INDIANAPOLIS (WLKI)- Indiana's Medicaid enrollment has fallen by more than 343,000 people in one year as the state continues reviewing eligibility following the end of pandemic-era coverage protections.
The decline represents an 18.5% decrease, placing Indiana among the states with the largest Medicaid enrollment drops in the country. According to the Indiana Capital Chronicle, state Medicaid enrollment stood at 1,512,713 Hoosiers in June, down from 1,856,272 one year earlier.
The decline follows the end of federal policies that prevented states from removing people from Medicaid rolls during the COVID-19 pandemic. Those protections ended in April 2023, leading states to resume routine eligibility reviews.
Nearly 2.2 million Hoosiers were enrolled in Medicaid in June 2023. Three years later, more than 687,000 people have lost coverage. While some people no longer qualified because of changes in income, household circumstances or other eligibility factors, state records show many others lost coverage because of what the Indiana Family and Social Services Administration classifies as "noncompliance."
Those cases include situations where the state did not receive required renewal paperwork or requested documentation, such as proof of income, residency or other eligibility information, before a deadline.
A procedural closure does not mean a person was found ineligible for Medicaid. Instead, it means the state did not have enough information to complete the eligibility review.
Advocates say many eligible Hoosiers have experienced interruptions in coverage because of missed notices, confusing paperwork requirements, online account issues and delays in processing submitted information.
The Indiana Capital Chronicle reported that thousands of people whose coverage ended later returned to Medicaid after resolving administrative issues. Advocates refer to that cycle of losing and regaining coverage as "churn," which can interrupt access to prescriptions, medical appointments and other health services.
One Hoosier affected by the process was Tyree Collins of the Merrillville area, who said he lost Medicaid coverage after missing a deadline to submit pay stubs. Collins said he was unable to afford some medications and canceled medical appointments while waiting to resolve the issue. Hospitals and health care providers say the decline in Medicaid enrollment is also contributing to a growing number of uninsured patients seeking care.
Scott Tittle, president of the Indiana Hospital Association, said hospitals are seeing more patients without coverage and increased reliance on emergency departments for care. The association reported that emergency department visits in Indiana increased 16.8% last year, compared with a 1.4% increase nationally. Hospital officials say rising numbers of uninsured patients are increasing financial pressure on facilities across the state.
At Eskenazi Health in Indianapolis, CEO Dr. Lisa Harris said uncertainty about insurance coverage has led some patients to delay care until their conditions become more serious.
Advocates say upcoming changes requiring more frequent eligibility reviews and additional reporting could create more challenges for Medicaid recipients.
FSSA said changes in state and federal rules have made Medicaid verification and documentation requirements more stringent. The agency also reminded recipients to pay close attention to deadlines and submit requested information on time.
Supporters of stricter eligibility reviews argue the state must control rising Medicaid costs. Indiana's share of Medicaid spending increased from $2.7 billion in fiscal year 2023 to a projected $5.2 billion in fiscal year 2027.
Critics say the state should focus on reducing administrative barriers that can cause eligible residents to lose coverage.
The decline has also affected children's Medicaid coverage. A recent analysis cited by the Indiana Capital Chronicle found an estimated 174,000 fewer Indiana children were enrolled in Medicaid or the Children's Health Insurance Program in April compared with January 2025.
Health advocates say maintaining continuous coverage is important for children because interruptions can delay preventive care, developmental screenings and treatment.
As Indiana continues adjusting its Medicaid eligibility process, health care providers and advocates say the challenge will be balancing program oversight with ensuring eligible Hoosiers do not lose access to needed care because of administrative problems.