State officials say they don’t feel there’s enough concern about impending changes to Medicaid eligibility.
During a Medicaid oversight committee meeting, Secretary of the Family and Social Services Administration Mitch Roob warned that federal work requirements could leave many without coverage.
The work requirements officially start in January but include a three-month lookback — meaning people need to start meeting requirements in October if they plan to apply for benefits.
Roob said he’s worried that hospitals and other healthcare providers haven’t been doing enough to get the word out.
“Health insurance is not a right. It’s a responsibility,” he said. “We want people to remain on the Healthy Indiana Plan, but to do that you have got to meet the requirements.”
Roughly 500,000 fewer people are covered by Indiana’s Medicaid program since the start of 2025, largely due to an increase in state eligibility checks. Critics argue those increased checks may cut people from coverage who would otherwise qualify because they can’t keep up with the paperwork.
Under the new work requirements, enrollees will need to show they are completing 80 hours of work per month. That can include employment, volunteering, attending school or an apprenticeship.
“I feel sometimes that I’m telling people to go out and buy a winter coat today because January is coming, and they are like, ‘It’s 80 degrees out; I don’t need a winter coat,’” Roob said. “I don’t get the sense that other people are as worried about this as I am.”
Roob told lawmakers Friday the state has hired an additional 400 staff members to help work through the expected uptick in paperwork.
Some advocates estimate 500,000 more people in the state could lose coverage due to the upcoming work requirements.
Tracey Hutchings-Goetz is with Hoosier Action. She said the state could hit one million disenrolled from Medicaid once the work requirements take effect.
“When that hits, that puts us at pre-Affordable Care Act levels of uninsurance in the state,” she said.
Hutchings-Goetz said the ripple effects of the loss in coverage will impact healthcare providers across the state — and beyond.
“Everyone should be deeply, deeply concerned about the viability of their healthcare providers right now, about their neighbors' ability to get and stay covered,” she said. “Just because you know the system-wide impact hasn't been fully felt yet, doesn't mean it's not coming.”
Providers have questions
Even as Secretary Roob encouraged providers to get the word out about coming changes, many of those same providers seem uncertain about how to manage the coming changes — or what to tell enrollees.
Providers and enrollees gathered at the Indiana Government Center Monday for a state-led town hall about work requirements.
One big question from providers was how a new definition of medical frailty would impact work exemptions for enrollees — and when people would find out if they would lose coverage because of it.
Roob explained last week that the definition previously included people living with diabetes but now does not. The exemptions at the federal level will generally only apply to people who cannot work because of a serious or complex medical condition, disabling mental disorder, or a substance use disorder.
Sunshine Beam, Director of the Division of Family Resources with the FSSA, told providers they were still working on what that rule would look like at the state level — and how they will inform enrollees of a change to their eligibility.
She said that rule is taking longer because it has to comply with both the change to the definition at the federal level and at the state level through SB1.
“Our general counsel has been reviewing the differences. He needs to read that, and we need to draw like, this is what we mean here in Indiana by that. Because it may not be for substance abuse treatment,” Beam said. “I think there are some outstanding questions.”
Other providers asked about confusion around implementing the work requirements. Some said they had received conflicting answers to questions.
“Yeah, I acknowledge that that is a problem,” Beam responded. “We have 3000 plus employees, and I wish that I could control everything that comes out of their mouths because I acknowledge sometimes they say the wrong thing, and it is confusing.”
Some providers, like Dulinda McFarland with Centerstone Health Services in Indianapolis, worried that clients without emails or phones won’t be able to navigate the state’s new online portal.
“We’re not being fair to the state employees because they don’t know the answers,” she said. “It’s a waiting game right now, the biggest thing we can do as providers is get patients signed up on that portal.”
Indianapolis resident Wendy Mabry is an enrollee who attended the meeting, worried about keeping her benefits. She said she doesn’t currently work and is looking at going to school or volunteering in order to meet requirements.
Still, Mabry said she didn’t feel the meeting cleared up much for her.
“I think there’s not a lot of answers yet,” she said. “The FSSA does not have the answers yet.”
The state is holding work requirement town halls across Indiana in the coming weeks.
Contact Government Reporter Benjamin Thorp at bthorp@wfyi.org
