement the policies to maintain the sustainability of the Medicaid program.
Pryor and other lawmakers also raised concerns about the frequency of eligibility checks and people losing coverage when they shouldn’t. An amendment to change quarterly checks to twice a year was stuck down in committee.
The bill now heads to the full House.
Abigail is our health reporter. Contact them at aruhman@wboi.org.