By Maureen Hayden
CNHI Indiana Statehouse Bureau
---- — INDIANAPOLIS — The federal government has given conditional approval to Indiana to extend its state-run Healthy Indiana Plan that provides health insurance coverage for about 37,000 low-income Hoosiers while officials continue to wrestle over what to do with the hundreds of thousands of state residents who remain uninsured.
On Tuesday, Gov. Mike Pence announced the decision by the Obama administration to grant a limited extension to the state-run insurance program through the end of 2014. As part of the agreement, Indiana will lower the income level for eligibility for the program, pushing about 11,000 current enrollees off its rolls.
"Securing the waiver to continue the Healthy Indiana Plan is a victory for Hoosiers enrolled in this innovative program and it will ensure that Indiana remains in the forefront of consumer-driven health care in the United States," Pence said.
The Centers for Medicare and Medicaid Services OK'd extending the plan, known as HIP, “in order not to disrupt the coverage currently afforded in Indiana as the state continues to consider its coverage options,” according to a letter sent by the the federal government to Debra Minot, head of the Indiana Family and Social Services Administration.
Pence said he was "grateful" for the negotiations with the Obama administration and is still seeking its approval to use the state plan as a vehicle for Medicaid expansion under the federal Affordable Care Act.
While 25 states have opted to expand the traditional Medicaid program using federal dollars to cover their uninsured citizens, Pence has resisted doing so. On Tuesday, he repeated his opposition to expanding the Medicaid program, citing concerns about long-term costs to the state.
Pence minimized concerns about the state’s estimated 300,000 uninsured residents who won’t be eligible for HIP or to buy the subsidized private health insurance that will be available through a federal health exchange program next year.
He said the uninsured can still access health care through hospitals’ charity care programs, emergency rooms, and public and privately funded clinics that serve the poor.
“Let’s make sure there is a distinction in the language between health insurance and health care,” he said. “Every person in this state has the ability, if they are struggling with illness to walk into an emergency room and receive care.”
That remark provoked a sharp rebuke from the House Minority Leader Scott Pelath of Michigan City.
"What we're seeing today is something being trumpeted as a success, when in essence it is a complete failure," Pelath said. "The continuation of coverage for a few people does nothing to move Indiana forward, it still leaves these people uninsured."
Senate Minority Leader Tim Lanane of Anderson said Tuesday’s announcement comes as a relief to the HIP’s current plan members but does little to help Hoosiers without health care coverage.
“To them, today’s announcement is nothing more than achieving the minimum.”
The Healthy Indiana Plan was approved in 2008 by the federal government as an option for the state to provide health coverage for low-income residents. But the number of Hoosiers who can sign up for the plan is capped at 45,000. Some 50,000 people are on the waiting list.
The plan requires participants to pay up to 5 percent of their incomes into a health saving account, which is used to pay their initial medical expenses. Participant health care costs beyond $1,100 a year are shared by the state and federal government.
Under the deal struck with the federal government to extend the HIP program until the end of 2014, the state will lower the income eligibility for participants, from the current 200 percent of the federal poverty level down to 100 percent, which is about $23,000 for a family of four.
That change will push about 11,000 current HIP participants off the program. Family and Social Services Administration Secretary Debra Minott said those persons will receive a letter recommending hey purchase private health insurance through a federally-managed health insurance exchange that goes online next month.
Moving those people off HIP will then allow FSSA to bring another 5,000 to 7,000 people who meet the new income requirements into the program.
Rep. Ed Clere of New Albany, the Republican chairman of the House Public Health Committee, called the federal approval of the HIP extension “good news.” But he said it falls far short of what’s needed to cover the estimated 300,000 Hoosiers who won’t have access to health insurance coverage. And he said it doesn’t address The hundreds of millions of dollars that hospitals lose each year, providing uncompensated health care to poor and uninsured patients,
“I respect the governor’s decision to prioritize the HIP extension application,” Clere said. “Now that it’s resolved, I would hope we could have a full and robust discussion about options for expanding Medicaid.”
Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at firstname.lastname@example.org.