Even without expansion, 40,000 more join Medicaid

Even without expanding eligibility for Indiana Medicaid, the program had enrolled 40,577 more Hoosiers as of March than it had in the same month last year.

More than 15,000 of that year-over-year increase occurred in March alone this year, as a flood of people here and nationally sought coverage before Obamacare would hit them with a tax for going uninsured.

More than 1,094,000 Hoosiers are now enrolled in Medicaid.

The pace of new enrollment could be inflated a bit because the numbers include participants in the state's Healthy Indiana Plan insurance plan, some of whom have been allowed to stay in the program a few months longer than planned, due to the disastrous rollout of the Obamacare insurance exchange. Healthy Indiana Plan eligibility was reduced this year to a cap equal to the federal poverty limit because Obamacare now provides tax subsidies for private insurance to anyone with an income equal to the federal poverty limit or greater.

"It would be difficult to attribute the recent increase in enrollment to any one factor," Jim Gavin, a spokesman for the Indiana Family and Social Services Administration, wrote in an email.

"While there has been increased application activity in recent months, with some applications being transferred to us from the federal marketplace," Gavin added, referring to the Obamacare insurance exchange, "I would also point out that total enrollment includes Healthy Indiana Plan enrollment, which is higher this month due to increased applications and the fact that some of our members over the federal poverty level hadn't yet transitioned to exchange plans."

However, the pace of enrollment is actually a bit slower than predicted by a 2012 analysis by the Indianapolis office of Milliman Inc., a Seattle-based actuarial firm hired by the state government.

Milliman expected Medicaid enrollment to grow by 91,000 by this time in 2015 due to what it called Obamacare's "woodwork effect."

Milliman expected enrollment to roughly double from 2014 to 2015. If that prediction proves true, it means Indiana would end up with about 81,000 additional Medicaid enrollees, not 91,000.

Milliman's forecast figured each new Medicaid enrollee would cost the state an average of $885 per year. If that cost proves accurate, the additional 40,000 Medicaid participants added so far will cost the state more than $35 million each year.

This "woodwork effect" would be created, Milliman said, by Obamacare's "individual mandate" tax on those who failed to obtain health coverage, by an increase in referrals to the Medicaid program due to the launch of Obamacare's online health insurance exchanges and because some employers might stop offering coverage if its employees could gain coverage through either Medicaid or the exchanges.

The individual mandate tax this year will equal $95 per adult or 1 percent of a household's income. Indiana Medicaid restricts enrollment to adults now making just 25 percent of the federal poverty limit, or less than $6,000 per year for a family of four.

Children are covered even if their household income is as high as 250 percent of the federal poverty limit, or up to $59,625 per year for a family of four.

Gov. Mike Pence and his staff are currently negotiating with the Obama administration to use the Healthy Indiana Plan to expand Medicaid coverage to Hoosiers earning up to 138 percent of the federal poverty limit, as called for by the Obamacare law.