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Thursday, July 20, 2017 1:00 am

State Medicaid hit: $4.9 billion

Estimated loss under Senate health care plan

NIKI KELLY | The Journal Gazette

INDIANAPOLIS – Indiana would lose $4.9 billion in funding for the poor, disabled and elderly on Medicaid under the flailing Senate health care bill.

That is a 14 percent drop from what the state would receive under current law through 2026.

The estimates come from a governors-only discussion on the future of health care that was presented last week at the National Governors Association and obtained by The Journal Gazette.

Gov. Eric Holcomb has refused to provide the figures and declined to comment.

Losing the money would force state lawmakers to make tough decisions to fill the shortfall.

The federal funding reductions would grow even more severe under the Senate plan by 2036 with Indiana's loss at 32 percent, or $36.5 billion.

The Senate version of the bill has essentially collapsed in recent days as Republicans try to find enough votes to move it.

One of the key points of opposition has been from governors concerned about the hit to state coffers.

Medicaid is more than just health coverage. It provides a vital safety net to 1 in 5 Hoosiers, according to Indiana's website. About 1.4 million Hoosiers are covered in some way.

The reductions in funding include backing off of a federal commitment to states that expanded Medicaid under Obamacare, including Indiana. It also would shift Medicaid from an open-ended entitlement dependent on those who qualify and their health needs to a fixed funding structure giving states dollars based on per capita caps and block grants.

Last week, Holcomb said: “When there is a vote that we know is going to occur we will weigh in. But this literally changes to the tune of billions of billions of dollars every hour. And for me to start chasing some target that continues to elude us is just not productive.”

Indiana Democratic Party Chairman John Zody accused Holcomb of slow-walking the release of the information.

“He knows cutting Medicaid means shrinking access to care, fewer resources to fight opioids and could force some rural Indiana hospitals to close their doors,” Zody said. “The Hoosier economy can't afford to lose these good-paying jobs. Hundreds of thousands of Hoosiers can't go back to a time when the emergency room was their only primary care option. We can't step back from the progress we've made fighting the opioid epidemic and helping Hoosiers get back on track.”

The PowerPoint from the meeting gives a number of options for states to offset the lost federal dollars.

They include:

• Raise taxes

• Reduce spending elsewhere in the state budget

• Tighten eligibility through reduced income thresholds

• Eliminate coverage for some optional services

• Cap benefits

• Implement job search or work requirements

• Require participants to cover some costs

• Cut provider reimbursement rates

According to the data, 22 states plus D.C. would see initial cuts between 10 percent to 20 percent. Twenty states would see reductions less than 10 percent, and eight states would see cuts of more than 20 percent.

nkelly@jg.net