Indiana Health Coverage Programs (IHCP), run by FSSA's Office of Medicaid Policy and Planning, covers Hoosiers through Medicaid managed care; per CMS's most recent managed care enrollment data, report year 2024, Indiana's managed care programs covered approximately 1.6 million members. Nearly all members are enrolled in one of four managed care programs: Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), Hoosier Care Connect (HCC), and Indiana PathWays for Aging, plus a small number in PACE.
Five managed care entities currently hold IHCP contracts, each covering a different combination of the four programs: Anthem covers all four (HIP, HCC, HHW, and PathWays); CareSource covers HIP and HHW; Managed Health Services (MHS) covers HIP, HCC, and HHW; UnitedHealthcare covers HCC and PathWays; and Humana covers PathWays only. PathWays for Aging, Indiana's dual-eligible managed long-term services and supports program, operates as a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) model, with Anthem, Humana, and UnitedHealthcare as its FIDE SNP carriers. FSSA extended Hoosier Care Connect's contracts through December 2028 to align with PathWays' own procurement cycle, and is planning a combined rebid of all four comprehensive managed care programs, with an RFP expected in August 2026 and new contracts targeted for January 1, 2029. Healthy Indiana Plan operates under its own Section 1115 demonstration, HIP 2.0, whose renewal status with CMS is pending; a successor version, informally called HIP 3.0, is moving through the state rulemaking process.
Indiana PathWays for Aging is the state's dual-eligible managed long-term services and supports program, delivered through Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs). Outside PathWays, LTSS for the broader population runs through five separate 1915(c) HCBS waivers administered by the Division of Disability, Aging and Rehabilitative Services (DDARS) rather than through the managed care plans: Community Integration and Habilitation, Family Supports, Health and Wellness, and Traumatic Brain Injury waivers, plus a 1915(c) component tied to PathWays itself.
Partially integrated into managed care
Behavioral health is carved into the managed care plans; Hoosier Healthwise, for example, covers acute, primary, specialty, and behavioral health services as part of its standard MCE benefit package.
Carved in
DentaQuest administers dental benefits for Healthy Indiana Plan members on behalf of the HIP managed care entities. HIP Plus, HIP State Plan-Plus, and HIP State Plan-Basic members are eligible for dental coverage; HIP Basic members generally are not, except when 19 or 20 years old or pregnant.
Optum Rx serves as the pharmacy benefit manager for Traditional Medicaid, other fee-for-service programs, and pharmacy services carved out of the managed care delivery system. Dental and pharmacy benefits are excluded from Hoosier Healthwise's own MCE benefit package.
Non-emergency medical transportation is arranged per MCO rather than through one statewide broker. As of January 1, 2026, HIP and Hoosier Healthwise members assigned to Anthem or CareSource use WellTrans; Verida is the broker for Indiana's fee-for-service Traditional Medicaid population.
Gainwell Technologies has served as Indiana's Medicaid fiscal agent since 1991, operating CoreMMIS (the state's Medicaid Management Information System) and handling provider enrollment, eligibility verification, member and provider customer service, and fee-for-service claims processing.
280 agency updates tracked for Indiana. Available with Pro.
See them with ProThe Indiana Hospital Association released its 2027 legislative priorities, calling for codified retroactive Medicaid coverage for Hoosiers eligible at time of service or disenrolled for administrative reasons, elimination of duplicative reporting requirements, and greater insurer transparency including a statewide review of Medicaid managed care claims. The push comes as federal work reporting requirements take effect in January for Healthy Indiana Plan enrollees, with the state estimating 58,000 Hoosiers at risk of losing coverage, and after FSSA already disenrolled more than 500,000 Hoosiers from Medicaid over the past two years. IHA also wants hospital assessment fee revenue preserved for HIP and Medicaid reimbursement as federal provider tax caps take effect, and raised concerns about a pending rule redirecting 340B Medicaid savings to the state. Lawmakers convene in January for a budget session with new health committee leadership in both chambers.
Indiana's Department of Child Services told the State Budget Committee it expects to need a $300 million transfer into its main account for fiscal year 2027, continuing a pattern of recent shortfalls. Director Jennifer Dorfmeyer said caseloads have flattened but cost per case keeps rising, prompting a new service utilization review team that is piloting referral reviews in Marion County offices, cutting average referral costs 19% in September and 34% in October versus prior averages. The agency is also working with consulting firms Milliman and Myers & Stauffer to restructure services and provider rates, with Dorfmeyer noting this could make it easier to identify additional funding sources such as Medicaid. She also reported progress on a federal performance improvement plan and said 16 children remain without placement, with a goal of ending the practice of housing children in department offices.
An OIG audit released Tuesday found that $205.2 million in Medicaid supplemental payments intended to boost reimbursement for Indiana nursing facilities was instead recouped by county hospitals, which operate about 97% of nursing facilities in the state. OIG reported that nearly half of Indiana's supplemental payments, $479.8 million total, were recovered by nonstate government-owned entities like county hospitals, including $274.6 million in state-share funds those entities had initially contributed. Indiana received the highest nursing facility supplemental payments nationally in fiscal 2022, about $1.02 billion of $2.36 billion reported nationwide, prompting OIG's audit. The audit also found $12.2 million in federal payments that did not comply with federal and state requirements, due to unreported overpayments, a leap-year calculation error, and an incorrect federal matching rate; OIG recommended Indiana refund that amount and explore ways to increase the share of payments retained by participating nursing facilities.
Indiana University Health reported operating income of $110 million, a 4% margin, for the third quarter of 2026, up from $6.4 million (0.3% margin) a year earlier, according to its financial report. Total revenue reached $2.7 billion in the quarter, up from $2.4 billion, while operating expenses rose to $2.6 billion from $2.4 billion. For the nine months ended Sept. 30, 2026, operating income was $146.4 million (1.9% margin), with revenue up 10% year over year to $7.8 billion and expenses up 9.8% to $7.7 billion, driven by labor, pharmaceutical and supply costs. The system's CFO said it is helping patients navigate evolving coverage requirements while investing in a new downtown Indianapolis hospital campus, a systemwide Epic implementation, and a new Fort Wayne hospital, both slated for a May 1, 2027 go-live.
Democratic state Sen. J.D. Ford declared victory over three-term Republican U.S. Rep. Victoria Spartz in Indiana's 5th Congressional District, flipping a seat that had trended Republican since 2021 redistricting. The race drew national attention partly because the candidates offered sharply different approaches to health care: Ford campaigned on protecting Medicaid funding and preserving rural hospitals, while Spartz pushed reduced federal spending and more transparency and competition in health care. Elsewhere in Indiana, incumbents including Democratic Reps. Frank Mrvan and André Carson and several Republicans won reelection, shifting the state's delegation to a six-to-three GOP edge from seven-to-two. The outcome feeds into the broader national fight for U.S. House control, which will shape federal policy on spending and entitlement programs including Medicaid.
18 active waivers tracked for Indiana. Available with Pro.
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See them with Pro48 managed care contracts tracked for Indiana. Available with Pro.
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