INDIANAPOLIS (AP) -
The health insurance expansion Gov. Mike Pence is touting relies on federal
Medicaid money and meets federal Medicaid requirements, but the Republican
governor insists it’s not Medicaid.
Pence is asking the
federal government to pay for an expansion of the state’s Healthy Indiana
Plan, saying his plan is much better than traditional Medicaid. He took his
pitch to Washington on Monday, unequivocally telling an audience gathered at
the conservative American Enterprise Institute that his plan is nothing
short of Medicaid reform.
“Last week, my
administration announced plans to submit a waiver to the Centers for
Medicare and Medicaid Services to replace traditional Medicaid in Indiana
for all able-bodied adults with an expanded version of the Healthy Indiana
Plan,” he said.
conservatives, his longtime support base, have been treating his proposal as
equivalent to the expansion of federal health care they ardently oppose.
proposal is in fact an expansion of Medicaid may depend on point of view as
well as how “Medicaid” is defined.
Kosali Simon, a
health economist and professor at Indiana University’s School of Public and
Environmental Affairs, said the law creating Medicaid is specifically
designed to allow states to develop their own options for administering the
law. By that definition, Pence’s proposal is an expansion of Medicaid.
because it fits into the definition of what states are allowed to do: States
are allowed to ask for waivers,” Simon said.
But she notes that
if one defines Medicaid as “not deviating at all” from how the federal
government asked states to expand Medicaid, then Pence’s proposal is not
Indiana is among a
handful of states that have proposed accepting the federal expansion of
Medicaid on their terms. Arkansas and Iowa won waivers allowing them expand
Medicaid coverage with some key changes, like providing payouts to
low-income residents to purchase insurance on the health insurance exchange.
Pence’s plan calls
for a series of major changes from how Medicaid expansions in other states
The first part of
the “Healthy Indiana Plan 2.0” would allow adults earning less than 138
percent of the federal poverty level to enroll in the state’s hybrid health
savings account plan. If the residents pay a small monthly fee, they would
be enrolled in “HIP Plus,” which provides dental and vision coverage, as
well as better prescription coverage. If residents miss their payments, they
would drop down to “HIP Basic,” which does not include vision and dental
coverage and other “extras".
“HIP 2.0” also
establishes “HIP Link", a nod to Arkansas, which would have the state
subsidize low-income workers whose employers offer health care benefits but
are too expensive for the workers.
But the details
include some key features of Medicaid, specifically measures that Health and
Human Services officials asked for when they rejected a similar proposal
submitted by former Gov. Mitch Daniels. The addition of dental and vision
coverage, as well as not being able to kick residents out of the program if
they don’t make payments, were key features of the federal Medicaid
And the program is
also funded heavily by federal Medicaid dollars.
executive director of Covering Kids and Families of Indiana, and other
health care advocates in Indiana pushed hard for an expansion of traditional
Medicaid, but have largely rallied around Pence’s proposed alternative.
The Pence proposal
includes many key facets and requirements not found in traditional Medicaid,
not Obamacare,” Roos said. “I think it’s a new critter. I think it’s exactly
what (waivers) are supposed to be: it’s a compromise.”