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Indiana’s Medicaid rolls have shrunk by more than 343,000 people in a single year — an 18.5% drop that ranks among the steepest in the country.

That has left hospitals, healthcare providers and advocates bracing for an increasingly uninsured population.

State enrollment stood at 1,512,713 Hoosiers in June, down from 1,856,272 one year earlier, according to the latest data from the Indiana Family and Social Services Administration.

The losses have mounted since pandemic-era coverage protections that prevented states from removing people from their Medicaid rolls ended in April 2023.Nearly 2.2 million Hoosiers were enrolled in Medicaid in June 2023. Three years later, more than 687,000 people have lost coverage.

Some of the drop-off was expected after states resumed routine eligibility reviews. Other Hoosiers have left the program because their income, household circumstances or other eligibility factors changed and they no longer qualified.

But state records show actual ineligibility explains only a fraction of the recent departures.

Far more Hoosiers have lost coverage for “noncompliance” — a broad FSSA category covering cases in which the agency did not receive a completed renewal form or requested verification of income, assets, residency or other information before a deadline.

A procedural closure doesn’t establish that a person was ineligible for Medicaid but instead indicates the state did not have what it needed to complete the determination.

Thousands of those recipients later returned to Medicaid, sometimes after enduring weeks or months without coverage.

The pattern has alarmed many stakeholders who say otherwise eligible Hoosiers are getting caught between missed mail, confusing notices, online portal problems, shifting documentation demands and an eligibility system that can close a case before submitted information is reviewed.

Advocates refer to that cycle of losing and later regaining coverage as “churn.” Even when coverage is eventually restored, the interruption can delay prescriptions and medical appointments, jeopardize home- and community-based services, and leave providers uncertain whether they will be paid.

Tyree Collins discovered his Medicaid benefits were cut off more than two months ago while trying to pick up a monthly prescription at his pharmacy.

Collins, who lives near Merrillville, said he didn’t know he’d missed the deadline to submit his pay stubs to the state. He’s since been unable to afford sinus and headache medications and canceled two doctor’s appointments.

“I have no idea if I’m going to be able to get back on (Medicaid) or how I get my medicines while I wait,” said Collins, who drove nearly three hours last month to a free clinic in Terre Haute. “I work. … I try to follow the rules. And now I have to do everything while I’m physically not good. It makes doing everything the way they want you to do it even harder.”

That clinic served people who have no insurance, including those who have lost Medicaid. It helped 200 people a day and some people were in line days before it opened.

Hospitals say the broader decline is also driving more uninsured patients to go without treatments or toward emergency departments, where care is more costly and hospitals generally must evaluate and stabilize patients regardless of their ability to pay.

The drop in enrollment comes after Indiana Medicaid officials added interim eligibility checks and stopped advertising Medicaid to Hoosiers. It also is an indication of what the state can expect when it implements another series of federal and state requirements expected to add more frequent redeterminations and reporting obligations next year.

Advocates fear the additional reporting and documentation hurdles could make procedural coverage losses even more common.

Procedural closures outpace findings of ineligibility

Republicans in Indiana control all branches of government and have leaned into the conservative movement to slim down safety net programs. It started with cost as Indiana’s portion of the Medicaid bill has jumped from $2.7 billion in fiscal year 2023 to a projected $5.2 billion in fiscal year 2027. The federal government pays the bulk of overall Medicaid costs.

That growth has eaten up state budget revenue that can be spent on other priorities such as education, infrastructure and public safety.

But some Hoosier Republicans also feel that “health care is not a right. It is earned.” That statement was included in an April 2026 quarterly financial review slideshow.

FSSA data obtained by the Indiana Capital Chronicle details the outcomes of more than 1.7 million Medicaid renewals due between March 2025 and June 2026.

The records divide those cases into four broad outcomes: recipients whose coverage was renewed; those whose cases were closed for noncompliance; those found no longer eligible; and an “other” category that includes people moved to another Medicaid category, cases closed before the end of the benefit period and renewals still awaiting disposition.

During most of the period, procedural closures substantially outnumbered cases in which FSSA concluded that the recipient no longer qualified.

In June 2026, for example, 110,382 Medicaid recipients were due for renewal. Just 20,834 — fewer than 1 in 5 — were renewed in the data supplied by the agency.

Another 38,732 people, or 35.1%, were closed for noncompliance. Only 7,875, or 7.1%, were closed because FSSA determined they were no longer eligible.

The remaining 42,941 cases, nearly 39%, were placed in the broad “other” category. Because that category combines various outcomes — including pending cases and recipients transferred elsewhere within Medicaid — the data does not show how many of those people ultimately retained coverage.

The pattern continued across several renewal cycles.

Between September and December 2025, roughly 36% to 40% of Medicaid cases due for renewal each month were terminated for procedural reasons, while fewer than 9% were terminated because recipients were found ineligible.

In September alone, FSSA closed nearly 47,000 cases for noncompliance — more than four times the roughly 10,200 recipients found no longer eligible.

Not everyone whose case was closed for noncompliance necessarily remained eligible. Some recipients who did not complete a renewal may have moved, obtained other insurance or become financially ineligible without reporting the change.

But the state’s numbers show that a large share of those whose coverage closed returned documents or regained Medicaid.

FSSA tracks how many recipients submitted information before a closure took effect, as well as how many returned within 30 days, 60 days, three months or one year. The categories are cumulative, meaning the longer-term totals include people counted during the earlier periods.

Among several 2025 renewal groups, more than half of the people whose coverage was slated to close had returned to Medicaid within one year.

In September, when more than 57,000 people were closed either procedurally or for ineligibility, nearly 20,000 submitted information before their termination took effect. More than 31,600 — about 55% of those whose coverage was slated to close — had returned within a year.

Some of those recipients may have become eligible again after their income or circumstances changed. The return figures alone do not show how many should have remained continuously covered.

Still, advocates say the scale of the returns suggests many of the closures did not represent permanent departures from Medicaid. Instead, they point to people cycling out of coverage and back in after resolving an administrative problem.

One way states can avoid unnecessary coverage interruptions is through automatic, or “ex parte,” renewals, which allow Medicaid eligibility to be verified using existing government records rather than requiring beneficiaries to submit additional paperwork.

Data Indiana reported to the Centers for Medicare & Medicaid Services shows the state completed about 49,000 to 57,000 ex parte renewals each month from March through August 2025. That fell to roughly 20,000 per month beginning in September and to 11,201 in March 2026, the most recent month for which federal data is available.

Karly Sciortino-Poulter, advocacy network director for The Arc of Indiana, a nonprofit that advocates for people with intellectual and developmental disabilities, said her organization increasingly hears from recipients who still qualify but encounter a problem somewhere in the renewal process.

Because FSSA does not maintain county-level disposition data or track whether recipients submit renewal information online, by mail, in person or through another method, it’s difficult to determine where procedural closures are concentrated or which parts of the process are most likely to break down.

FSSA did not provide details about the decline in automatic renewals or the number of cases ending procedurally, saying only that state and federal rule changes have made the verification and documentation required for Medicaid determinations “more stringent.”

“It is important for Medicaid members to pay close attention to deadlines to ensure documentation is turned in timely,” the agency said.

Enrollment workers and advocates agree recipients must respond but say the agency’s explanation omits what can happen after FSSA requests information and before a case closes.

The most common issue Sciortino-Poulter has encountered since states resumed regular post-pandemic eligibility reviews is a recipient being terminated because FSSA says it sent a request for information that the person — and sometimes multiple authorized representatives — never saw.

“You can’t provide information if you don’t know you’re supposed to,” she said.

She noted that cases can also close after recipients submit information but before it is reviewed. Correcting the problem can require repeated calls, visits to an eligibility office and help from an advocate who knows what documents are missing and how to prompt a closer review.

People who reach an experienced navigator or disability advocate often can regain coverage, Sciortino-Poulter said. She worries more about those who are told they do not qualify and do not know that the decision can be challenged.

“That is the part that actually scares me,” she said. “I think that happens far more often than anything else.”

Coverage restored — but not without consequences

Returning to Medicaid does not erase what happens during a coverage gap.

Recipients told the Capital Chronicle they’ve put off appointments, stretched medications, lost access to specialists or arrived for care only to discover that their insurance is inactive.

Providers, meanwhile, can be left to decide whether to delay treatment, absorb the cost or help a patient navigate an eligibility system that may take days or weeks to correct.

And in some cases, Hoosiers don’t learn they’ve been disenrolled until the moment they need care.

Rep. Wendy Dant Chesser, a Jeffersonville Democrat, said one Clark County constituent submitted renewal information in January but apparently never received a later request to verify his residency.

His Healthy Indiana Plan coverage closed at the end of April, but he did not discover the termination until he tried to fill a prescription in June.

The 36-year-old relies on medication to manage chronic pain. He and his authorized representative were unable to determine what happened until they contacted Dant Chesser’s office, and his coverage was eventually restored.

Dant Chesser said the state should explore whether it can verify basic information through records already held by other agencies rather than repeatedly asking Medicaid recipients to provide it.

In her constituent’s case, she noted, the Bureau of Motor Vehicles could confirm whether he had a valid Indiana driver’s license and address.

“There are bound to be other ways to do that,” Dant Chesser said.

Hospitals see more uninsured patients

Hospitals say Medicaid gaps are reshaping where Hoosiers seek care — and who ultimately pays for it.

Scott Tittle, president of the Indiana Hospital Association, said hospitals across the state have seen a significant decline in the number of patients carrying health coverage and a corresponding increase in reliance on emergency departments for routine and preventive services.

Emergency department visits in Indiana increased 16.8% last year, compared with 1.4% nationally, according to data cited by the association.

“Hospitals will continue to care for every patient who walks through their doors, but as coverage declines, uncompensated care rises, which adds to the financial strain for hospitals already operating on thin or negative margins,” Tittle said.

Continuous coverage for eligible Hoosiers, he added, is necessary both to keep patients healthy and to sustain the hospitals treating them.

The association said hospitals are seeing more uninsured and underinsured patients, with some facilities projecting that their bad debt could double in 2026. Charity care is also increasing, according to the group, which said Indiana hospitals already provide more uncompensated care than the national average.

The impact is especially visible in emergency departments, where federal law generally requires hospitals to evaluate and stabilize patients regardless of whether they are insured or able to pay.

Baptist Health Floyd in New Albany reported that the share of emergency department patients classified as self-pay rose 13.1% as Medicaid and marketplace enrollment declined. Its self-pay share across the broader hospital increased 15.2%.

Hospital President Mike Schroyer estimated the change would reduce annual Medicaid payments to hospitals by about $713,000.

At Indianapolis-based Eskenazi Health, the state’s largest safety-net hospital, Chief Executive Officer Dr. Lisa Harris said uncertainty over Medicaid coverage is also keeping patients from seeking routine care until their conditions become more serious.

Since April, emergency department visits at Eskenazi have increased 73%, while the share of uninsured patients admitted to the hospital has tripled, she said.

“Without coverage or uncertainty about their coverage, individuals are avoiding coming in for care until they have no choice,” Harris said. “The biggest problem is those lives are compromised.”

Eskenazi already employs more than 90 financial eligibility specialists to help patients enroll in Medicaid and restore coverage after interruptions, but those staff increasingly spend hours navigating paperwork, long hold times and other administrative hurdles, Harris noted. And even when coverage is ultimately reinstated retroactively, she added, many patients postpone appointments because they are unsure whether they’ll be covered.

The financial consequences are not limited to hospitals.

Home health agencies, behavioral health providers, therapists and others who depend on Medicaid reimbursement may be unable to bill for services delivered while a recipient’s coverage is inactive. Some continue care while hoping the state will restore coverage retroactively. But others can’t afford to take that risk.

Navigators based at hospitals, community mental health centers, federally qualified health centers and nonprofit organizations are increasingly being asked to intervene.

Susan Jo Thomas, executive director of Covering Kids & Families of Indiana, a statewide organization that helps Hoosiers enroll in health coverage, said procedural closures are often more complicated than a recipient simply failing to return paperwork.

Much of the eligibility process now depends on online portals, electronic data matching and automated notices, she said, and a case can break down at any of those points.

People who move frequently may never receive a mailed notice. Others manage banking, work and much of their daily lives through a smartphone but have never created an online benefits account or do not know that a new eligibility notice has been posted there.

“We’ve not been able to convert mailbox into inbox,” Thomas said.

Ann McCafferty, program director for the Indiana Rural Health Association’s Healthy Families Alliance initiative to help Hoosiers access healthcare, added that access to enrollment help also remains uneven, particularly in parts of southern Indiana.

Families working with an experienced navigator generally have someone who can interpret a notice, identify the missing information and help ensure it reaches the proper office. Those navigating the system alone may not know what went wrong or how to correct it before coverage closes.

McCafferty said missed mail and confusing state notices are recurring barriers, particularly in rural areas where a letter may arrive only days before the recipient’s deadline.

“I think people really want to do the right thing,” she said. “They value their benefits. They want to keep their benefits, but maybe the language is just a little confusing.”

Children also disappearing from Medicaid rolls

Enrollment has also fallen among younger Hoosiers.

An estimated 174,000 fewer Indiana children were covered through Medicaid or the Children’s Health Insurance Program in April than in January 2025, according to a recent Georgetown University analysis. The 20% decline was the largest percentage drop in the country and the third-largest numerical decline, behind California and Texas.

Children generally qualify for Medicaid at higher household income levels than adults, and they can remain eligible even when a parent does not. But families often apply or renew together, meaning a missed notice or unresolved eligibility problem can affect multiple household members.

Thomas said interruptions in children’s coverage can delay preventive care, developmental screenings and specialist treatment that may be difficult to quickly reschedule once Medicaid is restored.

“The loss of the coverage for the child is devastating,” Thomas said.

She noted that removing children from coverage does not spare the health system substantial expense because children generally cost less to treat than adults, while missed screenings can allow developmental or health problems to go unidentified.

“This has not saved the state of Indiana, or the federal government, or the healthcare groups, or the providers, or society one penny,” Thomas said of the decline in child enrollment. “Kids are really cheap to treat.”

State points to stricter verification rules

FSSA has provided limited explanation for the sharp enrollment decline or the growing share of renewals ending for noncompliance.

The agency did not answer questions from the Capital Chronicle about changes to staffing, automated renewal procedures, data-matching systems or its workflow for renewing recipients without requiring them to submit additional information.

FSSA also said it does not maintain renewal and disposition figures at the county level and does not track the method recipients use to return information.

Such gaps make it difficult to identify whether procedural closures are concentrated in particular regions of the state, or whether one method of responding produces better outcomes than another.

Dant Chesser said she doesn’t place responsibility for the breakdowns on any one agency, elected official or administration, but she argued that state leaders must improve how they communicate with each other and with Medicaid recipients.

Advocates don’t dispute that Medicaid recipients need to update their information and respond to eligibility requests.

But, they argue, FSSA also bears responsibility for ensuring notices reach their intended recipients, submitted documents are processed before cases close and eligible Hoosiers do not lose coverage because separate parts of the system fail to communicate.

“There are things falling through the cracks,” Dant Chesser said. “This is something they expect their state government to do.”