More than 1.4 million Indiana citizens — approximately 20% of the state population — receive healthcare support through state Medicaid programs. These multi-year planned programs have historically been managed by a selected group of contracted providers since its inception. At a quarterly meeting in January, Indiana’s Family and Social Services Administration (FSSA) secretary Mitch Roob announced the organization would open $68 billion of these managed care contracts for new bids later this year. The announcement has sparked further speculation on the process and concerns about the long-term effects on Indiana residents.
THE MEDICAID STATUS QUO
Indiana offers four state-specific programs:
- Hoosier Healthwise, for children 19 and under and pregnant individuals (670,000+ enrollees)
- Healthy Indiana Plan (HIP), for lower-income citizens ages 19-64 (599,000+ enrollees)
- Pathways for Aging, for seniors over 60 requiring long-term care (116,000+ enrollees)
- Hoosier Care Connect, for citizens 59 and under with disabilities who are not eligible for Medicare (79,000+ enrollees)
The managed care system budgets a flat fee to each enrollee instead of paying for individual services. Current providers overseeing these programs include Humana, Elevance Health (fka Anthem), United Healthcare, CareSource, and Managed Health Services, with MDwise exiting the pool in November.
The FSSA presentation for the new Managed Care Entity Procurement plan was positioned as a preliminary outline. Secretary Roob explained that further details about scope and expectations for providers would not be fully available until closer to the launch of the initiative. January 2029 is the target effective date for new contracts.
THE CASE FOR REFORM
Observers of the state’s Medicaid programs have previously described issues across the existing system in need of refinement. The Indiana Health Care Association identifies several concerns over the Pathways Program since its launch in 2023. Two of the four contractors originally engaged to oversee Pathways were required to follow state corrective action plans after instances of claims, billing, and other violations were found, with an additional contractor removing themselves from the program shortly after its inception. All three remaining providers were cited for owing over $100 million in delayed or denied payments to long-term care facilities.
A number of state lawmakers are urging caution in regards to the FSSA’s proposal. Rep. Ed Clere of Indiana’s New Albany district feels that a rebidding process of this magnitude may be “a recipe for additional disruption, if not disaster.” While agreeing that some reform is needed, he offers that a more measured approach — one that assesses covered populations and/or providers individually — would be less likely to impede care among Indianans who rely on medicaid dollars and programs.
With complete details from the FSSA yet to solidify, advocates for all positions within the state’s healthcare paradigm will have much to discuss and debate in the months ahead.