Limo Service in Lizton, IN

As Indiana lawmakers debate how to tackle the ever-rising cost of Medicaid, more than 10,000 Hoosiers in need of institutional-level care remain on waitlists for certain waiver services.

There's little sign Indiana lawmakers will legislate this problem away in the short term. The legislation directly targeting the waitlists won't make it out of committee before Monday's deadline, and the House's state budget proposal does not include a fix.

"That's hard to say," Rep. Jeff Thompson, R-Lizton and chair of the Committee on Ways and Means, said Friday about the odds of negotiating any relief. "A lot of discussion between now and April."

These waitlists restricting access to home and community-based care, like assisted living facilities, were enacted last year as a cost-cutting measure after the Medicaid office discovered it had underbudgeted by about $1 billion.

The main argument against the waitlists, besides the delayed care to people on them, is that they are self-defeating in terms of saving money: Those who can't get into assisted living when they need more advanced care might go to a nursing home instead, which is more costly.

The new FSSA Secretary Mitch Roob ― reprising a role he held during the Gov. Mitch Daniels administration ― said he subscribes to that argument.

“I think the previous administration, candidly, in a panic, decided to do this because they needed what was a quick fix," he told the House ways and means committee in January. "And it is a quick fix, but it’s probably not the best longterm fix.”

Republican Rep. Brad Barrett had introduced a bill to prohibit waitlists for assisted living facilities and require FSSA to petition the government for more waiver slots. House Bill 1592 had a hearing, but hasn't passed committee and isn't on the schedule before Monday's deadline.

So rather than legislate away the waitlists, the prevailing strategy is to go through an exercise of finding inefficiencies in Medicaid and scrutinizing eligibility ― through another piece of legislation, Senate Bill 2 ― in the hope that the cost savings will negate the need for them.

"I hear everybody talk about waitlists," Sen. Ryan Mishler, R-Mishawaka, told the Senate appropriations committee Thursday. "Well, until we rightsize it and figure out who should be on it, we’re going to have waitlists."

Senate Bill 2 also proposes that the state negotiate with the federal government to cap enrollment in the Healthy Indiana Plan ― a Medicaid program for adults who don't qualify for traditional Medicaid ― which could very well create yet another waitlist, Democrats argue.

"Waitlists are not solutions; they are state-sanctioned neglect," Indianapolis Sen. La Keisha Jackson said. "And now with SB 2, Indiana is poised to push even more families into this black hole of unmet needs."

The waitlists also affect children with medically complex conditions who need institutional care. Some of them used to be able to get cared for by their parents for an hourly wage, before one of FSSA's cost-cutting measures shifted that system to a daily stipend program and limited who could provide the care.

The House unanimously passed a bill last week encouraging FSSA to seek permission from the federal government to go back to allowing parents to provide that care, and to add a higher-pay tier of reimbursement for people requiring extraordinary levels of care. House Bill 1689 says the FSSA shall report to an advisory council about its efforts to do so.

There are some actions FSSA is taking to minimize the waitlists' impact in the meantime, Roob said.

Less than half the people invited off the waitlist are actually getting onto the Medicaid waiver, he said, either because they don't respond to FSSA's letters or because they're not actually eligible. After that notification, a person had 360 days to decide whether to get covered. In the meantime, others still wait on the waitlist. So the agency has already decided to shrink that period to 180 days.

It also plans to increase the amount of financial and health information it collects before people get on the waitlist.

"There are people on that waitlist who will not be invited off until April, May, June, who honestly won’t make it," he said. "We should be adjudicating this more quickly. We should have a higher threshold for getting on the waitlist."

Contact IndyStar state government and politics reporter Kayla Dwyer atkdwyer@indystar.com or follow her on X, formerly Twitter, @kayla_dwyer17.