WASHINGTON (WLKI)- Indiana's Medicaid program is entering a major new phase that could affect how hundreds of thousands of Hoosiers maintain their health coverage.
After more than a year of eligibility reviews that have already removed hundreds of thousands of people from Medicaid, the state is preparing for additional changes that will require more frequent eligibility reviews, additional documentation and, for some adults, new work or community engagement requirements.
The changes are expected to unfold over the next 18 months, with some of the most significant requirements taking effect in 2027.
Advocates say the biggest challenge may not be whether people actually qualify for Medicaid, but whether they can successfully navigate the paperwork and reporting requirements needed to remain enrolled.
Karly Sciortino-Poulter of The Arc of Indiana said Medicaid includes numerous eligibility categories, each with different requirements and exemptions.
She cautioned that people should not assume the same rules apply to everyone enrolled in the program.
Indiana has already increased the frequency of eligibility checks. In January 2025, the Family and Social Services Administration announced it would begin conducting interim eligibility checks quarterly rather than annually.
Beginning January 1, 2027, participants in the Healthy Indiana Plan, Indiana's Medicaid expansion program, will face formal eligibility redeterminations at least every six months instead of annually.
That change coincides with a federal requirement calling for states to conduct six-month eligibility reviews for adults covered through the Medicaid expansion population.
FSSA Secretary Mitch Roob has said the agency will help beneficiaries document their eligibility, but members ultimately have responsibility for providing the required information.
Supporters of the changes say more stringent reviews are necessary to make sure taxpayer-funded benefits go only to people who qualify.
Senator Chris Garten, a Republican from Charlestown, has argued that taxpayers should not be responsible for covering people who are no longer eligible.
Enrollment advocates, however, warn that additional paperwork and more frequent deadlines could cause eligible Hoosiers to lose coverage.
Ann McCafferty, who directs Indiana Healthy Families Alliance, said FSSA notices can be confusing and that people sometimes lose coverage because they move and fail to update their address.
The problem could be particularly challenging in rural communities where residents may have less access to enrollment assistance.
The biggest change for many Healthy Indiana Plan members will come January 1, 2027.
Certain adults enrolled in HIP will be required to complete and report at least 80 hours each month of work, job training, education, community service or another qualifying activity.
The state will review compliance at least every six months.
Because Indiana will look back at previous months when determining compliance, many beneficiaries will need to begin tracking qualifying activities before the requirement officially takes effect.
The requirement will not apply to everyone on Medicaid.
Children, pregnant women, older adults, people enrolled in Medicare and many people with disabilities or caregiving responsibilities are among those expected to qualify for exemptions.
Advocates say the challenge will be making sure people understand whether an exemption applies to them and what documentation they may need.
Susan Jo Thomas of Covering Kids & Families of Indiana said many Medicaid recipients are already working or participating in activities that could satisfy the requirement.
The problem, she said, may be documenting those activities and getting the information into the state's system.
A survey by the Health Management Academy found that 47.4% of Indiana Medicaid enrollees surveyed did not know work requirements were scheduled to begin in 2027.
The survey also found that some beneficiaries said they would ration medication or rely more heavily on emergency rooms if they lost Medicaid coverage.
Healthcare providers say interruptions in coverage can have serious consequences.
Dr. Amy Hale, a primary care physician with Columbus Regional Health, said losing coverage can interrupt medication, laboratory testing and routine appointments for patients with chronic conditions.
When those patients return to care months later, she said, problems that could have been managed through preventive care can become medical emergencies.
State Rep. Wendy Dant Chesser, a Democrat from Jeffersonville, said she has already helped constituents who lost Medicaid after missing a mailing or failing to provide additional documentation.
Enrollment organizations across Indiana are preparing to help beneficiaries understand the new rules, determine whether they qualify for exemptions and respond to requests from the state.
For Medicaid recipients, advocates say the message is clear: watch for notices, keep addresses updated, respond to requests for information and understand which requirements apply to you.
The coming changes could reshape how many Hoosiers access and maintain Medicaid coverage.