Uninsured children expected to grow Medicaid rolls

 The analyst hired by the state to estimate the impact of the federal health care law told Indiana lawmakers Tuesday that an unintended consequence could unearth tens of thousands of children who qualify for Medicaid but are not enrolled.

Rob Damler, an actuary for Milliman Inc. in Indianapolis, told members of the House Ways and Means Committee that residents are expected to grow the state's rolls in the coming years as the individual mandate forces low-income residents into federal coverage.

Milliman estimates roughly 92,000 more residents will seek Medicaid coverage under the "woodwork effect" next year and about 77,000 of them will be children. The boom in Medicaid enrollment is expected to cost the state $612 million over the next seven years, gradually increasing each year as more residents seek federal coverage.

"Where we anticipate a lot of this enrollment to occur is when children are brought to the emergency room or hospital setting, some sort of institutional setting where presumptive eligibility can be provided and these children are identified as potentially Medicaid eligible, however uninsured they can now enroll into the Medicaid eligibility programs," Damler said.

Medicaid spending is weighing heavily on lawmakers drawing up their next two-year budget this session, and that's without considering any expansion of the program under the federal health care law.

Milliman determined in its latest analysis, issued last September, that Medicaid spending will increase $67 million next year and $105 million in the 2015 fiscal year based on the "woodwork effect" alone. Accepting the full Medicaid expansion proposed in the Affordable Care Act, which would qualify residents for federal coverage who earn 133 percent of the federal poverty level, would cost an extra $95 million next year and $152 million in 2015.

Republican Gov. Mike Pence has ruled out building a state-run insurance exchange under the federal law, but has said he is open to the Medicaid expansion if the General Assembly wants it.