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House lawmakers vote to extend Medicaid reimbursement boost for out-of-state pediatric hospitals

Indiana Republican Party website

The Indiana House of Representatives has unanimously agreed to extend a measure to make it easier for kids to access children's hospitals closer to home.

In the past, if a Northwest Indiana family had a child diagnosed with cancer, nearby Chicago hospitals wouldn't accept Indiana Medicaid. State Rep. Hal Slager (R-Schererville) says that meant families had to make the much longer trip to Riley Hospital for Children in Indianapolis.

"They're oftentimes there for several weeks trying to figure out exactly what's going on with the child and what they're going to do and what kind of treatment. You know, it's very difficult if you have other children, if you have jobs," Slager noted.

He said the situation was similar for Hoosiers near Louisville and Cincinnati.

Two years ago, Slager authored a new law to boost the Medicaid reimbursement rate for kids traveling outside the state for medical care, for a two-year trial period. It increases the reimbursement rate to what Medicare would pay for the same service or 130 percent of the Medicaid reimbursement rate.

"It really wasn't much of a fiscal impact because we were going to pay that to Riley, anyway. This was about making lives better for these Hoosier families," Slager explained.

But Slager said there have been some hiccups.

"Unfortunately, if you were to simply call one of these hospitals looking for care and said you were on Indiana Medicaid, you'd probably be told that they don't take it," Slager said. "They do."

He said that's because private pediatric hospitals still haven't finalized contracts with managed care entities. And a federal waiver ended up making the reimbursement worse, not better.

House Bill 1313, now headed for the Indiana Senate, seeks to extend the program to 2025, as state officials gather more data.

The measure has bipartisan support from Northwest Indiana lawmakers.

"For those choosing the quickest option to get their kid help, we need to ensure they're able to retain Medicaid coverage in bordering states," coauthor Rep. Carolyn Jackson (D-Hammond) said in a statement. "This bill would do just that, and I'm hopeful this will move through the Senate and onto Gov. Holcomb's desk.”

In the same statement, coauthor Rep. Chuck Moseley (D-Portage) called the bill "a financial life-saver." "We need to put people's lives and well-being over economics, and we can do that by making sure that folks on Medicaid will not be financially burdened if they have to seek care in a neighboring state. This legislation opens the door for people to seek the best possible care available to them, and it will surely help save the lives of Hoosier kids," Moseley said.

But a number of challenges remain. Slager said there still isn't a similar law for adults who travel out of state for medical care.

"One of the things I've learned is that the state agencies that are involved with all this are unfortunately not leading on solutions, and it's difficult to learn the language — in this case, the language of Medicaid — and to extract the answers and to understand even what the questions are," Slager added.

And there's also the issue of Illinois residents who use Indiana hospitals for general, non-emergency care. Slager noted that Franciscan Health's Hammond hospital was the closest hospital for many Illinois residents before it closed.

"Now, Community Hospital in Munster is getting the brunt of that. And so, that's something I'm looking at right now, is what's going on there," he said.

Slager said he needs to get more information on what Indiana hospitals are experiencing when it comes to reimbursement, before figuring out potential solutions.