58,000 Hoosiers not in compliance with new HIP work rules

The Indiana Family and Social Services Administration shared internal estimates Monday showing 58,000 Hoosiers insured through the Healthy Indiana Plan are not in compliance with federal Medicaid work rules set to take effect next year.

Estimates suggest as many as 12% of current HIP members are at risk of losing coverage when the agency begins enforcement of Medicaid work requirements for new and existing members on Jan. 1, 2027.

New applicants and HIP members will need to show they are either working, attending school, volunteering or participating in an apprenticeship or work program — or some combination thereof — for at least 80 hours a month to continue receiving benefits unless they qualify for an exemption.

Participants can also earn at least $580 a month to comply.

While enforcement won’t begin until January, the agency is using a three-month look-back window. Anyone applying for or renewing coverage in January should be in compliance starting this month to be eligible or avoid disruption.

The Healthy Indiana Plan is one of five Medicaid plans available in Indiana, but it is the only plan subject to new federal work rules.

The plan is intended for adults ages 19 to 64 who earn a bit too much to qualify for traditional Medicaid, accounting for about 32% of all Medicaid enrollees in Indiana.

Some 461,700 Hoosiers were enrolled in HIP in as of August, according to FSSA’s Medicaid dashboard.

State officials in August estimated as many as 300,000 Hoosiers could be subject to HIP work requirements after exemptions are taken into account.

The agency is touring the state to answer questions about the change at a series of town halls, with the next one slated for 6 p.m. Tuesday at the Ivy Tech Valparaiso campus.

Exceptions and exclusions from work requirements are available for:

• Former foster youth under age 26;
• Members of a federally recognized tribe;
• Parents or caregivers of a dependent child up to age 13;
• Caregivers of disabled persons;
• Veterans with a total disability rating;
• Pregnant and postpartum women who are within 12 months of their pregnancy or birth;
• Incarcerated or recently incarcerated persons within 90 days of release;
• SNAP or TANF recipients already in compliance with federal work rules;
• Persons enrolled in drug or alcohol treatment programs;
• Persons considered medically frail or special medical needs, which may include blindness, disability, substance use disorder, serious mental health condition, serious physical, intellectual or developmental disability, or having another serious or complex medical condition.