(Music) Families of medically complex children sued the state.

Literacy training requirements change.

Plus, a clean sweep for the state's public health funding program.

And more from the television studios of WFYI it's Indiana Week in Review for the week ending May 24th, 2024.

Indiana Week in Review is made possible by the supporters of Indiana Public Broadcasting stations This week, families of medically complex children have raised concerns for months that an upcoming change to a Medicaid program would impact their ability to care for their children.

A lawsuit filed against the Family and Social Services Administration challenges the policy change to a program utilized by more than 1600 children with disabilities.

FSSA said family caregivers will no longer be able to provide attendant care, instead shifting to the Structured Family Caregiving Program on July 1st.

Indiana Disability Rights and the ACLU of Indiana filed a federal complaint on behalf of two Indiana children who receive attendant care from their parents.

The lawsuit alleges FSSA actions violate the Rehabilitation Act and the integration mandate of the Americans with Disabilities Act, as well as a number of Medicaid rules.

It also claims the policy change will deny medically complex children access to the critical in-home care they need, putting them at risk for institutionalization.

The plaintiffs are requesting the court issue a preliminary injunction to temporarily halt the scheduled policy change, as well as direct FSSA to ensure the state provides resources for medically complex individuals to remain in the community.

How big a ripple effect could this lawsuit have?

It's the first question for our Indiana Week In Review panel.

Democrat Ann Delaney Republican Ali Bartlett, Jon Schwantes host of Indiana lawmakers.

And Niki Kelly, editor in chief of the Indiana Capital Chronicle.

I'm Indiana Public Broadcasting's statehouse bureau chief, Brandon Smith.

Ali, lawmakers are preparing for a major look at the Medicaid program in general in the next state budget.

How might this lawsuit impact that process?

Well, you hit the nail on the head.

They are going to have to take a look at a lot of things in the 2025 budget.

It's going to be a huge year.

you know, every budget year is big, but this one is even bigger because of this nearly billion dollar Medicaid shortfall that we saw come about as of last January.

I think this issue in particular has raised a lot of questions for people and gotten a lot of attention because of the vulnerable population impacts.

So I think just solely based on the media attention that's been given to this issue in particular, lawmakers are going to have to take a very careful look in 2025 about how they can shift funds to both make up for that shortfall, but make sure that families like these are being taken care of and given the resources that they need.

I will note that that program came about during Covid.

And so there were some, you know, technicalities.

I think the program probably would have been rolled out anyways at some point.

But it does bring to light the greater issue here, which is that we have to make up for that shortfall.

So I think ultimately lawmakers are going to have to look at ways to generate new revenue in the state of Indiana.

We look a lot at cost savings in Indiana.

I think the way this is going to change in 2025, we're going to have to start looking at how to generate revenue for the state of Indiana versus just save costs.

Well, there's the.

Tax increase here.

It is not a tax increase.

The Republican majority call for that.

yeah.

Even though lawsuits lawsuits play out over a great length of time.

Sure, sure.

Lawmakers have to be making this decision theoretically, while this lawsuit will be going on in a potentially.

How do you how do you craft a budget in those circumstances?

I mean, let's start with the fact that the billion dollar mistake that FSSA made is huge.

And now what they're trying to do is if we recoup that money on the backs of the most vulnerable part of the population, that's just not acceptable.

The first question they need to ask is how do we properly and best care for these children with disabilities, that you can't even begin to imagine how impactful they are?

And it seems to me the way you care for them is enabling the parents to care for them.

And if they don't, if they when they rolled it out, it wasn't as fiscally responsible as it could have been.

But they are the best caretakers rather than somebody paid minimum wage.

Strangers coming through the house dealing with those.

If those people are even, that's maybe the biggest problem is those people often aren't available.

Exactly.

So we should be able to enable the parents in a fiscally responsible way to care for this population, because that's the best outcome.

And what we ought to be looking at is what is the best outcome for those children, not what is the cheapest way to provide care.

And that's the way FSSA is looking at it.

That's not acceptable.

Niki, does this lawsuit, itself seem like a bit of a longshot at this point?

You know, I'm obviously not a lawyer, and I don't understand the the basis of it, but, I mean, medicaid's an entitlement to a point, but but, you know, there are this program in particular, the attendant care which was rolled out during Covid.

The whole reason it was rolled out at the time was because you couldn't find nurses or medical professionals to come into your home to take care of the child.

So they said, okay, if the parents are going to do more of this, we're going to pay them a living wage, basically to take care of their own child.

And so but there's nothing in Indiana law, at least that requires those that exact program to be offered.

They are offering a different program that will still pay parents, but at a lower a lower rate.

and they will obviously have to need to find people who can come in and help them.

Yeah, it's it's it's at a rate the parents at least have said.

Yeah.

You know, they can't work, they can't have a job and take care of their kids.

And this is not enough to just take care of their kids.

Again, I go back to this affects about 1600 families, 1600 kids.

But the ripple effects it feel like if it does have an impact on the budget process, as lawmakers try to grapple with not just this part of Medicaid, but all of Medicaid, feel like it could be pretty large.

And this is going to be a big issue, in part because of the population that is being served here.

It's a very there's it's a sympathetic, population may be small, but as and suggested these are people who are vulnerable.

These are people who.

Are the most vulnerable.

The most vulnerable in our state.

So I don't think that there's anybody needs to whip up sympathy in terms of this issue, but that runs headlong into this notion that there's only so much money.

And if you're facing $1 billion unexpected shortfall, something's got to give it.

It illustrates several things.

It's tough to take away benefits that have been rendered.

I mean, that's again, government officials know that a long time.

So and we've seen a lot of times people have been wary to extend for that reason.

This is something we would have to do, not just for a year or one biennium, but.

For well, that was a whole problem with Covid, right?

But of course.

You know, this is.

Progress and we're still.

Feeling that was a huge.

Long haul effects, I guess you could.

Say give away your power.

It's hard to take it back.

And we were I teased you about the revenue increase tax increase.

And I don't think that's going to happen for any number of reasons.

But at some point, somewhere, somehow, one must assume that as these expenses aren't going to diminish over time, care costs, health care costs will go up.

We have, you know, already a a unhealthy population in the state, an aging population.

I'm not saying that that would be need to be served by this particular aspect of of the program, but costs are not going down.

Well, I mean, I'll note it's not a silver bullet because it is, over time, a diminishing return.

But there's always the cigaret tax increase, which is like the one tax increase that polling tells people are kind of okay with as opposed to all of the others.

So that's always just kind of in their back pockets if they want a time.

Now for viewer feedback, each week we post an unscientific online poll question.

And this week question is, is the state right to change its care policy for medically complex children?

A - yes or B - no.

Last week, we asked you whether Indiana Congressman Jim Banks would be a good choice as Donald Trump's running mate.

I got a I got to disagree with the results on this one.

Only 25% of you say yes, 75% say no.

I think Banks would align perfectly with Trump's administration.

If you'd like to take part in the poll, go to wfyi.org/IWIR and look for the poll.

Well, the Indiana Department of Education is making changes to a new literacy endorsement after educators spoke out against the requirements.

Indiana Public Broadcasting's Kirsten Adair reports.

The state's largest teachers union says the changes are a good start.

But don't go far enough.

IDOE changed the rules about which teachers must receive the training and will allow educators to complete the course asynchronously.

Jennifer Smith-Margraf is the vice president of the Indiana State Teachers Association.

She says ISTA will continue to advocate for the department to remove the requirement that educators pass an exam after completing the course.

It's our firm belief that if someone has gone through this coursework of 80 hours and has done all of the work and all the assessments that accompany that, that should be enough to prove that they are competent at doing this and they should not have to do anything additional beyond that in order to prove their competency.

Smith-Margraf says ISTA will continue to work with ideas to resolve educator concerns.

Ann Delaney is this is a step in the right direction?

It's a step, yeah, but I mean, we have a whole half marathon here before they actually make this thing workable.

If it is made.

It was ill conceived by the legislature.

It really was.

I mean, didn't it didn't we though we needed to do something to address the poor literacy rates.

And this is one piece of the puzzle.

Yeah, yeah.

You blame you blame the teachers.

You blame the principals who don't know which teachers ought to be teaching.

Reading is what you're doing.

You're saying you're not competent to determine that.

You know, we've had 20 years of educational reform at the hands of the super supermajority, and the results are pitiful.

So this isn't going to solve those results.

Okay.

And the other thing is, when they pass this original bill, every teacher had to take this.

If you were teaching calculus in high school, you still had to teach a read.

You had to take 80 hours of coursework on a reading program.

Come on now.

That's one of the big changes they made.

They said something only K through five.

If you're teaching.

If you're teaching reading, but then they don't have enough, free classes for this, and then you're going to compensate them to the tune of, what, 1600 and $1,800 for 80 hours, 80 hours of this.

And then you have to take a test afterwards.

The problem is not necessarily the teachers, although I know that, you know, the Republican majority would like to blame them.

The educational reforms that they have put in place have really screwed up education in Indiana, period.

They have.

And, you know, I'm all for making certain the teachers that are teaching reading know what they're doing.

But I also have confidence that the principals are doing that right now.

And they don't need the Indiana General Assembly stepping in, because every time they do, they screw it up.

Are the changes to the training requirements in your mind?

Have they done enough or do they need to do more?

I think it's a good reflection of the fact that the DOE is listening to teachers and listening to principals in their feedback, and they're responding accordingly.

I mean, we would be criticizing the General Assembly whether they were working to address this issue or not, working to address it, providing teachers the training and tools they need to do the best they can for our students or not.

And so they're going to receive criticism on this.

Either way, what they're trying to do here is to make sure that teachers are prepared and have the training that they need.

And as the daughter of a principal, I will say principals, at least mine, appreciate when the state helps them provide training and they're listening to their feedback, they're adjusting accordingly.

They're allowing these courses to be taken asynchronously.

Now, they want to make sure that teachers are equipped to help those poor literacy rates that are coming out of our state.

So our priority has to be on Hoosier students and their outcomes.

And making it obviously doesn't allow for the whole gambit to be felt, that it will allow for the program to actually be implemented, how it should be.

I was just going.

Make it optional and give them an incentive to take it.

Off.

Yeah, I want it to because some of them don't need it.

They just graduated.

They've got all the tools in hand.

Who does and does not need it.

We're trying we're trying to align.

We're trying to align into this new science of, of reading that we believe will be the better way to teach to, to get our literacy rates up.

Just taking it all the way to optional feel like a step too far in terms of now you're talking about, well, at that school district, I might be getting the instruction that the the science is telling us is the best.

But at that school I might not exactly.

What if the ones where you're where you're not having a teaching, what if their rates of literacy are much higher?

I mean, you're doing this across the board whether the teachers are excelling or not.

I'm not sure there's an appetite for making it entirely optional for the reasons that have been discussed.

I mean, there are people who would point.

Just because one has coursework doesn't mean that one is skilled in a given area.

You can go to medical school, but if you don't pass your boards, you're not going to practice medicine.

You can go to law school, but if you don't pass the bar, you're not going to practice law.

I mean, that's an a.

Graduated with a degree.

I, I, I guess I can see that.

And they have made some concessions and I perhaps they will make more for people who are newly graduated, for those who have.

Studied or demonstrated ability to take the test without doing.

But I don't think we'll see.

There's just too much.

The line has been drawn in the sand and and you make a good point about reform fatigue.

you mentioned 20 years.

It's actually about 35 or 36 years if you go back.

I think it really kind of started this era with Robert Orr and A-plus program for education reform in 88.

And then you're you mentioned Republicans being in the vanguard, but you had Evan Bayh and Frank O'Bannon and Joe Kernan They didn't do the vouchers and the charter schools...

But the reform it's been it's been the the front burner issue for 36 years.

Education is where the budget goes.

Is it really the 80 hours maybe that jumps out as the biggest, I think issue the teachers still have at this point?

Yeah, I guess I mean, I honestly don't think it should be optional.

I mean, if we're gonna, you know, give this training to all the teachers who are teaching, reading, I think they've made a huge, change by and concession and that's good.

I also they've added cohorts.

I also want to remind all these teachers, and I know they're all worried, and I guess I would be too, if it was my favorite, but no one has it.

It doesn't all have to be done this summer.

Like this is a couple years before they have to have this endorsement.

So I think everyone rushed.

And I think the asynchronous training is another big thing.

The other big change they just made.

Like you can now make it work with your schedule a little more than that.

So it also has to be free.

They don't have to pay for it.

And that's not it's.

Not think they do have to pay for it.

They get a $1,200 stipend.

Oh to pay for it.

So their hours are gone or is it $1,200?

Is that what the course is charging?

I don't know the answer to that question.

No, I don't think I don't think that I don't think the course charges.

No.

And the idea.

And to take it to cover their hours.

Okay.

To cover their hours.

But I understood when I had some discussion with this, with some teachers, that there weren't enough of those positions that were free and that they might have to go to a paid program, but might.

I'm just saying if they do that, the state has to pay for it.

Well, and we've got a whole nother budget.

But also, again, not everyone has to take it this summer.

And they opened up all these additional things.

I think we're getting a little too caught up in what might happen next summer.

Let's see how it goes.

See?

See if how many teachers they take and how how much progress is right.

And they've shown they're willing to respond and change.

Yeah, that's true.

All right.

All 92 counties have opted in to the second year of Indiana's historic public health initiative.

The state will disburse a total of $150 million to local health departments in January 2025.

The Health First Indiana initiative was a result of 2023 legislation that overhauled the state's public health system.

County elected officials were in charge of the decision to take Health First Indiana funding to provide additional core public health services.

All but six local health departments opted to receive a total of $75 million in 2024, before lawmakers expanded public health funding.

Counties shared about $7 million from the state annually.

To receive the funding, counties must spend at least 60% of it on core preventative services such as immunizations, chronic disease prevention, and maternal and child health.

The Indiana Department of Health said a key component of the initiative is to allow local health departments to determine how the funding is spent, since they have insight on what their communities need.

Jon Schwantes, how much pressure does this put on lawmakers to continue or even grow the program?

Well, it adds, but I think the pressure would have been there regardless, even if these six counties had decided not to participate, even if others had dropped out.

Because, of course, that's always been one of the provisions, too.

You don't have just, you know, not in for good.

If you don't like it, you can leave.

That was an important part of that.

That was an important part of it.

And I think and I'll go back to something I said, you know, five minutes ago, our state is unhealthy, we're aging, we have increasing health care costs.

And keep in mind that the the, the good work of the commission, that sort of set the stage for this reform, the first real fundamental funding reform in 100 years, I think, in the state for for health care, a public health.

They said, you know, initially it would take twice this amount to just get Indiana up to sort of.

Mediocre.

Or mediocre.

Or national standard, least to the middle of the pack per capita.

And we and of course, there was a lot of balking at that number.

And part of that was the carryover, of course, no secret about the those who were still concerned about state perceptions of state overreach by the executive branch and others in Indianapolis trying to decide what people out, you know, in the outlying areas should do.

Maybe now the pressure, I mean, thank goodness that those six counties are on board now because they were really giving, I think, doing a disservice to to their citizens.

And because the gap is so.

Low in some cases, it wasn't ideological.

I think with 1 or 2 it was like, we we're currently trying to step up.

We don't we can't implement this program in the first year.

But there were some to it.

The second, there were some ideological, is this playing out pretty much exactly the way Doctor Chris Box and Luke Kenley and Eric Holcomb envisioned it would.

I would think so.

And I think, you know, they're going to have a strong, you know, argument to make, although Eric Holcomb won't be here to make it next year.

so he'll have to find someone to be the bearer of that.

I think there are a few lawmakers who certainly.

Fit, you know, to at least continue it.

We need it at least for a few years so we can build, you know, a program and then see some returns from it.

And then you can maybe argue expanding.

but, you know, we at least have to continue it for a few years and see, you know, the sort of metrics that we get out of it.

Right?

You know, to go back to another thing, Jon said a little while ago, once you give benefits, it's real hard to pull them back.

Yeah.

Our lawmakers almost facing like no option here with this one.

That's probably right.

So we may need to look at enhancement of revenue.

But it's it's good.

Jon's right I mean, our our health index is awful.

Absolutely awful.

And this is a really positive step in the right direction to see if we can address that.

And it needs to be expanded.

Now, I'm glad all 92 counties are in.

That all comes back to the money.

And we've talked now twice on the show already about things that are going to cost and certainly the Medicaid program, a lot of money in this upcoming budget.

We're facing a lot of money needs and maybe not as much, revenue as we've had certainly in the last couple of budgets.

How high a priority do you think this will rate as they look at the whole picture?

I think it'll rate pretty highly just because, you know, we've talked about Medicaid.

We've talked about all these health care issues.

Health care is front and center health care cost, all these facets of health care.

I think it's going to be up there with the rest of them.

I think Niki's absolutely right.

We should, you know, at least have them maintain.

And I think they will, with that sort of pressure.

But maybe, you know, some of the positive outcomes of this program that we've seen are a lot of public private partnerships that have been formed locally.

I know, for example, Saint Joe County has formed a partnership with Notre Dame to pursue some of these, positive health outcomes.

I know, the hospitals have taken a pledge to partner with their local health departments.

So maybe long term, those types of positive outcomes that we're seeing as a result of this program could help drive down the cost and take some of that cost back to the business community, to private companies in partnership with the local health departments.

Once this community or once, this kind of helps establish those relationships going forward.

That and, you know, part of the argument for the program in the first place was if you because a lot of this starts to work at the preventative level, we're trying to to not necessarily treat sick people with this money, but stop people from getting sick or needed well, that's.

over long term, hopefully bends down the curve of the Medicaid program.

Indiana's education department wants schools to ignore new federal protections for LGBTQ plus students set to take effect next school year.

From WFYIs education desk Rachel Fradette reports on how a state lawsuit could delay the rules on sex based discrimination.

Attorney General Todd Rokita and other attorney generals from GOP led states have challenged the Biden administration's new title nine rules.

Title nine prohibits sex discrimination in educational programs and activities.

New orders from the U.S. Department of Education will expand protections for LGBTQ plus students.

Education Secretary Katie Jenner advises schools not to adopt them yet because of the legal challenges, but the state's largest teachers union said this delay undermines the rights of LGBTQ plus students.

Niki Kelly should the state just ignore federal rules because of ongoing litigation?

Probably not.

That seems like a bad move.

I mean, look, if I'm assuming they're going to ask for an injunction or a stay of the law, and if it's granted, then they can stop moving forward with it just like any other lawsuit, just like when we did the abortion ban or, you know, I mean, we didn't I didn't hear Todd Rokita saying we should stay the abortion ban because a lawsuit was filed.

You know, until until there's a stay or action by a court, I think you should continue following the law.

I mean, I'm not surprised that Todd Rokita would say these things, but this is the Department of Education.

I think, because repeated saying these things, the Department of Education going, don't worry about it.

Does that make a lot of sense to you?

Oh, it's problematic, I think, of those kids who are taking the basics civics course probably question why, if this is federal law, are you telling people to ignore it?

It just sort of a disconnect.

there.

I mean, the notion of state nullification, the ability of states to nullify was kind of resolved in, I think, 1830s or 1840s even before, as if the Civil War didn't put a exclamation point on it.

So that we've had that debate.

I know people want to have it again.

Well, increasingly, precedents don't seem to matter to these.

Well, sadly, that well, I guess.

Yeah.

Well, all right, I rest my case.

But that being said, I mean, does this just create I mean, it.

If it's not this policy, then.

Well, what's to stop, you know, the state in the future saying, well, let's just ignore that one or that one.

Anytime a lawsuit to file doesn't.

Don't you get into trouble this way?

Well, I think we should clarify a few things.

So these are regulations coming out of the U.S. Department of Education.

So we're not directly violating federal law first and foremost.

And so then also let's consider the fact that we just had a discussion about whether or not we should be providing support to our teachers for, you know, the literacy program and so wouldn't it be burdensome to our teachers and our school systems to implement a policy and have all these school corporations and principals go through the process of making these policies?

When 26 states and numerous local boards of education and other entities have now entered a lawsuit, that's more than half the states now found, they're all.

Have Republican attorneys general.

Right.

So the issue is rules are enacted pursuant to law because they enforce the laws.

We have that ridiculous attorney general of the state of Indiana saying that we should break federal law is what he's saying.

It's ridiculous.

And he's an embarrassment.

And, you know, just because he wants to discriminate against these kids doesn't mean he can ignore federal law.

All right.

Well, on that happy note, I do want to get this in.

This weekend is, of course, the 108th running of the of the Indianapolis 500.

And so it's time, as always, for predictions.

Ali Bartlett, who do you have winning the race?

I'm going with Alex Palou.

I love Carpenter but I'm going with Will Power.

Oh that's my pick.

A dark horse, Ferrucci.

Oh dark horse Colton Herta.

My pick was Will power too just because I like his name.

(laughter) That's Indiana Week in review for this week.

Our panel is Democrat Ann Delaney Republican Ali Bartlett, Jon Schwantes of Indiana lawmakers and Niki Kelly of the Indiana Capitol Chronicle.

You can find Indiana Week in Reviews podcast and episodes at WFYI.org/IWIR or on the PBS app.

I'm Brandon Smith of Indiana Public Broadcasting.

Join us next time because a lot can happen in an Indiana week.

(Music) The opinions expressed are solely those of the panelist.

Indiana Week in Review is a wfyi production in association with Indiana's public broadcasting stations.