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Indiana expands Medicaid

A remarkable experiment is about to begin in Indiana; the state will expand Medicaid, but recipients with incomes above the poverty line will have to contribute to the cost and pay something towards doctor and hospital visits.

I don’t buy the argument that this is a step onto the proverbial slippery slope, that next we know Medicaid beneficiaries will be forced to pay higher and higher deductibles and copays.

That’s as specious as the argument that states shouldn’t expand Medicaid because some day in the non-defined future the feds will pull the funding.

Nope, it is high time beneficiaries had some skin in the game.  Heck, I’d even go for giving the lower-income recipients a cash account they can use for similar deductibles and copays, with any balance at the end of the year going into a fund for education, child care, food, whatever.

Indiana follows in the footsteps of Iowa; several other states are looking into a similar program.  This is exactly what we need, states trying different things, seeing what works and what doesn’t.  We’ve learned a lot from Massachusetts – the state’s Connector plan has produced remarkably positive results.

Here’s hoping IN, IA and the other experimenting states learn a lot, and learn it quickly.



2 thoughts on “Indiana expands Medicaid”

  1. Joe, I don’t disagree with your thinking. The only cause for concern is with the concept of providing a cash account with any balance at the end of the year going into a fund the recipient can use for other needs. My fear is that some families may avoid getting needed health care services (for themselves or their children) because of the financial incentive, forcing them to choose between basic needs such as health care and food. It’s a conundrum, that’s for sure. When I worked in the Medicaid sector, one of my state clients used a federal grant to provide incentives to its recipients who exhibited healthy behaviors – in return, the recipients got a credit they could use at the pharmacy purchase health items such as toothpaste and toothbrushes, OTCs, etc. Unfortunately, I don’t know of any published outcomes from the program, but I liked the concept.

    1. I agree Nancy. It would be important to balance pragmatism against overly prescriptive rules; perhaps each state could decide what the $ could be used for, and it would only be accessible if recipients had done preventive care screenings and follow up.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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