As the Trump administration moves to give states more flexibility in running Medicaid, advocates for the poor are keeping a close eye on Indiana to see whether such conservative ideas improve or harm care.

Indiana in 2015 implemented some of the most radical changes seen to the state-federal program that covers nearly 1 in 4 poor Americans — including charging some adults a monthly premium and locking out some of those who don't pay for six months.

The changes were a part of Indiana's deal with the Obama administration to expand eligibility, adding about 240,000 Hoosiers to the Medicaid rolls under the Affordable Care Act. The controversial monthly fees and lockout provisions were spearheaded by then-Gov. Mike Pence, who is now vice president, and his top health consultant, Seema Verma, who now heads the federal Centers for Medicare & Medicaid Services. That demonstration project, known as Healthy Indiana, is up for renewal in February, and state officials seek to add work requirements similar to what CMS approved for Kentucky last month and to widen who is subject to lockouts.