On February 2, Indiana became the second state in the U.S. to get approval from the Trump administration to add work requirements to its Medicaid program. Kentucky was granted a waiver to add work requirements to its Medicaid program last month, a historic but controversial move that drew criticism from patient advocacy groups. Indiana, which had already been operating its Medicaid program under an approved waiver from the Obama administration, will now require able-bodied adults on Medicaid to complete work requirements for eligibility.
Indiana is one of 33 states, including the District of Columbia, that chose to expand its Medicaid program under Affordable Care Act guidelines. Traditionally a conservative state, Indiana opted to expand once it was granted a waiver that allowed them to implement radical changes to the program. These included requiring Medicaid recipients to pay a monthly premium for their plan and locking out enrollees who didn’t pay their premiums for two months.
Changes to Indiana’s Medicaid program were implemented in 2015 under then-Governor Mike Pence, who’s now the vice president, and his top health consultant Seema Verma, who is now administrator of the Centers for Medicare and Medicaid Services. Collectively, the changes were known as Healthy Indiana, a demonstration project to see how adding certain requirements would impact Medicaid enrollment and sustainability in that state. Last week, the federal government approved another waiver for Indiana to add work requirements to its program.
Since adding the stipulation that Medicaid enrollees would lose their coverage if they failed to pay their premiums, Indiana has lost 25,000 Medicaid enrollees as of October 2017. About half of those people found other sources of health insurance, primarily through jobs. Premiums range in price from $1 to $27 a month, with about half paying $1 a month. An additional 46,000 adults who signed up for Medicaid during 2016 and 2017 also lost coverage for failure to pay their first month’s premium.
But there have been positive changes as well thanks to Healthy Indiana, and there may be added benefits with the waiver that was recently approved. Along with making sweeping changes to the program itself, Indiana also decided to increase doctor pay to the same level as Medicare. This has boosted access for Medicaid recipients to see specialists for care.
Those who support the Healthy Indiana program also point out that without the first waiver to add premiums and lockouts, Indiana may never have expanded its Medicaid program at all. Since expansion, the Hoosier State has added 240,000 people to its Medicaid rolls. The uninsured rate in the state dropped from 14 percent in 2013 to 8 percent in 2017.
Under the new waiver, Medicaid recipients in Indiana will be required to work or volunteer for 20 hours a week on a graduated schedule, starting with minimal work requirements and building up to the full 20 over an 18-month period. Those aged 60 and over won’t be required to work, and there are other exemptions as well, such as for people going to school or those taking care of dependent children.
Medicaid advocacy groups believe the new changes, especially the administrative ones, will be detrimental to the Medicaid population. New rules will lock people out of Medicaid coverage for six months if they fail to submit redetermination paperwork on time. From August to October last year, about 12,500 Medicaid recipients lost their coverage for failure to meet redetermination guidelines