In what I think is a very significant political development, Governor Mike Pence announced his intention to submit a Section 1115 Medicaid waiver proposal to the federal government by the end of June, which would extend coverage to the newly eligible parents and adults below 133% of the federal poverty line.

One reason Indiana was not a surprise is because at the end of last year, the state, like Oklahama, received a one-year extension of its waiver program (known as “Healthy Indiana”) through the end of December 2014. So, note to Oklahoma, it is time to get moving on your waiver renewal to avoid a loss of coverage for those approximately 19,000 individuals enrolled in “Insure Oklahoma”.

There is still a lot to sort out here with respect to the details, so I will no doubt be blogging more on this topic.  But to provide a topline summary, Governor Pence is seeking to build on his existing Healthy Indiana program to extend coverage to the roughly 300,000 Hoosiers who stand to benefit from expanded Medicaid coverage. Healthy Indiana is best known for its use of “POWER” accounts, which purportedly promote consumer-driven care. (More to say on that in future posts.) You can see the waiver proposal here, and it will shortly be open for public comment at the state level.

But to shorthand this for you, those of you who have been following recent state activity, this is not Arkansas. No proposal here to buy private coverage in the marketplace – although the Governor indicates that he wants to expand premium assistance for employer-sponsored insurance (including for kids so we will definitely keep a close eye on this one) but that seems to be down the road in 2016.  So this one is more like Iowa – requiring premium-like contributions and limiting non-emergency medical transportation like Iowa did. For those who do pay their premiums, there appear to be rewards – in this case vision and dental benefits. But for those who don’t the state is seeking a very punitive lockout period of 6 months.

While I haven’t read the entire proposal yet, I always turn first to my favorite part, the actual list of waiver requests. There are ten such requests including a waiver of retroactive eligibility, playing around with the benefits as mentioned above, issues related to the POWER account, and significant copayments above acceptable levels.

So lots more to dig into, but to sum up, I think compromise is in the air on this one. There are clearly issues that will require more negotiating but I think the state and the feds can get to yes. And given that Pence is being talked about as a serious Republican presidential contender, his willingness to say yes could open the door for other states.