Erika Martinez is trying to wrangle two of her children at a busy coffee shop in Richmond, Indiana. She’s also trying to explain the complexity of her Medicaid situation, but her children aren’t willing to sit still.
Martinez said she doesn’t know exactly why her Medicaid coverage was cut. But she has a hunch.
“They were sending mailers to my old address. So I didn't get most of the mailers,” she said. “Some of them did get forwarded, and then it also showed that they had returned mail from an old address, and so that is what essentially caused a lapse in my benefits right now.”
In March, Martinez received notice that Medicaid coverage for herself and one of her three children was set for a year. She thought that meant she didn’t have anything to worry about.
But in that same month, her case was put into a pending status because the state received returned mail from her old address, triggering a request for updated information.
“Essentially, whenever they are requesting documents, you have a certain amount of time to get those documents turned in before they decide to deem you ineligible for benefits,” Martinez said.
State officials corroborated much of Martinez’s account, including an additional income verification check after her daughter applied to — but did not get — a job at WaWa.
Verifying her daughter was not receiving income would eventually require her daughter to sign a note that she was not taking an income.
One or both of the verification checks could ultimately have led to Martinez losing coverage.
Martinez has since gotten her Medicaid turned back on, but the process took a lot of time and energy.
“Somebody's benefiting from the system being the way it is, and it's definitely not the people that are receiving the benefits, the SNAP and Medicaid recipients,” she said.
WFYI spoke to other Medicaid recipients who lost coverage because they missed mail, didn’t return documents on time, or believed the state didn’t get to their case in a timely manner.
Indiana leaders have long wanted to establish work requirements for people on Medicaid. Federal approval was granted in 2018 but lawsuits and then the pandemic ultimately halted the move.
Last legislative session, Indiana made it a priority to bring the state in line with new federal work requirements and eligibility checks on welfare programs, including Medicaid, set to begin in 2027.
More than 500,000 Indiana residents have already lost Medicaid coverage since the start of 2025, according to the state’s dashboard. That’s due in part to the increased eligibility checks that started last year. The Family and Social Services Administration has attributed hundreds of millions in savings to the move.
Those losses in coverage have included a nearly 20% loss in Medicaid coverage for children, according to a Georgetown University report, the most of any state.
State officials argue most of the people losing coverage are simply ineligible, but advocates believe the losses are also because of the added red tape. Paperwork and mailers can become difficult for individuals to keep up with.
And once new work requirements get added to the Medicaid program in January, advocates believe the number of people losing coverage could double.
“When that hits, that puts us at pre-Affordable Care Act levels of uninsurance in the state,” said Tracey Hutchings-Goetz with Hoosier Action.
Hutchings-Goetz said everyone - not just Medicaid recipients - should be worried about the cliff the state is headed towards.
“None of us are safe because we all have bodies and we all share the same system. So yeah, it's scary,” she said.
Advocates like Hutchings-Goetz say the loss of health insurance for low-income people will mean more people in Indiana emergency rooms and poorer health outcomes for the state. That’s a concern shared by Indiana hospital officials.
”If that translates into increases in the un- or underinsured, it’s absolutely going to flow directly into the bottom line of health systems in an unfavorable way,” said Erik Swanson with Kaufman Hall, a healthcare consulting agency that recently conducted a study on Indiana hospitals.
FSSA Secretary Mitch Roob has concerns of his own. According to a state report, 58,000 enrollees have already been identified as noncompliant with the upcoming work requirements.
“I just don't get the sense that other people are as worried about this as I am, and that's why I start every meeting on work requirements,” he said during a recent meeting with state lawmakers.
The state has said it is in the process of hiring an additional 400 staff to help work through the increased eligibility requirements and checks.
But Roob has also repeatedly noted that the responsibility of staying on Medicaid rests with its members.
“Health insurance is not a right; it's a responsibility, and we want people to remain on the Healthy Indiana Plan,” he said. “But they've got to do that. They've got to meet the requirements, as outlined previously.
When reached for comment about the number of people losing coverage and struggling to navigate the state’s system, a spokesperson for the FSSA said that Medicaid requires eligibility checks.
“We understand that some people may need help navigating the system, which is one of the reasons we have at least one office in every county,” the spokesperson said. “We want people to keep their coverage.”
But Medicaid recipients like Erika Martinez said they aren’t buying it.
“I think that it's set up like this on purpose so that people will give up,” she said.
Indiana’s work requirements officially take effect on January 1.
Contact Government Reporter Benjamin Thorp at bthorp@wfyi.org
