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GOP govs: Not enough Medicaid 'flexibility'

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The Obama administration is giving states like Indiana a little flexibility in how to expand their Medicaid programs—but nothing like what state officials hoped for after the U.S. Supreme Court struck down part of the health reform law in late June.

The law calls for all states to expand eligibility for their Medicaid programs to include adults earnings as much as 138 percent of the federal poverty limit. Indiana’s current limit for adults is just 24 percent of the federal poverty limit.

But the Supreme Court, in its June 28 ruling upholding the law, said the states can opt out of the expansion without losing all federal funding for their Medicaid programs.

Republican governors of other states, including Louisiana and Florida, have said they will not expand their Medicaid programs. So earlier this month, officials from the U.S. Department of Health and Human Services told states that are skittish about expanding that, if they do so on schedule, they can later back out of the expansion.

Republican governors were not impressed.

In Indiana, Gov. Mitch Daniels has said he would leave the Medicaid decision to the state Legislature and the man who replaces him in January. But in the meantime, the Daniels administration has continued to push for an answer from the Obama administration on whether it can use the Healthy Indiana Plan to expand Medicaid, instead of the traditional Medicaid plan.

Traditional Medicaid pays all medical charges for its members, although it has struggled to find enough doctors willing to accept its low reimbursement rates. The Healthy Indiana Plan requires participants to make some contributions into a health savings account to help cover their bills.

Late last month, federal officials sent a letter to the Daniels’ administration saying it could continue the Healthy Indiana Plan for at least one more year—to the end of 2013—while the two governments keep discussing the idea of using the Healthy Indiana Plan to expand Medicaid coverage.

“We share the state’s goal of maintaining coverage for the approximately 42,000 parents and childless adults currently enrolled in the HIP program,” wrote Cindy Mann, director of the federal Center for Medicare & Medicaid Services, in a letter proposing the one-year extension.

But that wasn’t nearly enough for Michael Gargano, secretary of the Indiana Family and Social Services Administration, which oversees the Indiana Medicaid and Healthy Indiana programs.

In a press release issued Friday, Gargano warned that Indiana officials may be forced to close enrollment in the program because its future beyond 2013 is in doubt.

“We’re disappointed that after two years, Indiana still does not have an answer about the long-term future of HIP,” Gargano said in a prepared statement. “We will be forced to make a difficult decision about continuing HIP enrollment for a program that likely won’t exist after 2013. States have been seeking answers and flexibility, and this response hampers innovation and efforts to plan.”

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  • HIP
    HIP is a good concept but I don't think its really done much to cover uninsured hoosiers.Can't understand why they are upset. There is still approximately 800,000 uninsured in Indiana alone. Some elected offical needs to do something. 40,000 is just a drop in the bucket.

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  1. Good ole' Obamacare. Thanks liberals and those who didn't bother to vote.

  2. Yes. Blame those who were too lazy to go vote Obama out and those who voted him in again. That's my take on it. I know folks won't get it on the left. OK. Start berating me now!

  3. Serioulsy, people are AGINST this project? Most communities would be salivating over a project like this. You'd rather have an empty eye-sore gas station and shacks posing as apartments? This project is exactly what BR needs. BUILD IT MR MAYOR. And yes, I am a BR resident, and have been for 20 years.

  4. As a St. Vincent employee of over 20 years, I am saddened and disheartened by this announcement. Unfortunately, as the healthcare "industry" continues on this political and corporate path, all that St. Vincent Hospital has stood for spiritually for its employees and this community is being sucked dry. I know it truly has no choice. It is not just Obamacare or just competition or just any single thing. This trend started long before I was even born when the government became involved in healthcare and it became an "industry." I grieve for those who will lose their jobs, one of whom may be me, but I also grieve for this hospital which I have served for over 20 years. May God give us and it the grace to withstand the future of healthcare.

  5. Why do people constantly harp on this issue and act ignorant about what a city population measures? A city's population is the city's population. There is no argument or debate about it. If you want to measure the density of a city--measure it. If you want to measure the size of a metropolitan area, then measure the metropolitan population. City boundaries cover different sized areas--and they always have (though the disparity has probably increased since about 1900 or so when more cities began annexing their surrounding communities). For example, San Francisco only covers 49 square miles while Houston cover nearly 600 square miles. No one argues about the population rankings of either city even though they clearly cover extremely different sized areas. Indianapolis is the 13 largest city by population in the U.S. That is a fact. While the population of a metropolitan area may give you a better sense of how large a community is, as noted, even metro areas can vary widely in the size of geographic area they cover--so that is not a perfect comparison either.

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