Republican governor of Indiana wants to expand Medicaid under Obamacare and existing state program; federal OK needed

Approximately 24 states still have not participated in health reform's Medicaid expansion, which provides coverage for adults who earn up to 138 percent of the federal poverty level. Some Republican-controlled states are "still looking for alternative ways to accept hundreds of millions, and even billions, federal dollars to expand coverage?all the while trying to maintain some rhetorical policy distance" from the controversial law, Jason Millman writes for The Washington Post.

Republican Gov. Mike Pence of Indiana is discussing a new plan to provide coverage for low-income people through an existing state insurance program. remains to be seen whether the federal government will approve Pence's plan or ask him to make changes. It also remains unclear whether the program will be better than traditional Medicaid.

When Pence said last year he would only consider expanding coverage if it was through the Healthy Indiana Plan, the Obama administration said the state couldn't do that because the program had an enrollment cap and potential cost-sharing issues. Now, Pence plans to get rid of the enrollment caps and make the program available to all adults who earn less than 138 percent of the poverty line. "Between 334,000 and 598,000 people will be covered under the plan, according to Pence's office," Millman writes. "Enrollment will open in 2015, with federal approval."

The current program only provided coverage for those under the poverty line and required them to pay for the first $1,100 of their care, the new program will provide two levels of coverage. Participants will be allowed to make monthly payments, but if they do not, they'll be given simpler coverage that doesn't include vision and dental benefits. The lesser coverage calls for co-payments for services but not for preventive care and family planning services. Participants living above the poverty line who do not give a monthly payment within 60 days will be "locked out of the program for six months. They can't opt into the basic coverage level," Millman writes.

"Exposure to and awareness of the cost of care are key components of the consumer-directed model that encourages price and quality transparency from providers," according to a document from Pence's office. "The increased deductible aligns with private market high deductible health plans paired with a health savings account, providing members valuable experience with a private market plan design." (Read more)

Though Pence does not support President Obama's health-care overhaul, the governor said that states "have an obligation to lead the way on health care reform," Maureen Groppe and Barb Berggoetz write for The Indianapolis Star. Pence said, "Reforming traditional Medicaid through this kind of market-based, consumer-driven approach is essential to creating better health outcomes and curbing the dramatic growth in Medicaid spending." (Read more)

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