Latest news with #FSSA
Yahoo
2 days ago
- Health
- Yahoo
‘Indiana needs a HIP replacement', social services secretary says about insurance program
Mitch Roob, secretary of the Indiana Family and Social Services Administration, presents to the State Budget Committee on June 18, 2025. (Whitney Downard/Indiana Capital Chronicle) In his second tenure leading Indiana's most expensive state agency, Family and Social Services Administration Secretary Mitch Roob wants to significantly change Indiana's insurance program for low- to middle-income Hoosiers. But ongoing negotiations in Washington D.C. could undermine or fundamentally alter the third iteration of the Healthy Indiana Plan, otherwise known as HIP. Some congressional changes could be prohibitively expensive for the state, coming on the heels of a bleak revenue forecast projecting $2 billion less in Indiana's coffers over the next two years. 'This is a five-alarm fire for us,' said Roob, who introduced the first version of HIP while he was the FSSA secretary under former Gov. Mitch Daniels. In a sit-down with the Indiana Capital Chronicle, Roob previewed a Wednesday presentation before the State Budget Committee introducing HIP 3.0, including work requirements, provider taxes and wellness incentives. But the final details can't be determined until Congress agrees on President Donald Trump's 'big, beautiful bill,' which could be approved in the coming weeks. GOP senators warn mega-bill's new Medicaid cuts will hurt rural hospitals Work requirements for able-bodied adults on HIP were fiercely debated in the legislative session earlier this year, ultimately advancing with the support of the Republican supermajority. But the process would take months, requiring Indiana to submit a modified waiver for federal approval before it could be enacted. That timeline could be shortened under the latest version of the bill, which would force all states to adopt such regulations. 'Once the big, beautiful bill passes, we will move forward as quickly as we can with that,' Roob said about work requirements. Other states have stumbled in their rollout of such conditions, including Arkansas and Georgia. Roob said details of Indiana's plan would largely hinge on Congress' actions and pointed to support from Indiana Gov. Mike Braun. 'He believes in work requirements; he doesn't believe in work requirements to kick people off of the program,' said Roob. 'He believes that Medicaid ought to be a program that incentivizes individuals to work — not disincentivizes them to do so.' While Indiana's work requirements would have allowed an exception for parents in general, Congress now proposes limiting that exemption to parents of children who aren't teens. More than 712,000 Hoosiers rely on HIP for their health coverage, according to a May enrollment report. Other portions of the bill threaten to undo Indiana's program, particularly its cap on state provider taxes, according to Roob. The Senate has proposed a cap of 3.5% on the levy, which applies to hospitals and managed care entities. A higher tax means the state can leverage more federal dollars. But Indiana uses the maximum allowed tax of 6% on hospitals, known as a hospital assessment fee, to fund its obligation for HIP. Those taxes — along with a portion of the cigarette tax — pay for the entire program, meaning that no general fund dollars need to be dedicated to HIP. 'That's how we pay for the Healthy Indiana Plan,' Roob said. 'If (Congress' proposal is) signed into law, this would require the state of Indiana to significantly roll back eligibility in the Healthy Indiana Plan. 'Not because we want to — because we have no match.' Indiana is responsible for 10% of the costs while the federal government picks up the tab for the remainder. However, under its current waiver, Indiana could be on the hook if the hospital assessment fee is cut and would need to come up with the difference. Roob said he was working with Indiana's congressional delegation to provide states explicit authority to change their plans in a later version of the bill. This rate cap would also apply to any provider tax levies on managed care entities, which oversee several of Indiana's Medicaid programs, including services offered under the divisive PathWays for Aging waiver. Indiana submitted a plan to tax managed care entities earlier this month based on the plans of other states, such as Ohio and Illinois, which could net the state $865.8 million. But Congress could invalidate that proposal by prohibiting that type of tax, which isn't uniform and varies by provider type, in favor of something more equal across the board. 'It is not law yet, so we are racing to try to get this approved,' said Roob. 'I view our prospects of getting this done as not quite as good as the Pacers winning the series.' Portions of the proposal in Congress would require copays and premiums for certain Medicaid enrollees, something that was halted in Indiana by a federal judge last year. If allowed, Roob said the state would 'likely' bring that back — though he said the state was seeking more 'explicit authority' to implement cost-sharing requirements in the final version of the bill. Undoubtedly, such a move would be challenged in the courts. But Roob said Hoosiers on HIP could reduce such charges by meeting certain wellness guidelines, such as preventative care check-ups. Women getting regular pap smears, for example, would lower their cost-sharing obligations. 'And while we recognize that that won't save Indiana much money in that particular year, it may save that woman from having cervical cancer,' Roob said. 'So it is the governor's desire to 'Make Indiana Healthy Again,' and part of that is to incentivize changes in behavior.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Chicago Tribune
4 days ago
- Business
- Chicago Tribune
Indiana budget cuts threaten On My Way Pre-K
Indiana is slashing statewide funding for its pre-kindergarten program and advocates say it could reverse years of growth in supporting its most vulnerable children prepare for school. On My Way Pre-K provides state vouchers for quality, free preschool for 4-year-olds from income-eligible families. Earlier this month, the Family and Social Services Administration announced it trimmed back the program because of a state budget shortfall. Former Gov. Mike Pence signed legislation establishing the program as a pilot in 2014 and heralded its enrollment. Pence later flip-flopped back and forth on his willingness to take federal dollars saying he didn't like the 'strings attached.' Under former Gov. Eric Holcomb, the program expanded statewide in 2019. With a voucher, children can attend participating private and public preschools authorized by the state. Last year, the FSSA said On My Way Pre-K increased enrollment to about 6,200 students, with federal funding assistance. By June, the FSSA said it would limit available seats in the program to 2,500 in the wake of a 10% budget cut. Since 2017, the FSSA's Child Care and Development Fund has been a funding stream for On My Way to Pre-K, but recently it saw a funding decrease and now has a waitlist of 18,000 children waiting for an available subsidy. GOP lawmakers pushed through early education cuts when a $2 billion budget deficit loomed because of a lowered revenue growth outlook, under President Donald Trump. When the session began in January, Gov. Mike Braun sought $369 million for the Child Care and Development Fund and the doubling of funding for On My Way Pre-K. He also wanted to eliminate the CCDF waitlist. The cuts worried early education providers and rankled one local House member. 'It's going to be impactful to a lot of children who won't have access,' said Karen Carradine, Head Start Geminus Vice President of Early Childhood Services. Carradine said the state cuts won't impact Head Start but will make a big dent in state provider funding. 'It will tremendously reduce state vouchers and the funding to pay for the vouchers. In On My Way Pre-K, they've changed the rules,' she said explaining providers will have to pay 5%, possibly out-of-pocket. 'That's a big hurdle and children will get 46 weeks, instead of 52 they have to attend. 'I feel providers will be looking at how many they can serve. And at the end of the day, it comes down to dollars and cents,' she said. The Gary Community School Corp. offers an On My Way Pre-K program at its Bethune Early Childhood Development Center. Superintendent Yvonne Stokes said the district still isn't sure of the impact. 'We are committed to supporting any affected families by identifying other resources and means to help fill the gaps of any shortages,' she said. Meanwhile, state Rep. Carolyn Jackson, D-Hammond, voiced concern Monday about the impact of the On My Way to Pre-K cuts. 'Over 85% of 4-year-olds in Indiana do not have access to preschool. On My Way Pre-K is already an extremely limited program to help the most vulnerable afford to send their children to pre-K. 'Now, 3,500 fewer Hoosier children will likely not be able to enroll in pre-K because their families cannot afford it without the voucher.' Jackson, a member of the House Family, Children and Human Affairs Committee, said the financial incentive for providers to accept On My Way Pre-K vouchers decreased up to 46% in Lake County. 'Reducing this incentive will reduce class sizes even more. Families who desperately want to give their child a leg up with early childhood education are being left high and dry,' said Jackson who added Indiana was one of six states that don't fund universal Pre-K. 'If pre-K is a luxury that only wealthy families in well-off suburbs can afford, children living in underserved communities will be hurt the most,' said Jackson. She criticized Republican lawmakers for cuts to early childhood education, but still green-lighting $1.2 billion to expand private school vouchers. 'This is not about fiscal responsibility. This does not help working Hoosiers. This policy is harmful for children, families and our economy,' Jackson said.
Yahoo
30-05-2025
- Business
- Yahoo
FSSA secretary: Braun administration ‘inherited a mess'
FSSA Secretary Mitch Roob addresses a crowd at the Indiana Fiscal Policy Institute's 2025 Policy Summit on May 30, 2025 to discuss the agency and Medicaid policy. (Whitney Downard/Indiana Capital Chronicle) When it comes to the Family and Social Services Administration — which oversees Medicaid alongside other state programs like child care subsidies — Gov. Mike Braun 'inherited a mess,' FSSA Secretary Mitch Roob said Friday. Roob is taking his second turn leading the agency, which has the single largest budget due to its federal funding. Previously, he led FSSA under former Gov. Mitch Daniels. Donning his now-standard 'Make Medicaid Boring Again' hat, Roob said the state had 'no other choice' than to make the program more sustainable and fiscally sound. He spoke at the Indiana Fiscal Policy Institute's 2025 Policy Summit in Indianapolis. 'Very few people wear — other than (President) Donald Trump — wear their job description on their hat, but I do,' said Roob. 'That is our task for the next four years.' House GOP overwhelmingly votes to impose Medicaid work requirements Under Daniels, Roob launched the earliest version of the Healthy Indiana Plan, which covers moderate-to-low-income Hoosiers but has grown since its first iteration. HIP 3.0, on the other hand, would return to its roots and 'inject personal responsibility for able-bodied adults again,' Roob said, putting it into alignment with federal discussions on work requirements for the Medicaid program. Also in his first term, Roob said the agency conducted monthly finance reporting and other fiscal checks to tamp down on spending. He said departing from that norm in subsequent administrations is when the program went awry, pointing specifically to cost growth for applied behavior analysis therapy and attendant care. The former is a treatment sought by some parents with autistic children while the latter is a program that previously allowed parents to be paid as caregivers for their children with complex medical needs. '… that lack of accountability, that lack of paying attention to the dollars is why we had ABA therapy growing at a pace that we did. It's why we had attendant care growing at the pace that it did,' said Roob. 'It's very difficult to put that genie back in the bottle here because, in both of those cases, we had created, inadvertently, a dependency.' He never specifically named former Gov. Eric Holcomb in his criticism. In 2019, Indiana's Medicaid program spent $120 million on ABA therapy, but the program ballooned to $639 million by 2023. In response, Braun established a panel to consider cost controls earlier this month. 'If you think this is sustainable, you're budgeting at the federal level,' quipped Roob. 'Because this will bankrupt Indiana.' Similarly, attendant care costs for parents of disabled children grew rapidly during that time span. Roob said the agency spent $11 million monthly in July 2020 but the number soared to $84 million each month by May 2024, when the agency diverted parents to a structured family caregiving program that paid at a lower rate. Combined, Roob said those numbers contributed to a December 2023 state forecast determining Indiana was $1 billion short in its Medicaid budget. Providers, seniors continue to experience challenges under PathWays program 'Many folks look at the Medicaid program and they go, 'How did you get in debt a billion dollars?' Well, it's because you have so many more people receiving care and help. Because we are paying so much more for very discrete parts of the agency,' Roob said. Another program that transitioned care for elderly Hoosiers from state oversight to a contract with insurers — known as managed care entities — would 'never' be something he would pursue, said Roob. 'I have been quite clear this program … I never would implement (it),' said Roob. 'Because it's very difficult for managed care companies to manage the care of individuals who are in nursing homes. What is the value?' Early pitches said the PathWays to Aging program would deliver savings because the state would pay a flat fee for Hoosiers and private companies would manage their care, rather than Indiana paying piecemeal for every cost. However, the transition to get there 'is very difficult,' Roob said. 'We have not, today, seen the results that we are hoping for,' said Roob, adding that the state will pay $300 million extra to the companies in cost overruns this year. '… it's been painful for everybody involved so far and that pain shows signs of easing — but only signs.' Roob didn't limit his criticisms of previous administrations solely to health care programs, also saying there was 'a lack of planning' when it came to the state's child care options. Roughly 75,000 children currently receive some form of child care through the agency, an increase initially funded by federal pandemic dollars, Roob said. 'Their plan was in April of this year simply to take children off of the child care program with no particular warning,' asserted Roob. 'Gov. Braun and the legislature felt that was probably not the best answer, so they have allowed us to create a slope to slowly dr0p people from the child care program. 'That doesn't minimize the fact that we're losing over 20,000 daycare slots for the children of men and women who make below 127% of the poverty level,' continued Roob. CONTACT US Additionally, the 'lack of planning and forethought by our predecessors' meant that there would be even fewer options for parents seeking child care for infants or one year olds. Part of the problem with Indiana's Medicaid spending can be attributed to the state's high health care costs, an explicit priority for Braun. Since his tenure under Daniels, Roob said the disparity between what Hoosiers pay and what they receive has worsened. 'When Gov. Daniels was in office, I used to tell people that Indiana residents were buying a Cadillac and getting a Chevrolet,' Roob said. 'Unfortunately, today, we're no longer driving Chevrolet. We are driving a used Kia.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
09-05-2025
- Health
- Yahoo
Indiana panel to consider ABA therapy cost controls
A psychologist takes notes on a clipboard in a therapy session for children. (iStock/Getty Images Plus) Twenty-one agency leaders, health industry professionals, disability advocates and others will look to contain Medicaid spending on Applied Behavior Analysis (ABA) therapy — while ensuring continued care for thousands of young, autistic Hoosiers — the Indiana Family and Social Services Administration (FSSA) announced Friday. Gov. Mike Braun directed the agency to create the working group in a February executive order. A report featuring three cost-containment recommendations is due by December. ABA therapy is commonly used to improve social, communication and learning skills in children and young adults with autism or other developmental disorders. Some critics, however, object to the teaching tool and say it encourages compliance over independence. Additionally, some practitioners coupled it with electroshock therapy as late as 2022. Indiana Medicaid spending on ABA therapy has risen over time: 2019: $120 million 2020: $102 million 2021: $276 million 2022: $420 million 2023: $639 million Source: Indiana Capital Chronicle reporting Nevertheless, it's increasingly popular. Families, however, often struggle to access the therapy because of the price, limited insurance coverage and other health care industry stumbling blocks. State coffers are also taking a hit. Indiana Medicaid expenditures for ABA therapy rose from about $14 million in 2017 to $120 million in 2019, according to FSSA, then dipped to $102 million in 2020 — still the second-highest in the nation, per U.S. Health and Human Services' Office of Inspector General. The cost surge prompted the federal office to audit Indiana's 2019 and 2020 ABA payments. The 2024 report found at least $56 million in improper payments — citing problems with documentation, diagnostic evaluations, staff credentials, referrals and more. It recommended that Indiana refund more than $39 million to the federal government. Soaring totals since then have prompted greater scrutiny from Hoosier leaders worried Medicaid costs are growing too much, too fast. The financial pressure has only worsened. A grim April revenue forecast forced lawmakers to cut $2 billion in spending out of the state's next two-year, now-$44 billion budget. Braun's order charged the working group with evaluating cost-containment strategies that 'minimize the negative impact felt by enrollees and their families.' He directed the group to evaluate the 'best' clinical care models to provide the right therapy in the right setting at the right ages. The order sought recommendations for 'a better coordinated experience' for children, 'but in a financially sustainable manner.' Under the order, group members must also consider potentially implementing quality metrics for ABA services, caps on the number of therapy hours per week, caps on the number of months children can receive the therapy, an appeals process for 'extenuating circumstances' along with new provider enrollment and billing requirements. The 'comprehensive review' of ABA therapy in Indiana should 'identify key drivers of Medicaid expenditures,' Friday's news release read. An evaluation must be completed by September 30. A written report has to include three recommendations for 'meaningful' cost-containment, plus the advantages and disadvantages for each recommendation. That's due to Braun by November 30. The working group's members include: FSSA staff, some of whom lead disability and Medicaid utilization efforts Health care industry representatives, including a pediatrician, psychiatrist and a health insurance company lobbyist Autism, other disability and special education organization advocates State lawmakers Other parents Controversy over ABA cuts ensnarled Braun's predecessor, former Gov. Eric Holcomb. Families rallied repeatedly, urging Holcomb and his FSSA to reconsider. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Indianapolis Star
08-05-2025
- Business
- Indianapolis Star
The Indianapolis Star Subscription Offers, Specials, and Discounts
As Indiana officials try to rein in spending in the face of a predicted revenue shortfall, advocates fear a behind-the-scenes move to privatize the state's Adult Protective Services program could prevent elderly and at-risk Hoosiers from receiving the help they need. Indiana Family and Social Services Administration confirmed to IndyStar that it has awarded PCG-Indiana Inc. a 3-year contract, estimated at more than $19 million, for the firm to staff and operate Adult Protective Services starting July 1. An award letter released April 30 greenlighted contract negotiations with the company. The contract could contain an option for the state to add three one-year extensions, potentially lengthening the deal to six years. Indiana's Adult Protective Services is responsible for investigating reports of neglect, abuse and exploitation of vulnerable adults and coordinating a response to protect them. Traditionally, FSSA has contracted with the Indiana Prosecuting Attorneys Council 's hub prosecutor offices to operate the program, but those contracts expire on June 30. The new contract takes Adult Protective Services out of the hands of local prosecutors, who for years have complained that Indiana underfunded the program, and puts the program under a subsidiary of Boston-based Public Consulting Group. The parent company, with offices in nearly a dozen states, works with public-sector health, human services and education agencies. PCG-Indiana, the subsidiary, has contracted with Indiana since 2010, providing consulting services related to education, children and social services, and workforce development, according to public records. "Over the next two months, the Division of Aging, will work with PCG-Indiana and the current APS units to establish an APS model for Indiana that is in line with new federal requirements and best practice recommendations," FSSA said in an emailed statement. Public Consulting Group did not respond to a request for comment. Meanwhile, prosecutors and advocates say FSSA hasn't been transparent about the procurement process and what the APS model would look like under a private contractor with a motive to make a profit. "It's been a very opaque discussion that's been going on the state level with regard to what's going on with APS," said H. Kennard Bennett, executive director and senior counsel for the Center for At-Risk Elders, Inc., a lawyer-led nonprofit that provides guardianship and advocacy for endangered adults in Marion County. "They've not sought any input from any stakeholders." Adult Protective Services fields 20,000 calls a year A report is made to Adult Protective Services whenever an individual 18 years or older is suspected of being deprived of food and water, improperly clothed, neglected medically, exploited financially, or in other ways. In 2023, Adult Protective Services received more than 20,000 calls for service, according to the FSSA Division of Aging Adult Protective Services 2024 Annual Report. Of those, 11,653 cases resulted from the calls. Vulnerable adults can include individuals unable to care for themselves due to age, mental or developmental disabilities, incapacitating injuries, mental illness, or those suffering from isolation or neglect. The program, which resides in FSSA's Division of Aging, is funded through state appropriations. Indiana operates Adult Protective Services within the county-based criminal justice system and contracts with 17 prosecutors to administer it through a hub model. Most hubs service multiple counties. Prosecutors say the program repeatedly had funding issues. "For multiple budget cycles, the State and the Family and Social Services Administration (FSSA) declined to provide sufficient financial resources to the Adult Protective Services (APS) program, leaving prosecutors concerned that the standard of care to Indiana's increasing elder population and vulnerable adults could not be maintained," Whitney Riggs, spokeswoman for the Indiana Prosecuting Attorneys Council, said via email. A 2016 IndyStar investigation revealed that Indiana Adult Protective Services was too understaffed, underfunded and ill-equipped to handle the deluge of calls requesting assistance for at-risk adults. At the time, Indiana had budgeted roughly $3.5 million for the program — significantly less than other states. The lack of support left adults who could not protect themselves exposed to abuse and neglect, and well-intentioned investigators overwhelmed by caseloads. Shortly after the investigation was published, Indiana lawmakers pledged an additional $1.1 million to hire more full-time investigators for adult protective services. But, advocates say funding shortfalls did not cease. The situation is becoming more dire as the state's population ages. "The hope was that there would be an approach taken to reorganizing the APS model into a better, more efficient agency and to fund it appropriately," Bennett said. "There was some more funds dedicated following that series of articles.... but, I don't think it has been sufficient by any means." Riggs said there have been times when county governments subsidized budgetary shortfalls, leaving residents of some counties to finance services for residents of other counties. "This was unsustainable long term," she said. According to the Adult Protective Services 2024 annual report, the APS Unit Contract was $5.6 million in 2023. The majority of the funding — $4.4 million — was from a state appropriation. The remaining $1.2 million was from federal Medicaid dollars. Acting on continued funding concerns, Indiana Prosecuting Attorneys Committee notified FSSA in late 2023 that the majority of hub prosecutors did not intend to renew their contractual relationship again. FSSA, in turn, issued in September 2024 a request for proposals soliciting vendors interested in administering the program. Prosecutors bid to keep providing services Riggs said the Adult Protective Services Hub Prosecutors Committee submitted a bid for the new contract. It was "at an amount of money that nearly forty years of experience doing this work told us would be the minimal amount of state money that should be allocated for a successful program, and in the same amount previously requested," she said. For months, the council heard nothing. It's unclear how the model for Adult Protective Services could change under PCG-Indiana. Neither the state nor the company responded to IndyStar questions about the for-profit company's plans for the program or what the transition would entail. IndyStar has requested copies of the state's initial request for proposal and the responses to it. According to the award letter recommending PCG-Indiana for the contract, the Massachusetts company will subcontract with three partners. Marion Edward Associates Inc., a Boston-based staffing firm, will get 9% of the contract value. Local consulting company Briljent LLC will get approximately 12% of the contract value while Axon Advisors LLC, a market research firm also based in Indianapolis, will receive about 4%. PCG-Indiana beat out IPAC's Adult Protective Service Hub Prosecutor Committee and Community Care Hub of Indiana for the contract. The proposals were evaluated by FSSA and the Indiana Department of Administration, which oversaw the procurement process. According to the letter, the agencies were made aware of updates that were part of the state's budget process and limited the maximum amount of funding available. Respondents were invited to withdraw or revise their proposals to align with the changes and new budget cap. "Only one of the three respondents updated their technical and cost proposals to align with a reduced scope of services within the new budget maximum. This Respondent was PCG," the letter reads. Said Riggs: "Prosecutors were hopeful they could persuade the state to provide adequate resources for this important mission." 2-month transition window causes concern Prosecutors, investigators and advocates who reached out to IndyStar have expressed concern about the lack of communication regarding the procurement process from FSSA and state officials. "We're very concerned about what will happen and I know the courts are very concerned about what will happen with APS," said Bennett, who wasn't familiar with PCG Indiana or Public Consulting Group. "I'm hoping that whomever takes on the contract provides good services to be able to respond to complaints that APS might receive, but I think I may have to take a wait and see attitude on that. He said FSSA has not sought input from stakeholders. Prosecutors will focus on a smooth transition and handover of the program, Riggs said, though advocates wonder if there's enough time to transition the program. The state awarded PCG-Indiana the Adult Protective Services contract just two months before the expiration of the current contracts on June 30, leaving some investigators to wind down active cases without a resolution and advocates wondering where they should turn to report suspected cases of abuse and neglect.
