The state is preparing to seek federal approval to continue the Healthy Indiana Plan through 2030, even as Attorney General Curtis Hill Jr. is backing a lawsuit that could eliminate nearly all funding for the health program that covers some 418,000 low-income Hoosiers.
On Nov. 6, the Indiana Family and Social Services Administration posted notice of its intent to request a 10-year extension of the federal Medicaid waiver that established the current HIP program, which otherwise would expire Dec. 31, 2020.
Indiana also is proposing to extend the expanded substance abuse and serious mental illness components of HIP through 2025, according to the notice.
FSSA expects to submit Indiana's HIP extension request shortly after the public comment period on the state's application closes on Friday.
An independent evaluation of HIP that's set to accompany Indiana's renewal application finds the program has improved health care access in Indiana, particularly for people previously uninsured.
Records show the state's HIP renewal application will go to the U.S. Centers for Medicare and Medicaid Services.
That agency took eight months to consider and approve Indiana's last HIP renewal request in 2018.
In the meantime, however, a lawsuit nearing a final decision by the Fifth Circuit Court of Appeals could eliminate nearly all federal funding for HIP, if the court — as requested by Texas, Indiana and other states — strikes down the Affordable Care Act in its entirety.
That's because HIP is an approved alternative to the Medicaid expansion provided for by the Affordable Care Act, also known as Obamacare, and nearly all the costs of HIP — which total more than $3 billion a year — are paid for by the federal government.
FSSA spokesman Jim Gavin said the agency is monitoring the lawsuit and remains committed to HIP.
But without federal funding, Indiana likely could not afford to continue HIP, absent tax increases or significant spending cuts, since its general fund spending for all state services amounts to $17 billion a year.
That doesn't bother Indiana's Republican attorney general.
Hill said earlier this year that regardless of any good it does, the Affordable Care Act remains a federal government overreach.
"This law's obvious incompatibility with the Constitution was the reason my office chose to challenge it," Hill said.
"Congress should never have imposed the one-size-fits-all mandate in the first place. Choice, freedom and the roles of the individual states must remain part of the health care equation in America."
No matter how the court rules, it's unlikely HIP would disappear immediately since any decision probably will be appealed to the U.S. Supreme Court.