Starting July 1, some Hoosiers on Medicaid will be required to work part time or risk losing their health coverage.

But there's a chance that might never happen.

Late last month, a federal judge blocked similar Medicaid work requirements in Kentucky and Arkansas, saying they went against the health insurance program's objective of providing medical care for the needy. And a lawsuit has been filed to stop the only other active program of its kind, in New Hampshire. 

So where does that leave Indiana?

Some observers say its new work requirements could be challenged in court, as happened in the other three states, and potentially overturned.

"Local lawyers are waiting to see how hard this hits their clients," said Sara Rosenbaum, a professor of health law and policy at George Washington University.

They may decide to sue to halt the program, she said, or they may determine that Indiana's version is "not as onerous" as the other states, that "maybe the state is taking a softer approach."

She said such a lawsuit likely would come from Indiana Legal Services, a nonprofit that provides legal assistance to the poor.

"We have heard concerns about the work requirements," said that organization's director, Adam Mueller. "We're exploring all legal options on behalf of our clients."

U.S. District Judge James Boasberg stopped Kentucky's program before it even started, saying the state never demonstrated that there wouldn't be a large loss of health coverage, while blocking Arkansas' work requirements, which resulted in nearly 20,000 residents getting thrown off Medicaid rolls since June.

In total, the Trump administration, trying to transition people off government assistance, has approved waivers for eight states to require Medicaid beneficiaries to work. But only New Hampshire and Indiana's are active.

"Indiana has had the opportunity to watch a couple of these other states implement their programs, and I'm sure they're able to probably learn from some of the mistakes other states have made," said Brian Tabor, president of the Indiana Hospital Association.

Indiana policy different?

He noted that Indiana's policy is less punitive. Arkansas residents who didn't comply for three months were kicked off Medicaid for the rest of the calendar year.

In Indiana, by comparison, people who are noncompliant for five months out of the year will have their coverage suspended beginning the next calendar year. Even then, they can get their Medicaid back as soon as they work 80 hours in a month.

And while Indiana's so-called Gateway to Work program technically started Jan. 1, Medicaid recipients don't have to start working until July 1. At that time, they will have to be employed 20 hours a month, a number that will increase to 60 on Jan. 1, 2020, and 80 on July 1, 2020.

Arkansas, by contrast, began its 80-hour requirement right away for Medicaid recipients between ages 30 and 49, then six months later for 19- to 29-year-olds.

"Indiana has taken a vastly different approach in implementing Gateway to Work," said Jim Gavin, a spokesman for the Indiana Family and Social Services Administration.

"We are using an extended ramp-up period to educate and engage members how to successfully report work, job training, education or community engagement activities."

And, as Gavin pointed out, Hoosiers can satisfy the requirements with activities other than actually working: looking for work, volunteering, homeschooling kids, studying for a GED, even taking care of grandchildren.

The requirements only pertain to people on the Healthy Indiana Plan, or HIP, which was Indiana's Medicaid expansion under Obamacare, not those with traditional Medicaid, Hoosier Healthwise (for children) and Hoosier Care Connect (for people who are elderly, blind or have disabilities).

Even then, many HIP enrollees are exempt from the requirements, including people with a serious illness or substance abuse disorder, pregnant women, students, the homeless, and Hoosiers 60 and older. FSSA predicts the requirements will apply to about 80,000 Hoosiers.

Hoosiers only have to log their hours annually, online or by calling their health plan (documentation isn't required). In Arkansas, residents had to report monthly, and at first could only do so online, before an outcry caused the state to add a phone option.

But even though Indiana's program is seemingly less burdensome, Tabor added: "I think it's certainly a possibility that someone may challenge it."


Health Reporter

Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World. He is a graduate of Northern Illinois University.