Democratic leaders said Thursday that the General Assembly might need a special session to deal with unresolved questions about a Medicaid expansion required by federal health-care reform.
Gov. Mike Pence has asked federal authorities to send Indiana additional Medicaid money in a block grant so the state can design its own program for some 400,000 low-income Hoosiers who could be covered under the Affordable Care Act.
Republicans - including Pence and legislative leaders - want to model any Medicaid expansion after the state's Healthy Indianan Plan, which requires users to pay part of the costs and includes a medical savings account.
But Pence received a letter from the Department of Health and Human Services two weeks ago informing his administration that its request would not be considered until it meets requirements that include taking public comments on the issue.
"After completing a preliminary review of your extension request, we have determined that the state's extension request has not met the requirements for a complete extension request," wrote Diane Gerrits, director of the state demonstrations and waiver division of the Centers for Medicare and Medicaid Services.
Democrats say that means a federal decision won't occur before the end of session, when lawmakers could act to implement it. That means thousands of Hoosiers would remain without health coverage. They say Medicaid expansion is too big of an issue to wait another year.
House Minority Leader Scott Pelath, D-Michigan City, and Senate Minority Leader Tim Lanane, D- Anderson, wrote a letter to Pence expressing their "considerable concerns as to whether this will hamper the state's ability to inject billions of dollars of federal funds into Indiana's economy, create tens of thousands of jobs and give hundreds of thousands of Hoosiers a plan to receive affordable health care services."
In the letter, they ask Pence whether he'd call a special session to vote on the issue if lawmakers are not able to before the April 28 end of session and what plans he has to ensure the 400,000 Hoosiers without health insurance would receive coverage.
They're calling on Pence to offer what they called a credible alternative plan before proceeding.
"All Hoosier families deserve access to affordable health care services," they wrote. "We find it unacceptable to proceed without offering a credible contingency measure to provide that coverage."
The Pence administration says the issue could be resolved more quickly, though. It has scheduled two public meetings on the Medicaid issue next week.
Christy Denault, a spokeswoman for Pence, told the Associated Press that the administration always knew it had to collect public comment, but it wanted to get the ball rolling on its waiver request because of approaching deadlines.
On Thursday, the governor sent Senate Minority Leader Tim Lanane, D-Anderson, and House Minority Leader Scott Pelath, D-Michigan City, a response saying the letter from CMS was "not in any way unexpected."
"It is a part of the all-too-familiar bureaucratic process of corresponding with HHS on this particular subject," he wrote.
Pence told the Democrats that the original letter his administration sent to federal authorities was actually just an advanced copy, not the actual request for a waiver of Medicaid rules. But the letter accompanying the original request never said it was preliminary.
The governor said his administration's action was not premature but rather proactive.
"The Indiana General Assembly has instructed us to see our Healthy Indiana Plan waiver application through, and we fully intend to do so," Pence wrote.
For that reason, he said, it's too early to discuss alternative approaches to expanding HIP. He said he looks forward to continuing to work with Democrats on the issue.
"Your inquiry highlights the critical need for greater flexibility in the operation of Indiana's Medicaid program, where we can be free from the many unnecessary and often easily misconstrued federal mandates," he wrote.
Samm Quinn is a reporter for TheStatehouseFile.com, a news service powered by Franklin College journalism students and faculty.