But some of the other points in the Tennessee proposal might have raised eyebrows in the Hubert Humphrey Building. The governor proposed “co-pays for those who can afford to pay something.” As for what that would mean in practice, Andy Sher at the Chattanoga Times Free Press reports that the governor wanted Medicaid beneficiaries to pay the same cost-sharing as other exchange enrollees.
Medicaid experts I’ve spoken with have made it clear that such an approach wouldn’t fly: Even if they receive private coverage, the Medicaid agency would need to ensure they aren’t spending more out of pocket than they would in the public plan.
Unfortunately, this seems to be one of the things that Gov. Pence wants Medicaid-eligible people to do in Indiana as part of the HIP. I have believed, and now believe more strongly, that HHS will not approve such a plan.
This bodes poorly for the Medicaid expansion in Indiana.