Holcomb not yet backing specific changes to Medicaid
WASHINGTON – Gov. Eric Holcomb is supporting an effort by GOP governors to revamp Medicaid but declined to say Monday whether those changes should include the spending cuts proposed by some Republican lawmakers.
“We’ll run the numbers when we know what the equation looks like. There are a lot of different factors,” the Indiana Republican told IndyStar after attending the National Governors Association winter meeting. “What we are seeking as states, as Republican governors, is more control to have a better handle on cost.”
Holcomb said he expects the GOP governors' plan to be put forward "within a matter of days, weeks."
Possible changes to Medicaid and other parts of the 2010 Affordable Care Act commonly referred to as Obamacare was a major topic at the national meeting of governors, which occurred as Republicans are struggling to agree on a way to meet their promise of repealing and replacing Obamacare.
President Donald Trump told the governors Monday his administration has come up with a solution "that's really, really, I think very good." While not detailing what that solution is, Trump acknowledged the difficulty of overhauling the health care system.
"Nobody knew that health care could be so complicated,” he said.
Medicaid accounts for more than half of all federal funds spent by states and the states’ share of the jointly-funded program is a major chunk of state budgets.
Governors received an independent analysis showing Medicaid changes proposed by House Republicans would significantly reduce federal support of states’ programs and increase the number of people without insurance.
“I think it had a real chilling effect on many of us,” said Virginia Gov. Terry McAuliffe, a Democrat who chairs the National Governors Association.
Indiana’s uninsured rate fell 7.2 percentage points after implementation of the Affordable Care Act, which increased access to coverage primarily through expanding who is eligible for Medicaid and through private insurance subsidies for those who make too much to qualify for Medicaid but aren’t offered coverage through an employer.
Holcomb is seeking to expand the benefits offered through Indiana’s Medicaid plan, known as HIP 2.0. He has asked the federal government’s permission to expand access to substance use disorder services for an estimated cost of $70.75 million a year.
Asked if HIP 2.0 can cover as many Hoosiers if federal funds are cut, Holcomb said it depends on how much flexibility states are given to run the programs.
“We will seek to cover as many as we can and are compassionate about the folks that are receiving coverage right now and want to make sure that we continue to do so,” he said.
The independent analysis by the consulting firms Avalere Health and McKinsey & Company said the tools states could be given to control spending include tightening eligibility criteria, requiring able-bodied beneficiaries to work, limiting benefits, reducing payments to providers and increasing patients’ cost sharing.
The request Holcomb recently filed with the federal government to continue HIP 2.0 includes additional incentives for unemployed Medicaid recipients to look for jobs. But it does not include a work requirement.
“That’s something I’m still interested in down the road,” Holcomb said. The governor said he is not seeking a work requirement now in part because there are ongoing discussions about whether that should be added to the program nationally, and because he was focused on expanding services to help address the opioid epidemic.
But the state law codifying HIP 2.0 says the program must end if federal funding falls below what was included in the ACA.
The federal government currently pays for at least 90 percent of the costs for the Hoosiers newly eligible for Medicaid. The federal government covers more than two-thirds of the cost of other Medicaid recipients, with most of the money going to the elderly and people with disabilities.
Congressional proposals to change Medicaid include ending the higher federal match for those newly eligible for Medicaid and capping the total amount of money states can receive.
A draft proposal of the plan being worked on by Republican governors that was obtained by the Associated Press would put states in charge of their programs while the federal government would still pay most of the bills.
“The conversation we had today was to ensure that those that have their coverage are going to be able to continue to have coverage,” Nevada Gov. Brian Sandoval, vice chair of the National Governors Association and one of the governors working on the GOP proposal, told reporters.
McAuliffe said governors are open to new ways of running Medicaid, as long as the program is adequately funded.
“We do not want anyone to lose their health care,” he said. “We’d like to expand it.”
Contact Maureen Groppe at mgroppe@gannett.com. Follow her on Twitter: @mgroppe.
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