Indiana Medicaid

Indiana Medicaid Renewals Show High Procedural Closures, but Not a Verified Count of Coverage Losses

Indiana renewal data show that procedural or administrative reasons accounted for a large share of several recent Medicaid and CHIP renewal cohorts. But those figures do not establish how many people were ineligible, wrongly terminated, uninsured, or permanently off Medicaid.

Matthew Colley

Matthew Colley

— 6 min read
Indiana Medicaid Renewals Show High Procedural Closures, but Not a Verified Count of Coverage Losses

Indiana Medicaid and CHIP renewal data show a clear and important administrative pattern: a large share of people due for renewal in several 2025 and 2026 cohorts were recorded as disenrolled for procedural or administrative reasons.

That finding deserves attention. A procedural closure generally means a person did not complete required renewal steps or provide requested information. It is different from a finding that the person no longer met Medicaid eligibility rules.

But the available evidence does not establish that every procedural closure was wrongful, that everyone affected remained eligible, or that every person who left a point-in-time enrollment count became uninsured. It also does not verify the often-cited claim that 343,000 unique Hoosiers lost Medicaid coverage.

The public record instead shows a combination of substantial enrollment decline, high procedural-closure rates in certain renewal cohorts, large pending and other-outcome categories, and major unanswered questions about transfers, re-enrollment, retroactive eligibility and individual coverage outcomes.

What the renewal data show

CMS reported that 116,660 Indiana Medicaid and CHIP beneficiaries were due for renewal in September 2025. Of that cohort, CMS reported:

  • 34% renewed;
  • 50% disenrolled; and
  • 16% remained pending.

CMS also reported that 47% of the full September renewal cohort were disenrolled for procedural or administrative reasons. That percentage is a share of all people due for renewal, not a share only of those who were disenrolled.

In the same CMS data, substantive ineligibility accounted for about three percentage points of the full renewal cohort.

A similar pattern appeared in CMS data for May 2026. Of 98,256 Indiana beneficiaries due for renewal that month, CMS reported:

  • 16% renewed;
  • 47% disenrolled; and
  • 37% remained pending.

CMS reported that 46% of the full May 2026 cohort were procedurally or administratively disenrolled.

These figures show that procedural or administrative outcomes made up a substantial portion of the reported renewal cohorts in those months. They do not show why each person did not complete renewal requirements, whether each person continued to qualify, or what happened after an initial closure.

FSSA data reported by the Indiana Capital Chronicle indicated that about 36% to 40% of renewal cohorts from September through December 2025 were closed for procedural reasons, while substantive ineligibility was below 9%.

For June 2026, FSSA data reported by the Chronicle showed 110,382 people due for renewal. The reported outcomes included:

  • 35.1% closed for noncompliance;
  • 7.1% found ineligible; and
  • 38.9% classified as “other.”

The “other” category cannot be treated as a termination or coverage-loss count. Indiana’s reported category can include transfers to another Medicaid category, closures before a benefit period ended and pending cases.

The September 2025 CMS figure of 47% procedurally or administratively disenrolled differs from the 36% to 40% range reported from FSSA data for September through December. The available evidence does not fully reconcile those numbers. Differences may reflect reporting extracts, timing or how outcomes were classified. They should not be combined as though they came from one identical dataset.

What a procedural closure means — and does not mean

A procedural closure occurs when required renewal steps or information are not completed. It is not, by itself, a determination that someone was financially or otherwise ineligible for Medicaid.

It is also not, by itself, proof that a state agency made an error or that a closure was unlawful.

Some people whose coverage is procedurally closed may have moved, obtained other insurance, become ineligible or decided not to continue coverage. Independent reporting indicated that many people later supplied documents or regained coverage. That information suggests that initial outcomes may not always be final, but it does not prove those individuals were eligible at the time of the initial closure.

Indiana’s Medicaid policy manual describes annual renewals and an ex parte review process. In an ex parte review, the state uses available electronic information to determine whether a person can remain eligible without requiring additional paperwork. The manual also describes a 90-day reconsideration process for some procedural discontinuances.

CMS approved Indiana CHIP amendments on December 9, 2024, implementing 12-month continuous eligibility and requiring ex parte review before certain end-of-period CHIP disenrollments.

Enrollment fell, but an enrollment decline is not a unique-person loss total

Indiana’s point-in-time Medicaid and CHIP enrollment declined substantially during 2025 and 2026.

FSSA reported enrollment of 1,752,020 in September 2025 and 1,559,424 in April 2026, a difference of 192,596 in the two point-in-time counts.

FSSA reporting also indicates enrollment fell from roughly 2.01 million in April 2025 to about 1.73 million in April 2026, a decline of approximately 283,000.

Those are important enrollment changes, but they are not a count of unique people who lost coverage. Point-in-time enrollment can change because of terminations, new enrollments, deaths, moves, voluntary withdrawals, transfers among coverage categories, duplicate cleanup, retroactive eligibility changes and other ordinary churn.

FSSA’s April 2026 report compared enrollment of 1,559,424 with a state fiscal year 2025 average of 2,012,645. That comparison should not be used as a measure of how many people lost coverage because it compares one monthly point-in-time figure with an annual average.

A number near 343,000 may be plausible under a particular enrollment comparison. But the available public record does not verify it as the number of unique Hoosiers who lost Medicaid. A responsible assessment would need to identify the starting month, endpoint and enrollment definition, and explain how re-enrollment, retroactive eligibility, program transfers and reporting changes were handled.

Why cohort data do not answer every question

Renewal reports follow groups of people who were due for renewal in a particular month. They are not a complete record of every change in statewide enrollment.

CMS cautions that renewal data are cohort-based, can be revised and may reflect pending cases, delayed actions, later corrections and state-specific reporting practices. A person who is pending in a given month should not be counted as terminated. Likewise, an “other” outcome should not automatically be treated as a coverage loss.

FSSA also warns that its enrollment figures may be revised and are affected by retroactive and presumptive eligibility.

The available public evidence does not provide a complete statewide month-by-month account from January 2025 through August 2026 showing outcomes by program, population, termination subtype, reinstatement timing or voluntary closure. Public CMS outcome and call-center data in the reviewed record extend through May 2026; August 2026 data were not verified.

Those gaps matter because a statewide enrollment total and a renewal cohort are different measures. Neither one alone can establish how many distinct individuals ultimately lost Medicaid coverage or how long any loss of coverage lasted.

Effects appeared across multiple programs

FSSA’s September 2025 figures showed enrollment across several major programs, including:

  • 599,014 Healthy Indiana Plan enrollees;
  • 677,762 Hoosier Healthwise enrollees;
  • 116,515 PathWays for Aging enrollees; and
  • 278,931 fee-for-service enrollees.

The largest numerical enrollment reductions appear to have occurred in the Healthy Indiana Plan expansion population and among Hoosier Healthwise children. But available aggregate data do not establish how much of any program’s decline resulted from procedural closures, substantive ineligibility, transfers or ordinary churn.

Operational signals, not proven causes

CMS-reported call-center data show increased access strain between September 2025 and May 2026.

In September 2025, Indiana reported 275,076 calls, a six-minute average wait and a 12% abandonment rate. In May 2026, the reported figures were 249,547 calls, a 16-minute average wait and a 19% abandonment rate.

Those measures indicate operational access strain. They do not establish that call-center conditions caused procedural closures.

Beneficiary-assistance organizations also described confusing notices, address problems and increased administrative burdens, particularly in rural areas. Those reports are useful operational signals, but they are not population-wide estimates and do not prove unlawful terminations.

In January 2025, FSSA Secretary Mitch Roob publicly described a move to quarterly eligibility checks that were separate from annual renewals. Quarterly checks increased administrative contact outside scheduled annual renewals and could increase documentation burden. The available record does not quantify their effect or establish that they caused the procedural closures reported in renewal data.

Future Healthy Indiana Plan six-month redetermination and work or community-engagement changes scheduled for January 1, 2027 do not explain renewal outcomes in 2025 and 2026.

The state’s position

At an April 2026 Budget Committee meeting, Secretary Roob said FSSA followed existing rules, reduced enrollment based on eligibility and sought to maintain enrollment for people who qualified.

That is the agency’s position. It is not independent proof that every disenrollment was substantively correct.

At the same time, the reviewed record does not contain a verified public audit establishing statewide wrongful renewal terminations between January 2025 and August 2026.

What remains unknown

The evidence supports a narrow but significant conclusion: Indiana’s reported renewal outcomes included high procedural or administrative closure rates in the documented September 2025 and May 2026 CMS cohorts, with similar late-2025 patterns reported from FSSA data.

What it does not establish is equally important. The public record does not show:

  • how many people who were procedurally closed remained eligible at the time;
  • how many were reinstated and when;
  • how many transferred to another Medicaid or CHIP category;
  • how many obtained other coverage, moved, voluntarily withdrew or became ineligible;
  • how many distinct people experienced a loss of Medicaid; or
  • whether 343,000 unique Hoosiers lost Medicaid coverage.

For beneficiaries and families, the distinction is practical. A procedural closure is an administrative outcome, not a complete explanation of a person’s eligibility or coverage situation. For the public, it means enrollment totals and renewal percentages should be read carefully: they document important trends, but they do not settle every question about individual coverage outcomes.

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