Eliza Brader was cut off from Indiana’s Medicaid expansion program, the Healthy Indiana Plan, once.
Brader, 27, moved to Bloomington from New Mexico in 2019 to start her master's degree in public affairs at IU. She also moved to be closer to the national clinic for her rare genetic disease, Hypermobile Ehlers-Danlos Syndrome, which had just relocated to Indianapolis.
As a master's student, she didn’t qualify for university sponsored health insurance, so she got on HIP.
In 2019, Brader’s ability to walk began to deteriorate, forcing her to pursue getting a wheelchair — often a long process that can take several months. Hurdles include approval from a doctor, approval from a physical therapist and getting insurance to cover the cost.
However, during this process, her HIP status went under review. That was when she found out her work study program didn’t count under then-HIP work requirements. At the time, Brader was working 15 hours a week in work study and going to school full time.
The state cut her from the plan in October 2019.
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Indiana Senate Republicans have made reforming HIP one of their top priorities, a move that could effectively cut nearly 200,000 Hoosiers off the plan, and constrict its benefits.
Proponents say reform is needed to save money.
HIP is an expansion of Indiana’s traditional Medicaid program, providing low-income adults from ages 19-64 without disabilities with accessible health insurance. To be eligible for HIP, someone's income must be no more than 138% of the federal poverty level.
State Sen. Ryan Mishler, vice-chairperson of the Medicaid Oversight Committee and chair of the Indiana Senate Appropriations Committee, proposed Senate Bill 2 on Jan. 14, which would cap enrollment in HIP at 500,000, with all remaining users put on a waitlist.
As of December 2024, almost 2 million Hoosiers are enrolled in Medicaid. 686,364 of those Medicaid recipients are enrolled in HIP. In Monroe County, 25,628 people are enrolled in Medicaid, 10,449 of whom are enrolled in HIP.
Mishler was not able to do an interview within the Indiana Daily Student’s two-week deadline.
Adam Nuñez, a 55-year-old Monroe County resident, got onto HIP when he faced chronic back issues and had to reduce his work hours at his physical labor-intensive job in 2017.
He was removed from the plan after having Medicare for a year but is now on Qualified Medicare Beneficiary. He said the proposed cap could be devastating for current HIP users, as they often require prescriptions and consistent doctor’s appointments. He said that without HIP, he does not know how much healthcare would cost him or if it would be affordable.
Nuñez added that it is dangerous to push people into the private healthcare system by removing or waitlisting them from HIP.
“There’s going to be procedures that are going to be rejected. There’s going to be doctors’ visits that are going to be refused,” he said. “I just think it immediately becomes unaffordable for a lot of people.”
Mishler’s proposed bill would also limit individual coverage to only 36 months of one’s lifetime.
Tracey Hutchings-Goetz is the communications and policy director for Hoosier Action, a grassroots organization dedicated to “improving the everyday lives of Hoosiers.” She testified during the Senate Appropriations Committee Hearing of SB 2 on Jan. 16.
The bill is set to proceed to a committee vote. After testimonies, Mishler announced he would hold the bill for adjustments, but it would ultimately return for further votes.
“At 36 months, people don’t magically stop needing healthcare,” Hutchings-Goetz said, referencing diabetics who rely on HIP for insulin and cancer patients who need HIP for their chemotherapy. “The idea that those care needs disappear in 36 months is absurd.”
The bill would also bring back most Medicaid work requirements, which a federal lawsuit prompted Indiana to suspend in late 2019. Biden’s administration revoked the work requirements in 2021 in response to worries that the requirements would lead to substantial loss of coverage during the pandemic.
These requirements previously necessitated some Hoosiers on HIP to work no less than 20 hours per week in order to remain beneficiaries. The current proposed bill would require federal approval to reinstate work requirements and would likely create another waitlist for those unable to work.
“People need that care to be able to work,” Hutchings-Goetz said. “The idea that you somehow will earn or deserve healthcare by working is exactly backwards.”
Mishler told Indiana Public Broadcasting that those removed from the program should not lose coverage completely, since they can find and access insurance through the federal health insurance marketplace. However, for many people qualified for HIP, insurance outside of HIP is unaffordable.
“Having the HIP when I wasn’t on Medicare, I mean, it was amazing,” Nuñez said. “I couldn’t believe the state had such a good system.”
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Mishler pointed to Medicaid budget shortfalls as a reason for implementing SB 2, saying, “We can only spend what we have.”
However, capping or ending HIP is unlikely to save the state money. The program is 90% funded by the federal government, and the remaining 10% paid by Indiana is covered by cigarette tax revenue and hospital assessment fees. Though the cigarette tax revenue, equaling about $97 million in 2024, could be used to cover another state cost, cutting HIP users off would create new costs, Hutchings-Goetz said.
Hutchings-Goetz said those costs could include the re-enrollment and re-verification processes of those who are kicked off. She said money from the plan, mostly from the federal government, would stop going to healthcare workers and subsequently the state’s economy.
“That money goes towards the jobs of the people who work at the insurance companies that run HIP, it goes to your health care provider,” she said. “We’re pulling $3.5 billion out of our economy and from probably tens of thousands of jobs that HIP pays for, like good health care jobs.”
She said the reform would also hit people who are only part-time workers or independent contractors, who often do not receive insurance benefits from their workplaces.
“Down the line, in terms of public health, you’re looking at not only an increase in death, but people get sicker,” she said. “And when they get sicker earlier, their care and treatment becomes more expensive down the line. So, there’s absolutely no cost savings to this proposal.”
Hutchings-Goetz said the bill must still go through multiple hurdles before it is passed, and suggested people email or call any of the 13 members of the Senate Appropriations Committee to make their voices heard in the decision.
“It is cruel, it is dangerous, it is a job killer, it is a people killer and it will hurt our economy,” she said. “Even if you think that this bill is not going to affect you, you will experience its impacts.”
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![camedicaid012625(1).jpg](https://snworksceo.imgix.net/ids/0d94991b-ea07-4d9a-8d1d-a6e08eefe8af.sized-1000x1000.jpg?w=325&dpr=2)
Eliza Brader is pictured. Brader got back onto HIP in April 2020 after a federal lawsuit prompted work requirements for the program to be dropped.
The proposed reform is also concerning to some that consider HIP benefits vital. Brader said the plan saved her life.
Brader got back onto HIP in April 2020 after the federal lawsuit prompted work requirements for HIP to be dropped, allowing her to finish the wheelchair-acquirement process.
During the process, her condition worsened to the point where she could often not stand up without blacking out.
Getting her wheelchair took seven months.
In 2021, she was diagnosed with a rare spinal injury, Craniocervical Instability, after hitting her head in a car accident. This turned out to be the cause of her inability to walk without fainting. She had to get spinal fusion surgery, which cost about $100,000 for a one-week inpatient stay. Luckily, the surgery was successful, and HIP was able to cover its costs.
After surgery, a month of recovery and attending a rehab hospital for three weeks, Brader relearned how to walk.
Though she could potentially access regular Medicaid due to her genetic disease, she is not considered eligible due to Indiana’s monetary and income-based requirements. A single adult must make no more than $1,255 a month and have no more than $2,000 in saved assets.
Brader said, like many others, she does not quite quality for disability, but finding a full-time job is incredibly difficult due to her health.
“Disability (as considered by the state) is essentially just surviving barely, and I want to do more than that,” Brader said. “I went to a lot of trouble to relearn to walk, I finished this master’s degree, I want to work. I came from a very low-income household, so for me, the idea of continuing to live in poverty for the rest of my life is just not appealing.”
Brader said the 36-month lifetime limit could be “life-limiting” for those who have lifelong disabilities or even disabilities that last more than three years.
“I wouldn’t be able to survive without it,” Brader said. “But at the same time, it is so stressful, living in the constant fear of the state just deciding one day that I don’t deserve this medical care that I need to survive.”