Testimony to House Public Health Committee on Senate Bill 551
Family Voices Indiana serves Indiana families who are raising children who have disabilities and special health care needs. As our state’s federally funded Family to Family Health Information Center we help families navigate the world of Health Care Financing. Today, I am here to speak about how Senate Bill 551 impacts the families we serve and will address, Medicaid Block Grants, Health Benefit Exchange Navigators, and Medicaid Expansion.
In our direct work with Hoosier families we see the complexity of health care financing and are well versed in the variety of intricacies of eligibility and access. Given this, you might assume that we embrace the promise of reduced bureaucracy offered by the concept of a block grant. However, the opposite is true: we have deep concerns that block grants would create an Indiana Medicaid system that offers reduced access to and coverage for children and adults who have disabilities and complex health care needs, as this group is disproportionately costly. A block grant creates an environment where cost controls put the health and well-being of the children we serve at risk. The Children we serve rely on the protections of Early Periodic Screening, Diagnosis and Treatment (EPSDT) which requires that Indiana cover all medically necessary services for children who financially qualify for Medicaid or participate in Medicaid waivers, this protection would not exist with a block grant. Similarly, a block grant could eliminate Indiana’s Medicaid Waiver system leaving children without the supports and services that allow them to at home with the families who love them.
Our work with families reflect that real need for a robust network of Health Benefit Exchange Navigators in Indiana ready to assist families in navigating insurance options available under the ACA. We are concerned the regulations for Navigators currently outlined in SB 551 will prevent many existing grassroots and community organizations from serving in this role. The proposed regulations more closely match those of insurance agents than the role outlined in the ACA. We urge you to pass regulations that meet the ACA requirement, yet remain broad enough to allow community organizations throughout our state to serve in this role.
As we have followed the discussions about Medicaid expansion in Indiana and the possibility of using HIP as a vehicle to accept the federal dollars we urge you to move in a way that allows Hoosiers to benefit from expansion. In our work this issue is about parents. Thankfully the overwhelming majority of children we serve have pathways to coverage. But in truth that is not enough; what happens to their parents matters. Several studies have concluded that parental coverage improves the continuity of coverage in children and access to care and reduces the likelihood of breaks in coverage. We have found this to be true for the families we serve. We also see how critical preventative health care is for parents of children who have special health care needs; the stresses of care giving greatly raise the importance of access to care for this population of parents.
Today we ask you to make sure that an option for low income parents continues to be available. Much has been said about the use of HIP as the expansion vehicle. In its current form HIP includes some barriers to coverage that disproportionately impact the parents we serve.
· Families raising children who have disabilities and special health care needs often have significant burdens on their budgets that make the premium requirements unmanageable. A parent whose child requires a nutritional supplement that costs over $200 a month is not able to reallocate those funds to pay their own premiums.
· Parents of children who have disabilities and special health care needs are all too aware of the overwhelming reality of unexpected medical cost and are skeptical about coverage that contains yearly and lifetimes caps and thus they may not access coverage that is limited in this way.
· The current eligibility parameters of HIP do not allow for seamless coverage transitions between the Health Insurance Exchange for parents whose income changes. This is critical for the families we serve as they need a way to maintain coverage when their child’s medical needs require a change in their work status.
We are committed to appropriate reform of Medicaid and all dimensions of our country’s s social safety net, and remain engaged in ongoing discussions at the federal level. We urge you, as leaders here in Indiana, to be an active voice in that effort. We believe strongly that what is best for Indiana families is not to pass legislation that is at odds with federal leadership; instead Indiana needs legislation that allows federal programs and dollars to work for Hoosier families.
In short, Family Voices Indiana asks that you pass legislation that allows families and communities to benefit from the Affordable Care Act, have access to Medicaid Expansion and are the support of a network of navigators and that continues to work within the protection that Medicaid includes for individuals with disabilities and special health care needs.