Indiana wraps up Medicaid unwinding, prepares for return of cost-sharing

By Abigail Ruhman / May 28, 2024

A significant number of Hoosiers lost their Medicaid coverage during a process known as “unwinding,” following the end of the COVID-19 public health emergency. Certain Medicaid members will resume paying premiums as early as July.

Medicaid officials said the state completed its final unwinding renewals in March. As of May, nearly 500,000 Hoosiers were disenrolled.

Indiana still has a couple months in its reconsideration or redetermination period for people who lost coverage at the end of the unwinding period. If someone does not respond to requests for additional information to determine eligibility, the Indiana Medicaid program allows for a 90-day reconsideration period. This allows people to regain coverage if they are still eligible.

During the unwinding, the state found that 21 percent of those who failed to respond to requests for verification regained eligibility during their reconsideration period.

Officials said Indiana processed nearly 1.8 million renewals over the last year — about half of those resulted in a successful renewal. Of those renewals, 78 percent were ex parte renewals. Those are also known as “auto-renewals,” meaning the state has enough information to know the individual is still eligible for Medicaid without needing additional verification.

The federal health insurance marketplace has a special enrollment period for people who lost coverage because of the unwinding.

Nonis Spinner, director of eligibility and member services at the state Office of Medicaid Policy and Planning, said that enrollment period has been extended through November.

“This extends that period until the regular open enrollment opens,” Spinner said. “So it does give them kind of a longer runway to find other coverage if they've found that they are no longer eligible for Medicaid.”

Spinner said most people who lost coverage qualified to have their account transferred to the federal marketplace.

Despite the unwinding, state data showed a net increase in Medicaid enrollment numbers. The most recent enrollment numbers grew about 540,000 over February 2020 enrollment numbers. Medicaid officials pointed to continuous coverage requirements for children younger than 19 as a major contributing factor for that increase.

The continuous coverage requirements are separate from the public health emergency and Medicaid unwinding. If a child is enrolled in Medicaid, they are given 12 months of continuing coverage even if their circumstances change in a way that would make them ineligible. Medicaid officials said this affected Medicaid enrollment numbers, but not the unwinding process.

One of the final parts of the Indiana’s “return to normal” process is the return of cost-sharing, including copayments and premiums.

Cost-sharing paused for Medicaid members at the beginning of the COVID-19 pandemic. But it will restart in July for about 1 million Hoosiers in the Healthy Indiana Plan, the Children's Health Insurance Program (CHIP) and the MEDWorks program.