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Indiana latest state to expand Medicaid

But those above poverty line must pay premiums, contribute to HSAs

Indiana is the 28th state, plus the District of Columbia, to expand Medicaid under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) announced yesterday. Expansion will bring healthcare coverage to an estimated 350,000 low-income residents beginning Feb. 1.

The plan does not include a work requirement, as Indiana Gov. Mike Pence (R) had wanted, but it does include monthly premiums of up to $25, as well as co-pays of $4 for doctor's visits and $75 for emergency room visits, for coverage that includes dental and vision care, the New York Times reported. These premiums do not apply to Indiana residents below the federal poverty line.

Another differentiator for Indiana's brand of Medicaid expansion is a requirement that enrollees make monthly payments into a health savings account (HSA).

Adults below the poverty line can contribute as much as $20 a month and do not risk losing coverage if they don't contribute, according to the Washington Post. Those above the poverty line, but within the 138 percent threshold that qualifies them for Medicaid expansion--$16,105 for a single adult and $27,310 for a family of three--must contribute between $20 and $27 per month, depending on their income.

"It's just common sense that when people take greater ownership of their healthcare, they make better choices," Pence told the Times.

The Indiana plan also differs from most Medicaid expansion efforts in how the state will pay for it, Kaiser Health News reported. Under the Affordable Care Act, the federal government foots the full bill for Medicaid expansion until 2016, declining to no less than 90 percent of the cost starting in 2017. Rather than use tax dollars, Indiana will pay its share through hospital fees and a cigarette tax.

The Hoosier State's approach may appeal to Republican states considering Medicaid expansion but have been wary to pay for "free" healthcare for no-disabled, low-income residents.  

"I think this raises the level of interest in looking at these issues in states that have not expanded Medicaid," Joe Antos, a health economist at the conservative American Enterprise Institute, told KHN.

For more:
- here's the CMS statement
- read the New York Times article
- check out the Washington Post story
- here's the Kaiser Health News article

Related Articles:
Childless adults biggest winners under Medicaid expansion
Push is on to expand Medicaid in Kansas, Wyoming
Texas and Florida remain wary to expand Medicaid
Medicaid expansion helps hospitals' bottom lines
Medicaid expansion roundup: Where are all the states now?