Eager to get Republican-led states to expand Medicaid, the Obama administration seems increasingly willing to allow them to impose new premiums and cost-sharing on very low-income adults. But some experts say those costs likely will deter eligible people from signing up and seeking needed healthcare. In addition, they warn the added administrative costs will exceed beneficiary payments.
Last December, the CMS allowed Iowa to impose a monthly premium of up to $5 a month for adults with incomes as low as 50% of the federal poverty level, although it barred the state from canceling coverage for failure to pay. In May, Indiana's Republican Gov. Mike Pence proposed charging a monthly “contribution” ranging from $3 to $15 for people under the poverty line; those who don't pay would lose vision and dental benefits and would be liable for copayments out of pocket. A CMS decision on Indiana's waiver proposal is pending.