Indiana’s Medicaid landscape is undergoing significant transformations in 2025, with implications for physicians across the state. Grant Achenbach, JD, and Meghan Linvill McNab, JD, CPA, presented a webinar May 7 on Medicaid 101: Federal Oversight, State Administration, Provider Level Matters & Important Updates. 

Senate Enrolled Act 2 introduces work requirements for Medicaid recipients, mandating 20 hours of work or volunteer service per week for able-bodied adults aged 19 to 64. Exceptions are provided for caregivers, students, individuals with disabilities, and those undergoing substance abuse treatment.
 
To address concerns about rising Medicaid spending, Senate Bill 2 also mandates more frequent and rigorous eligibility verification processes. The Indiana Family and Social Services Administration (FSSA) is required to conduct monthly checks using state and federal records to confirm continued eligibility for Medicaid recipients. This initiative aims to reduce improper payments and ensure that only qualified individuals receive benefits.

FSSA has announced changes to the coverage of Applied Behavioral Analysis (ABA) therapy for individuals with autism. Effective in 2025, Medicaid members will be limited to 30 hours of comprehensive ABA services per week, with a maximum duration of three years. After this period, recipients may continue with focused ABA services at a reduced frequency. A continuity of care period is provided until Sept. 1, 2025, to allow for transition planning.

An important reform to Medicaid reimbursement rates enacted in 2023 remains in effect in the new two-year state budget. The current budget, which expires on June 30, aligned Medicaid reimbursement rates with Medicare rates. This adjustment represented an increase for physicians providing services through the Healthy Indiana Plan (HIP 2.0), who previously received 75% of Medicare rates. ISMA has been actively involved in advocating for these changes and safeguarding them in the new budget to ensure fair compensation for healthcare providers.

The webinar was recorded for use. The session is accredited for 1.0 AMA PRA Category 1 credit™.