Sen. Ryan Mishler (R-Mishawaka) was the sole state legislator at Friday’s Kosciusko Chamber of Commerce Legislative Review Session, but he discussed a number of bills down at the Statehouse without breaking a sweat.
The 2024 legislative session is at the halfway point, which is when the bills switch houses, so the legislators get a few days off. Friday’s session took place at the Zimmer Biomet Center Lake Pavilion, provided through the courtesy of Mishler Funeral Homes and Mishler Monument Co.
Medicaid
Medicaid was a big talking point at the Jan. 19 session, and Mishler brought it back up for Friday’s session.
“There’s a lot of misconception about it. I mentioned it last time, and unfortunately it’s got tossed into the governor’s race, and they say we lost a billion dollars. Nobody lost anything. There’s nothing missing. They’re calling for an audit, all these things,” he said.
A forecast is an estimate of future costs.
“So based on our previous costs, the company comes in and helps prepare this forecast to forecast out a little bit of growth. What happened between the forecast in April and the forecast in December - that eight-month period - the expenses went sky high. Like skyrocketed! One program alone up five times,” he said.
Mishler said nobody made a mistake, it’s just that the expenses skyrocketed. After the last budget, he said expenses went up by $2.4 billion in Medicaid alone. “I said it’s taken up a larger percent of our budget than it had in the past, and so the percentage of our budget on education shrunk and the percentage on Medicaid grew a couple percent,” Mishler said.
With that shift, after the legislative session, Mishler said he was very concerned about the growth of Medicaid and the state had to be very careful. Now the costs with Medicaid are skyrocketing.
“The issue is, we have to find ways to cut back on Medicaid to lower that curve, because if we don’t lower that curve, that’s our starting point at the next budget cycle,” Mishler said, noting it would be $984 million over.
The state reverted some money back to savings and some to Medicaid, which took the hole back to about $700 million.
“We made some changes within. Found one program that didn’t even comply with their waiver, and made a couple other changes, and they were able to come up with another $300 million,” Mishler said. “So, right now, we’ve lowered that curve to $400 million, so we still have $400 million to go.”
He reiterated it’s a forecast and they haven’t lost the money. “But if we do nothing, we’ll be $400 million in the hole at the end of the biennium.”
Chamber Board member Doug Hanes, 1st Source Bank, later asked how the Medicaid shortfall will have an impact on the state’s Medicaid Aged and Disabled Waiver that allows family members who are legally responsible for the care of their disabled children or spouses to receive payment.
Mishler responded, “When I said something skyrocketed five times, that was it. And that’s the one that they found out they were in violation of their waiver.”
In February 2020 - right before Covid-19 - “they started allowing family members to take care of their loved ones,” he said. Health care providers had been providing the care, but during the pandemic the providers couldn’t find enough workers to help so more family members were doing it. Family and Social Services Administration (FSSA) was getting federal dollars, so they let it go during Covid.
“But the funny thing is, it didn’t really ramp up during Covid. It was after Covid in 2022 where it really took off,” Mishler continued. “So, Covid wasn’t even an excuse of why they needed to do it when they were having a hard time. It went up a little bit during Covid, and we had the extra money but then the ... extra money went away, and so this program was still happening.”
The providers never told FSSA whether they were billing for a family member or an employee. Mishler said he heard a provider pays an employee about $16-17 an hour.
“So they get $34 an hour to the provider, and then they hire their people at $16 an hour to take care of these folks,” he said. When they started allowing a family member to provide the care, money would go to a provider and the family member would cut a deal with the provider at $14-$15 an hour. “But they were allowed to turn in 24 hours a day. But do that 24 hours a day, seven days a week, that’s roughly $130,000 a year, and then the provider is getting more than that because they’re keeping probably 60-70% of that.”
The funding for the program went “off the rails” in 2023, he said, because through word of mouth it got out to people living in other states how much Indiana pays for a person to take care of a family member.
The program the state is currently doing runs the risk of losing federal funds because it doesn’t comply with the waiver. So, Mishler said, FSSA has to make a change.
“So really what they’re changing is, instead of getting rid of the program. they’re saying some people probably benefit from the program so we’ll keep the program, but we’re going to make it a per diem per day,” Mishler said.
There’s three tiers to it, which depends on the level of care that’s being provided. There’s a $77-, $99- and a $133-per-day tier.
“But, again, it goes to a provider. The provider will cut a deal. And they’ll cut a different deal with every family. Every family seems to have a different deal. And so, they may say, ‘we’ll give you $75 a day and we’ll keep the rest because we bill Medicaid and we write you a check.’ So, really, the providers are making out,” Mishler stated.
He said the federal government requires the money goes to a provider and a family can’t be paid directly.
“So no matter what program we do, it has to go through a provider. I think now people are aware it has to go through a provider, so I’m hoping providers don’t keep as much as they have been. But, there is still going to be a program,” Mishler said.
U.S. 30 & Airports
Hanes also asked Mishler to weigh in about U.S. 30 and the Warsaw and Fort Wayne airports as Zimmer Biomet CEO Ivan Tornos spoke about them at the Chamber dinner last month and how critical they are.
“I’ve been pushing (U.S.) 31 for a long time, now 30, because the funny thing is both of those are in my back yard, so I’ve got 30 and 31,” Mishler responded.
In a meeting with the Indiana Department of Transportation commissioner after the dinner, Mishler said he told him about 30’s importance not only to the orthopedic companies but also to any future growth of Kosciusko County and the entire corridor.
“So, he’s aware of that, but they only have so much money and they plan their projects seven years out,” Mishler said. “Now, they did expediate some of the projects.”
He said the U.S. 30 Coalition has been very helpful for the project. “I think you’ve got good representation on pushing for 30,” he said.
The ProPEL U.S. 30 East study team will be at the Warsaw Community Public Library on Tuesday, Feb. 13 from 11 a.m. to 1 p.m. Information on the study can be found online at https://propelus30.com/.
Regarding the airport and future possible funding for it, Mishler said if they want buy-in from the state, the city-county airport authority - that was approved by the city of Warsaw in 2023 but tabled to 2024 by the county council - would help raise money for the airport.
“The hard sell is there. So if I live in Syracuse, I’m going to say, ‘Why in the world am I paying a fee for the Warsaw airport?’ And most people aren’t going to understand that everybody benefits from the growth of the orthopedics in Warsaw. But that’s a hard sell to explain to someone: ‘If we fix the airport up, we have more growth, you get more money for your schools and things like that.’ That is a hard sell,” Mishler said.
That would be a local decision, he said, but if they did go to a city-county airport authority, they’d probably get more matching funds.
Opioid Money
At the Jan. 19 Legislative Review Session, legislators were asked if they knew why cities and counties were not getting their share of the national opioid settlement money as was expected.
While they didn’t have an answer then, Mishler provided more information at Friday’s session.
“Only one has been settled ... but J&J, Walgreen’s, all those, we haven’t received the money for those yet,” he said, noting he couldn’t remember the name of the company that settled. “So, Kosciusko County did get $10,000 of that first settlement. That’s been distributed. Now, since then, since I asked three or four weeks ago, I’m not sure if we’ve received the other ones yet or not.”