After a financial review of the Patient Protection and Affordable Care Act’s impact on the Indiana health insurance Medicaid program and the state budget, Milliman reported its findings last week to the State Budget Committee. Milliman placed the total fiscal impact to the budget during the next 10 years at an estimated $3.6 billion. The predominant driver is expected to be enrollment expansions, which are estimated to increase from 1 million in 2010 to 1.55 million under PPACA. Other cost drivers include the impact of a reduced FMAP on Medicaid eligibles, pharmacy rebate loss, administrative expenditures (personnel and data systems), and increases to the Indiana Medicaid fee schedule from 60-65 percent of Medicare today to 80 percent of Medicare, to assure access to care. It was stressed that the final actual cost will be largely dependent on how many residents enroll in health care programs while eligible for Medicaid.