IndianaSB 2First Regular Session 124th General Assembly (2025)SenateWALLET

Medicaid matters.

Sponsored By: Ryan Mishler (Republican)

Signed by Governor

Summary

Requires the office of the secretary of family and social services (office) to report specified Medicaid data to the Medicaid oversight committee. Requires the office to annually prepare and present a report to the budget committee concerning the enforcement of the Medicaid five year look back period. Prohibits specified persons from advertising or otherwise marketing the Medicaid program. Provides that the office may adopt rules concerning permissible advertising or marketing indicating participation in the Medicaid program by a person that has contracted with the office. Allows the office to reimburse medical providers at the appropriate Medicaid fee schedule rate for certified medical claims prior to the beginning of benefits, provided the claims satisfy certain conditions. Repeals language allowing for marketing of the Medicaid program. Requires the office to receive and review data from specified federal and state agencies concerning Medicaid recipients to determine whether circumstances have changed that affect Medicaid eligibility for recipients and to perform a redetermination. Requires the office to establish: (1) performance standards for hospitals that make presumptive eligibility determinations and sets out action for when hospitals do not comply with the standards; and (2) an appeals procedure for hospitals that dispute the violation determination. Sets out a hospital's responsibilities when making a presumptive eligibility determination. Imposes corrective action and restrictions for failing to meet presumptive eligibility standards. Specifies requirements, allowances, and limitations for the healthy Indiana plan.

appropriationsthe housepublic health

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Bill Overview

Analyzed Economic Effects

7 provisions identified: 1 benefits, 4 costs, 2 mixed.

Funding limits Healthy Indiana Plan access

Beginning July 1, 2025, Indiana must limit Healthy Indiana Plan enrollment to what available state funding supports. The law sets no specific enrollment cap. Indiana must end the plan if its federal waiver is revoked, rescinded, vacated, or changed so Indiana cannot follow the law. Indiana may also end the plan if the federal funding share falls below 90%. Falling below 90% does not, by itself, require the plan to end.

More frequent checks on Medicaid eligibility

Beginning July 1, 2025, Indiana must make regular data checks to see whether Medicaid recipients still qualify. Unless federal law prohibits it, specified federal and other records must be checked at least monthly. Records include income, earnings, addresses, deaths, incarceration, child support, and taxes. Monthly state checks also cover lottery and gambling winnings of $3,000 or more, vital records, SNAP information, and prison records. Workforce and certain tax records require quarterly checks; tax records on adjusted gross income and family makeup require yearly checks. New information that may affect eligibility requires a prompt review. Verified winnings end enrollment only when they make the recipient ineligible; $3,000 is not an automatic cutoff. Indiana may hire outside firms to search more databases. Tax information shared for these Medicaid purposes must stay confidential, and wage-data sharing costs must be paid under state law.

Stricter adult Healthy Indiana Plan eligibility

Beginning July 1, 2025, adults in the Healthy Indiana Plan's covered adult group must meet an activity or exemption. They must also meet Indiana residency and the plan's other eligibility requirements. Work, work programs, workfare, volunteering, or combined activities generally require an average of at least 20 hours weekly. Other routes include receiving unemployment benefits while meeting work rules, substance-use treatment, medical unfitness, or pregnancy. Parents or caretakers of children under six and people caring for someone with a serious condition or disability also qualify. Release from incarceration less than 90 days earlier or full-time accredited education as an Indiana resident are additional routes. These routes do not remove the plan's other eligibility requirements. The law removes listed routes for certain parents and caretakers, low-income adults ages 19 and 20, and transitional medical assistance recipients. The secretary cannot negotiate the work requirement below 20 weekly hours unless federal law expressly requires it.

Medicaid applicants face stricter information checks

Beginning July 1, 2025, Indiana must verify six types of information before Medicaid enrollment. These are income, residency, age, household makeup, caretaker or relative status, and other health coverage. An applicant's statement alone is not enough unless federal law requires the state to accept it.

Healthy Indiana Plan coverage requires federal waiver

Beginning March 14, 2025, Indiana must provide Healthy Indiana Plan eligibility through an approved federal demonstration waiver. The law generally bars the covered adult group from the regular Medicaid state plan, with a stated statutory exception. Indiana must amend its state plan to exclude that group. The amendment's effective date is delayed, but no later than completion of the 3.0 waiver negotiations and approved implementation. Indiana must keep operating the plan as it stood on January 1, 2025, during the transition. That duty ends when the 3.0 waiver starts or the existing waiver expires, is terminated, or is vacated.

Earlier care payments for Indiana plan applicants

Beginning July 1, 2025, Indiana may pay providers for certified care received before Healthy Indiana Plan benefits begin. Care must fall within 30 days before the application, and the applicant must have been eligible when treated. The applicant must later be approved and enrolled in the plan. Payments use Medicaid fee rates and go to providers, not directly to patients.

New hospital rules for temporary Medicaid

Only qualified hospitals can grant temporary Medicaid coverage through a presumptive eligibility decision. Hospitals must report each decision within five business days, help with full applications, and give written deadline notices. Applicants must file a full application before the last day of the following month to keep coverage through the decision. Without a full application, temporary coverage ends at that month's end. A hospital's first violation in a calendar year requires written notice within five days. A second violation within 12 months requires staff training. A third violation within 12 months of the second ends the hospital's approval to make these decisions. Indiana must set performance standards and an appeal process; appeals of second or third violations require clear and convincing evidence.

Sponsors & Cosponsors

Sponsor

  • Ryan Mishler

    Republican • Senate

Cosponsors

  • Brad Barrett

    Republican • House

  • Chris Garten

    Republican • Senate

  • Ed Charbonneau

    Republican • Senate

  • Jeff Raatz

    Republican • Senate

  • Jeffrey Thompson

    Republican • House

  • Linda Rogers

    Republican • Senate

  • Martin Carbaugh

    Republican • House

  • Michael Young

    Republican • Senate

  • Mike Gaskill

    Republican • Senate

  • Tyler Johnson

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 409 • No: 706

Senate vote • 4/17/2025

Senate concurred with House amendments

Yes: 37 • No: 10

House vote • 4/8/2025

Third reading: passed

Yes: 66 • No: 28

House vote • 4/7/2025

Amendment #1 (Garcia Wilburn) failed

Yes: 28 • No: 60

House vote • 4/7/2025

Amendment #2 (Shackleford) failed

Yes: 26 • No: 67

House vote • 4/7/2025

Amendment #3 (Shackleford) failed

Yes: 28 • No: 66

House vote • 4/7/2025

Amendment #4 (Shackleford) failed

Yes: 27 • No: 67

House vote • 4/7/2025

Amendment #10 (DeLaney) failed

Yes: 28 • No: 60

House vote • 4/7/2025

Amendment #8 (Porter) failed

Yes: 27 • No: 64

House vote • 4/7/2025

Amendment #6 (Shackleford) failed

Yes: 28 • No: 65

House vote • 4/7/2025

Amendment #12 (DeLaney) failed

Yes: 28 • No: 67

House vote • 4/7/2025

Amendment #5 (Shackleford) failed

Yes: 28 • No: 65

Senate vote • 2/18/2025

Third reading: passed

Yes: 40 • No: 9

Senate vote • 2/17/2025

Amendment #7 (Qaddoura) failed

Yes: 9 • No: 39

Senate vote • 2/17/2025

Amendment #8 (Qaddoura) failed

Yes: 9 • No: 39

Actions Timeline

  1. Signed by the Governor

    5/1/2025Senate
  2. Public Law 126

    5/1/2025Senate
  3. Signed by the President of the Senate

    4/23/2025Senate
  4. Signed by the President Pro Tempore

    4/22/2025Senate
  5. Signed by the Speaker

    4/22/2025House
  6. Senate concurred with House amendments; Roll Call 470: yeas 37, nays 10

    4/17/2025Senate
  7. Motion to concur filed

    4/10/2025Senate
  8. Returned to the Senate with amendments

    4/9/2025House
  9. Third reading: passed; Roll Call 390: yeas 66, nays 28

    4/8/2025House
  10. Amendment #4 (Shackleford) failed; Roll Call 378: yeas 27, nays 67

    4/7/2025House
  11. Second reading: ordered engrossed

    4/7/2025House
  12. Amendment #7 (Porter) ruled out of order

    4/7/2025House
  13. Amendment #6 (Shackleford) failed; Roll Call 381: yeas 28, nays 65

    4/7/2025House
  14. Amendment #3 (Shackleford) failed; Roll Call 377: yeas 28, nays 66

    4/7/2025House
  15. Amendment #12 (DeLaney) failed; Roll Call 382: yeas 28, nays 67

    4/7/2025House
  16. Amendment #8 (Porter) failed; Roll Call 380: yeas 27, nays 64

    4/7/2025House
  17. Amendment #2 (Shackleford) failed; Roll Call 376: yeas 26, nays 67

    4/7/2025House
  18. Amendment #1 (Garcia Wilburn) failed; Roll Call 375: yeas 28, nays 60

    4/7/2025House
  19. Amendment #10 (DeLaney) failed; Roll Call 374: yeas 28, nays 60

    4/7/2025House
  20. Amendment #5 (Shackleford) failed; Roll Call 379: yeas 28, nays 65

    4/7/2025House
  21. Committee report: amend do pass, adopted

    4/3/2025House
  22. Committee report: amend do pass, adopted

    3/20/2025House
  23. Recommitted to Committee on Ways and Means pursuant to House Rule 126.3

    3/20/2025House
  24. Representative Carbaugh added as cosponsor

    3/20/2025House
  25. First reading: referred to Committee on Public Health

    3/3/2025House

Bill Text

  • Engrossed Senate Bill (H)

  • Enrolled Senate Bill (S)

  • Introduced Senate Bill (S)

  • Senate Bill (H)

  • Senate Bill (S)

Related Bills

Back to State Legislation