An estimated 174,000 fewer Hoosier children were insured through Medicaid programs in April compared to January 2025, according to a report from Georgetown University School of Public Policy.
That’s a 20% decline — the highest rate in the nation, the report found.
Indiana reported the highest percentage decline and third-highest absolute decline in the nation in this timeframe, behind California (-382,776, or 8%) and Texas (-190,956, or 6%).
The report does not indicate how many children are uninsured, but notes changes in child Medicaid enrollment typically correspond with increases in children going without health insurance.
Child health advocates attribute the trend to confusion about Medicaid eligibility and fears that identifying undocumented family members to authorities to qualify for insurance coverage could result in their deportation.
Meanwhile, officials at Indiana’s Family and Social Services Administration say the report covers a limited timeframe. A broader look at changes in Medicaid enrollment and wage growth since states resumed eligibility redeterminations in 2023 provides a more complete picture, they say.
“It is important to note that … Indiana’s Medicaid enrollment for children and CHIP is just 2.6% below pre-pandemic levels,” FSSA officials said in the statement.
A ‘chilling effect’
Susan Jo Thomas, executive director of Covering Kids and Families, described a “chilling effect” as Hoosiers learn about coming changes to Medicaid eligibility, ultimately opting not to enroll anyone in the family.
Mixed-status immigrant families are at greatest risk of not enrolling in Medicaid due to fears they’d have to identify undocumented family members who live in the same household, she said.
“It has the effect of them saying, ‘It’s not worth the risk to the family unit to draw scrutiny or draw attention to our family,’ because on the application you have to list everyone that’s in the household, and it’s scary to reveal that kind of information to a governmental entity,” Thomas said.
“You’re not sure what they’re going to do with the information, and we know there’s national and statewide policies now about reporting everybody that’s listed on the application to either the Department of Homeland Security or some other government body that checks status.”
Confusion about work requirements for able-bodied adults, which take effect next year but will not affect children, and the resumption of eligibility redeterminations may be to blame too.
Thomas said the redetermination process is simple for some Hoosiers, but complex for those who must provide documentation of a disability or medically frail condition.
The prolonged hiatus on redeterminations during the pandemic meant the agency did not have accurate addresses for some Hoosiers, while other beneficiaries forgot how the process worked, she said.
Thomas advises Hoosiers to work with an insurance navigator to determine their family’s eligibility ahead of work requirements — a child may be eligible even if the parent is not— and to sign up for electronic notifications to avoid delays.
How Medicaid enrollment changed
Hoosier enrollment in Medicaid reached 2.2 million in 2023, according to the Indiana Family and Social Services Administration.
Enrollment stands at 1.5 million Hoosiers as of May — a decline of more than 400,000 since January 2025 alone.
FSSA resumed eligibility redeterminations at the conclusion of the public health emergency in 2023, but it wasn’t until 2025 that the agency started issuing must-return mailers and related verification requirements, FSSA officials said in a statement to the Capital Chronicle.
Officials attribute those changes with improved accuracy of Medicaid applications and redeterminations, as well as the decline in Medicaid enrollment found in the Georgetown report.
Looking at the full “unwinding” period, which began in March 2023, FSSA officials found that Indiana reported a 12% decline in children enrolled in the Children’s Health Insurance Program and 23% decline for children enrolled in traditional Medicaid — moving Indiana’s ranking from No. 1 to 14th and 11th in the nation, respectively.
At the same time, they say Indiana reported wage and GDP growth, which can affect eligibility for families who no longer meet income limits.
“FSSA will continue to ensure that eligibility determinations are made accurately for those individuals seeking Medicaid coverage.”
FSSA Secretary Mitch Roob told reporters earlier this year the decline in Medicaid enrollment has not resulted in a commensurate decline in the state’s Medicaid costs, which he attributed to a higher concentration of the sickest patients remaining insured.
Thomas said modest investments in pediatric preventative and primary care can prevent or delay the onset of serious, expensive medical conditions the state will pay for later.
“If in fact the state wants to save money, having fewer kids enrolled in Medicaid is not a saving of money,” she said. “It’s not very expensive to deliver care unless it’s a serious condition. If it’s just a routine screening or routine vaccinations, those kind of things are relatively cheap compared to the cost to society and cost to the family.”
Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.
