Even without expansion, 40,000 more Hoosiers join Medicaid

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Even without expanding eligibility for Indiana Medicaid, the program had enrolled 40,577 more Hoosiers as of March than it had in the same month last year.

More than 15,000 of that year-over-year increase occurred in March alone this year, as a flood of people here and nationally sought coverage before Obamacare would hit them with a tax for going uninsured.

More than 1,094,000 Hoosiers are now enrolled in Medicaid.

The pace of new enrollment could be inflated a bit because the numbers include participants in the state's Healthy Indiana Plan insurance plan, some of whom have been allowed to stay in the program a few months longer than planned, due to the disastrous rollout of the Obamacare insurance exchange. Healthy Indiana Plan eligibility was reduced this year to a cap equal to the federal poverty limit because Obamacare now provides tax subsidies for private insurance to anyone with an income equal to the federal poverty limit or greater.

“It would be difficult to attribute the recent increase in enrollment to any one factor,” Jim Gavin, a spokesman for the Indiana Family and Social Services Administration, wrote in an email.

“While there has been increased application activity in recent months, with some applications being transferred to us from the federal marketplace," Gavin added, referring to the Obamacare insurance exchange, "I would also point out that total enrollment includes Healthy Indiana Plan enrollment, which is higher this month due to increased applications AND the fact that some of our members over the federal poverty level hadn’t yet transitioned to exchange plans.”

However, the pace of enrollment is actually a bit slower than predicted by a 2012 analysis by the Indianapolis office of Milliman Inc., a Seattle-based actuarial firm hired by the state government. Milliman expected Medicaid enrollment to grow 91,000 by this time in 2015 due to what it called Obamacare’s “woodwork effect.”

Milliman expected enrollment to roughly double from 2014 to 2015. If that prediction proves true, it means Indiana would end up with about 81,000 additional Medicaid enrollees, not 91,000.

Milliman's forecast figured each new Medicaid enrollee would cost the state an average of $885 per year. If that cost proves accurate, the additional 40,000 Medicaid participants added so far will cost the state more than $35 million each year.

The “woodwork effect” would be created, Milliman said, by Obamacare’s “individual mandate” tax on those who failed to obtain health coverage, by an increase in referrals to the Medicaid program due to the launch of Obamacare’s online health insurance exchanges and because some employers might stop offering coverage if its employees could gain coverage through either Medicaid or the exchanges.

The individual mandate tax this year will equal $95 per adult or 1 percent of a household’s income. Indiana Medicaid restricts enrollment to adults now making just 25 percent of the federal poverty limit, or less than $6,000 per year for a family of four.

Children are covered even if their household income is as high as 250 percent of the federal poverty limit, or up to $59,625 per year for a family of four.

Gov. Mike Pence and his staff are currently negotiating with the Obama administration to use the Healthy Indiana Plan to expand Medicaid coverage to Hoosiers earning up to 138 percent of the federal poverty limit, as called for by the Obamacare law.



  • To Dave
    Please direct those wishing to enroll to this page: http://www.in.gov/healthcarereform/2381.htm - they just choose their income level and it will send them to the right place to apply. Also - there is a no wrong door policy. Even if someone applies to Medicaid and is denied, they can then take the denial letter to the Exchange and if they make 100+% FPL they can get a large tax credit.
  • Thanks J K
    JK: I thoight that I had read somewhere that the marketplace covered those 105% of FPL or higher. That being said, healthcare.gov made him sign up for Medicaid, first instead of offering him the Marketplace. I'm sure he will be denied and then have to appeal to get access to the Marketplace?
    • Good Column & Comments
      Good column and good comments! I learn something every time I read JK's column as well as the comments.
    • To Dave in Indiana
      The Marketplace (or exchange) can be for anyone. However, tax subsidies are available on the Marketplace only for those with household incomes of 100 percent of the federal poverty limit up to 400 percent of FPL. If your brother has income of 103% of FPL, then he would qualify for a large tax credit to help him buy health insurance on the exchange.
      • Gap?
        I helped my brother apply for "Obamacare." PLEASE correct me if I'm wrong but the Marketplace is for those who fall into the "105-350% FPL." Indiana Medicaid is for those who are below 100% FPL. My brother is at 103%, how does he get the required coverage?
        • To Alan:
          http://www.in.gov/fssa/ompp/4859.htm Indiana is moving Medicaid eligibility up to 100% - only for members that are categorically eligible due to being aged (over 65), blind, or disabled. For the "ABD" group as they are known, they will now be able to receive full Medicaid without a spend down if they are at or below 100% of FPL. If they are above that income limit, they are now guaranteed coverage on the Marketplace, and most people who had a spend down will probably be eligible for a tax credit. I actually think this is a great move for Indiana - it's also going to save state tax dollars because starting June 1, a Social Security (Federal) disability determination will be accepted by the State of Indiana. Prior to this change, Indiana would not accept a Federal determination and instead did their own parallel process to determine disability. If anyone does lose Medicaid effective June 1 due to this change, it will trigger a special enrollment period (due to loss of insurance) and the individual can then enroll in the Marketplace without penalty. For Medicare recipients, although Medicaid spend down is going away, they have two options: The full Medicaid program is still available if they are at or below 100% FPL as above. And - Indiana is expanding its Medicare Savings Programs so that help will be available for those up to 185% of FPL. Now - the big question that faces the state - and one that I hope they'll soon answer - is whether or not to expand Medicaid for childless, able bodied adults aged 19-64. There is over $10 billion dollars available in Federal funds over the next several years to cover this group, and the only thing required is about $550 million in state matching funds and the Governor's signature on the dotted line. http://www.expandincoverage.org/
        • Federal Poverty Level
          J.K., You might want to check with Medicaid. I think, come June 1, that its spend down program will be eliminated and eligibility for single adults and couples will be increased to 100% of FPL. This should mean an increase in the number of people eligible. But you would be best served by confirming this with Medicaid.
          • And just imagine...
            ...what adding another 350k enrollees could do for the state's uninsured population and working poor. The next Democratic gubernatorial candidate better raise this as an issue in 2016.

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