CMS and the state of Indiana reached agreement on a waiver to expand the state’s Medicaid program from only mothers and children with incomes less than 25% of FPL to all eligible individuals with incomes under 138% of FPL. This is projected to add 350,000 uninsured Hoosiers to Medicaid.
The twist is that newly eligible individuals must pay premiums ranging between $3 and $25 a month for an individual (2% of income). For individuals with incomes less than 100% of FPL, if they do pay premiums, they will have dental and vision coverage. If adults do not pay premiums, they will have basic medical coverage, but no dental of vision coverage. For individuals between 100 and 138% of FPL, they must pay their premiums to get coverage. If they do not, they are locked out of the program for 6 months. This is a hybrid between the Exchanges and Medicaid.
Hospital reimbursement rates will be increased to Medicare levels (about a 25% rate increase).
Financing for the Medicaid expansion and rate increase will come from the federal government, an increase in the state’s tobacco tax and hospital fees. The state’s existing Healthy Indiana program that offers some coverage for 60,000 low income Hoosiers will be fully folded in.
National advocates were critical of the waiver to allow states to charge premiums to individuals with incomes less than the poverty level. Iowa currently charges $5 a month for individuals with incomes 50-100% of FPL and Michigan charges 2% of income to individuals with incomes 100-138% of FPL.
See http://www.wthr.com/story/27949852/pence-to-speak-on-health-care-policy; http://www.usatoday.com/story/news/nation/2015/01/27/feds-ok-indianas-medicaid-expansion/22433397/, and http://www.nytimes.com/2015/01/28/us/politics/indiana-will-allow-entry-to-medicaid-for-a-price.html