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Indiana Medicaid and the new work rules
Healthy Indiana Plan (HIP) — the ACA expansion group for adults 19 to 64 — plus Traditional Medicaid, Hoosier Care Connect and Indiana PathWays for Aging for adults who are aged, blind or disabled is run by Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP); eligibility is determined by the FSSA Division of Family Resources (DFR). Indiana expanded Medicaid on February 1, 2015, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.
From January 1, 2027, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 227,690 people in Indiana. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
The timing catches people out, so start here: the rules bite on applications and renewals begun on or after January 1, 2027, and FSSA looks backward three months. Apply in January 2027 and the state checks October, November and December 2026. If you are already a member, the review covers the three months before your renewal month or quarterly review — and you can look up your own renewal date in the Benefits Portal under "Assistance Group." FSSA says it checks compliance every three months, starting with wage and program data the state already holds, and only sends a member a notice asking for proof when it cannot confirm hours or an exemption electronically. Self-employed members can document hours or earnings with their most recent tax return or other business records. Any taxable income counted under MAGI budgeting, including Social Security or investment income, can count toward the $580 monthly earnings alternative. Members are told to report changes in work, school, health or family within 10 days — through the Benefits Portal at fssabenefits.in.gov, by phone to the DFR at 1-800-403-0864, by mail to the FSSA Document Center at PO Box 1810, Marion, IN 46952, or in person at a DFR office.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
No HIP member is being charged a POWER account contribution or a copayment right now, and nobody can be moved to HIP Basic or lose coverage for not paying one.
Indiana suspended all Medicaid cost-sharing in March and April 2020 for the COVID-19 public health emergency. It planned to restart on July 1, 2024, and then a federal court vacated the 2020 federal approval of HIP on June 27, 2024. FSSA pulled HIP out of the restart: the updated version of IHCP Bulletin BT202461 states plainly that "No cost sharing for Healthy Indiana Plan (HIP) members will resume," and only CHIP and MEDWorks cost-sharing resumed. The D.C. Circuit's March 2026 opinion describes the resulting legal position precisely — the rest of HIP 2.0 stays in effect under a stay, but "Indiana now lacks authority to collect premiums related to the POWER accounts or to terminate HIP Plus coverage based on non-payment of POWER premiums." FSSA says the same thing in its own HIP 3.0 waiver application: "Following the remand, HIP has been permitted to continue only in a diminished form, without POWER account premiums or coverage consequences for nonpayment," and that during the suspension "members were automatically enrolled in HIP Plus, rather than moving between HIP Plus and HIP Basic based on required contributions.".
Every HIP member still has a POWER account, and the state still funds the full $2,500 that pays the first stretch of care each year. What has gone away is the member's share. Nobody is invoiced $1 to $20 a month, nobody pays the tobacco surcharge, and nobody is downgraded from HIP Plus to HIP Basic or dropped from HIP for missing a payment. Members have been defaulted into HIP Plus, which is the better package — it includes vision, dental and chiropractic care and charges no copayments except $8 for using an emergency room when there is no emergency.
The six-month penalty period that used to lock a member out of HIP for not paying was suspended on March 20, 2020 and removed from the program entirely effective July 1, 2021, so it no longer exists even on paper in the current policy manual.
Indiana wants cost-sharing back, but in a different shape. The HIP 3.0 waiver application would retire the POWER account construct and the HIP Plus and HIP Basic split altogether, replacing them with copayments paid at the time of service — the proposed schedule runs from $5 to $35 depending on the service, with $35 for non-emergency emergency room use, no copayment at federally qualified health centers, rural health clinics or community behavioral health clinics, and a cap so that no member pays more than 5% of income in a quarter. Members who complete at least three preventive care or chronic disease management activities would drop to the lower copayment tier for the rest of that benefit period and the next one. FSSA opened public comment on August 5, 2026, closed it September 4, 2026, and planned to submit to CMS by September 30, 2026, asking to start HIP 3.0 on October 1, 2027 with copayments possibly sooner. None of it is approved.
The state's own website has not caught up. FSSA's own consumer-facing HIP pages have not caught up. As of October 1, 2026 the POWER accounts page, the HIP frequently asked questions, the Am I Eligible page and the How to Enroll in HIP page all still describe the $1 to $20 monthly contribution as required, and the POWER accounts page still says that members with income above the poverty level who "choose not to make their POWER account contributions will be removed from the program." That is contradicted by FSSA's own IHCP bulletin, by its own waiver application, and by the federal appeals court opinion. The current rule — no contributions charged, no consequences for nonpayment — is what is published here, because it comes from the more recent and more authoritative sources. The practical risk runs one way: a member who reads the consumer page and concludes they owe money they are not being billed for may worry unnecessarily, and a member who gets an invoice anyway should call the DFR at 1-800-403-0864 and their health plan before paying it. If you get a bill, call before you pay it.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64133% of the poverty line
- 1 person
- $1,835.50
- 2 people
- $2,489.20
- 3 people
- $3,141.88
- 4 people
- $3,795.50
- 5 people
- $4,449.20
- 6 people
- $5,101.85
- 7 people
- $5,755.50
- 8 people
- $6,408.20
Parents and caretakers133% of the poverty line
- 1 person
- $1,835.50
- 2 people
- $2,489.20
- 3 people
- $3,141.88
- 4 people
- $3,795.50
- 5 people
- $4,449.20
- 6 people
- $5,101.85
- 7 people
- $5,755.50
- 8 people
- $6,408.20
Source: FSSA Medicaid Policy Manual (IHCPPM) Chapter 3000 and 3500 income standards and the Indiana Medicaid Eligibility Guide, income standards effective March 1, 2026 and based on the 2026 federal poverty levels; HIP figures cross-checked against the FSSA HIP Federal Poverty Level Income Chart. A note on precision: Two FSSA pages differ by three cents on the HIP limit for a household of three: the HIP Federal Poverty Level Income Chart says $3,141. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
Indiana has a law that would end expansion automatically
Coverage here is tied by statute to how much the federal government pays.
Who this reaches. The law covers everyone covered through HIP — adults 19 to 64 up to 138% of the poverty line, including members who are medically frail and pregnant members.
Indiana Code 12-15-44.5-4, as amended by Senate Enrolled Act 2 (2025), P.L.126-2025. The statute orders FSSA to terminate the Healthy Indiana Plan if any of three things happens: the federal matching rate for the expansion population falls below the rate the Affordable Care Act promised and the hospital assessment fee committee does not change its fee formula to cover the shortfall; the method of calculating the incremental hospital assessment fee is changed in a way that cuts available funding and neither the fee committee nor the agency makes up the difference; or the Medicaid waiver approving the plan is "revoked, rescinded, vacated, or otherwise altered in a manner that the state cannot comply with the requirements of this chapter." A separate subsection says that if federal financial participation for HIP enrollees falls below ninety percent, the agency may terminate the plan. The statute also bars FSSA from running HIP in a way that would obligate the state beyond its appropriation, and requires an annual actuarial analysis to the state budget committee showing that enough funding is reasonably expected to be available.
This is one of the harder trigger laws in the country, and Indiana is routinely counted among the states where expansion would end more or less automatically rather than after a legislative debate. Two features sharpen it. First, the money behind HIP is unusually narrow: the state share comes almost entirely from a hospital assessment fee and a slice of the cigarette tax rather than the general fund, so a squeeze on either can reach the trigger without any change in federal matching rates — and FSSA has told CMS that declining cigarette tax revenue and uncertainty over the hospital fee are part of why it wants new cost-sharing authority. Second, the clause about a vacated waiver was added in 2025, a year after a federal court actually vacated the federal approval of HIP. FSSA describes its own position bluntly in the HIP 3.0 waiver application: if CMS will not let Indiana cover the expansion group through a waiver alone while keeping the 90% enhanced match, the agency says state law will require it to end HIP. Nearly half a million Hoosiers are covered through HIP.
On the books and unexercised. HIP is still operating and still enrolling, so FSSA has not treated the 2024 vacatur of its federal approval as having tripped the new waiver clause: the court stayed its own order except as to the POWER account payment provisions, and the matter is back before HHS on remand after the D.C. Circuit dismissed Indiana's appeal in March 2026. One practical consequence is worth knowing, because it saves members money and worry. Indiana lost the authority to collect POWER account contributions, so no HIP member is being invoiced for one, nobody pays a copayment, and nobody can be moved from HIP Plus down to HIP Basic or dropped from the program for not paying — FSSA's own words are that HIP now continues "only in a diminished form, without POWER account premiums or coverage consequences for nonpayment." The six-month lockout that used to follow nonpayment was removed from the program outright on July 1, 2021. Some of the state's own consumer pages still described the monthly $1 to $20 payment as mandatory when they were checked on October 1, 2026, so if you receive a bill, call the Division of Family Resources at 1-800-403-0864 and your health plan before paying it. Indiana has asked CMS for a new waiver, HIP 3.0, that would replace POWER accounts with copayments of $5 to $35 at the point of service from October 2027; that is not approved.
Nothing has changed, and this is not a reason to delay applying. It is a reason to keep your contact details current, open everything the state sends, and not assume coverage renews itself.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
About the phone numbers: FSSA does not publish call-center hours for either main line, so treat them as business hours and call mid-morning. Local DFR offices are open 8:00 a.m. to 4:30 p.m. Eastern, Monday through Friday, except state holidays — and note that Indiana spans two time zones, so offices in the northwest and southwest corners of the state run on Central time. Indiana has no general Medicaid ombudsman: the FSSA waiver ombudsman at 1-800-622-4484 handles only home- and community-based waiver complaints for people with intellectual and developmental disabilities, so for a HIP or Hoosier Healthwise problem you go through your health plan's grievance process and then a state fair hearing. FSSA also does not publish a dedicated Medicaid TTY number, so Deaf and hard-of-hearing callers should reach the lines above through relay at 711.
Deaf, hard of hearing or speech-impaired: 711 (national Telecommunications Relay Service).
Free interpreter line: 877-261-6608.
The FSSA Benefits Portal and Indiana's application for health coverage are published in English and Spanish, and the state's HIP work-requirement materials — the FAQ, the exemption list and the pre-screening tool — come in both languages. If you are more comfortable in another language, interpreters are free: call the Division of Family Resources at 1-800-403-0864, or the DFR language line at 877-261-6608, and ask for one. If you are Deaf or hard of hearing, you can reach those lines through relay at 711, and your HIP health plan will arrange an American Sign Language interpreter at no cost to you.
Most people who lose coverage lose it over paperwork, not eligibility
Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.
Check your doctor is in the plan before you choose it.
Questions people ask about this
Do the new Medicaid work rules apply to me in Indiana?
How many hours a month do I have to work?
Who is exempt from the work requirement in Indiana?
When do the Indiana work rules start?
What is the income limit for Indiana Medicaid?
How do I apply for Healthy Indiana Plan (HIP) — the ACA expansion group for adults 19 to 64 — plus Traditional Medicaid, Hoosier Care Connect and Indiana PathWays for Aging for adults who are aged, blind or disabled?
How often do I have to renew Indiana Medicaid?
Guides for neighboring states
The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.
No Healthy Indiana Plan member is being charged a POWER account contribution right now, and you cannot be moved to HIP Basic or lose coverage for not paying one — several state pages still say otherwise — but the new 80-hour-a-month work rule does start on January 1, 2027, and Indiana looks back three months, so this month's hours are among the first that count.
Make sure your address is right in the Benefits Portal, find your renewal date there, and use the state's pre-screening tool to see whether an exemption already covers you.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to FSSA Benefits Portal (fssabenefits.in.gov) — choose "Apply Online for Health Coverage" →