Medicaid expansion is one of the Affordable Care Act’s mechanisms for bringing health insurance coverage to millions of uninsured. However, a June 2012 rulining by the US Supreme Court granted states the authority to refuse Medicaid expansion (and accompanying billions of dollars of federal aid, albeit short-term). As red as they come, it’s no surprise that Indiana is one of 22 states that have refused the expansion on the grounds that  Medicaid is a “broken system.”

As explained in a previous post, Indiana has been pushing the White House to accept its version of Mediaid managed care–the Healthy Indiana Plan (HIP)–rather than traditional Medicaid. CMS recently granted a one-year extension of HIP but called for sizable changes. The most significant change is a new limit on earnings; while HIP currently serves residents earning up to 200% of the federal poverty level (FPL) ($22,980 for a single adult), eligibility will decrease to 100% of the FPL ($11,490 for a single adult). While this will enable Indiana to increase enrollment in Medicaid managed care from 35,000 to 45,000 Hoosiers, it’s a far cry from Governor Pence’s original proposal to cover more than 400,000 Hoosiers through an expansion of HIP under his administration’s terms.

While the debate seems to have cooled, it could continue to be a work in progress since there’s no deadline within the PPACA for states to make a final decision about Medicaid expansion.