INDIANAPOLIS – Indiana’s SEA 1, signed by Governor Braun on March 4th, is poised to deepen Indiana’s healthcare affordability crisis by stripping Medicaid coverage from an estimated 387,546 Hoosiers by 2034, according to recent analysis by Hoosier Action Resource Center. The passage of SEA 1 comes as Hoosiers face mounting barriers when it comes to getting and affording healthcare. Surveys demonstrate that more than half of all Hoosiers have reported delaying or going without health or dental care due to cost. In Indiana, nearly 1 in 5 Hoosiers suffer under the weight of medical debt in collections.
In 2026, the passage of HR 1, also known as the One Big Beautiful Bill (OBBB), led the cost of marketplace healthcare premiums in Indiana to spike on average by 20.5%, which led to 16% drop in ACA enrollees in Indiana – one of the highest in the country. SEA 1 codifies and expands the 2026 federal budget reconciliation bill HR 1 into state law, which will increase bureaucratic barriers to both Medicaid coverage and SNAP. SEA 1 increases previously projected Medicaid coverage losses caused by HR 1 by an estimated 137,500 Hoosiers.
“The processes and procedures they’re putting people through will kill them while they wait for coverage,” said Joe Burgess, a Medicaid member from Mooresville living with Primary Progressive Multiple Sclerosis (MS). Burgess relies on Medicaid to manage his disease, and is terrified about the impact of SEA 1 for his caregivers as well as his family members: “choice of medication and rent, choice of medication and food, that’s where a lot of this is going. It’s absolutely catastrophic.”
SEA 1 creates dangerous barriers to care for Hoosier families by:
- Increasing and expanding the frequency of eligibility redeterminations from one year to 6 months for most adult Medicaid members, which will make Medicaid more expensive to run and cover fewer Hoosiers.
- Requiring medical certification for someone to be determined medically frail, increasing the barriers to care for individuals with serious chronic health conditions, cancer, and disabilities.
- Requiring three months of Medicaid pre-enrollment eligibility and compliance, including work reporting requirements, before a person is eligible to receive Medicaid.
- Banning hardship exemptions from work reporting requirements for Medicaid members. This will result in the state taking healthcare away from Hoosiers if they don’t turn in monthly paperwork while facing emergencies, like hospitalization or a tornado.
- Not allowing for exemptions for Medicaid members leaving incarceration, which will likely lead to increased recidivism and overdoses.
- Leaving out part-time education as a countable activity toward the 80 hours required for federal compliance with work reporting requirements.
“This bill will cause a lot of hurt. It will leave people struggling, families in need, seniors, and people with disabilities facing new challenges without delivering the help they actually need,” said Lucretia Buford, an Indianapolis worker with SEIU Healthcare and mother of a special needs child who relies on Medicaid. She knows firsthand how hard it already is for Hoosier families to get the care they need: “As someone who’s trying to navigate this system through all the confusion and frustration and some of the access being denied and delayed, I know that someone’s going to fall through the cracks with this bill. I want to see people get the care they need without red tape and hassle.”
Rural communities where wages are lower, Medicaid enrollment is higher, and healthcare providers operate on slim margins are especially at risk because of SEA 1. Dr. William Cooke, a family physician with a practice in Scott County also expressed his disappointment at the bill’s passage: “Healthy communities are fiscally responsible communities. In two decades as a rural family physician, I’ve seen how early intervention and prevention keep people healthier and strengthen local economies. Restricting Medicaid coverage for low-income Hoosiers may look like savings on paper, but it ultimately shifts higher costs onto Hoosier families while putting our already fragile healthcare infrastructure—including struggling rural hospitals—at greater risk.”
However, the state has provided no evidence that SEA 1 will provide any cost savings for Hoosier families: neither the bill’s fiscal note nor FSSA have provided any publicly available coverage loss estimates for Medicaid or projected cost savings. There is, however, evidence that increasing barriers to care will make Indiana’s Medicaid programs more expensive to run, wasting public dollars to create costly new bureaucracy. As a result, money that could be used to feed Indiana’s most vulnerable families and ensure they can see the doctor will instead go toward managing a complex system of repetitious eligibility checks and exemptions, significantly increasing FSSA’s workload, and likely providing no cost savings to the state. These provisions place a significant burden on individual Medicaid members and FSSA, but fail to address the primary sources of fraud and profiteering in the Medicaid system: insurance corporations, healthcare conglomerates, and false provider billing.
In response to SEA 1’s passage, Hoosier Action members plan to organize house meetings, distribute Medicaid navigation resources, and organize Town Halls across to draw attention to the state’s growing healthcare affordability crisis.
HR 1 & SB 1 Disenrollment Projection Analysis
| Cause | # of Individuals | % Impact | Explanation |
| Work reporting requirements from HR 1 and SEA 1, including hardship exemption bans and 3 month retroactive compliance requirement added by SEA 1 | 235,875 – 347,437 | 51% of HIP Expansion Population | Projected expansion population 462,500-681,250 based on Congressional Budget Office (CBO) HR 1 impact estimate and 2026 projection of 352,175 HIP expansion members. 51% disenrollment estimate based on Indiana’s previous implementation of POWER Accounts which resulted in 51% otherwise eligible HIP expansion members losing coverage due to confusing new rules and paperwork. |
| 6 month redetermination to non-expansion adult Medicaid members in SEA 1 | 25,516 – 37,585 | 10% coverage loss for non-expansion HIP enrollees | Projected expansion population 255,166-375,853 based on Congressional Budget Office (CBO) HR 1 impact estimate and 2026 projection of 194,299 HIP non-expansion members. |
| Other HR 1 Medicaid Provisions | 64,000 – 64,680 | Projection based on Congressional Budget Office (CBO) HR 1 impact estimate. | |
| TOTAL AVERAGE | 2 325,391 – 449,702 387,546 | 21% of total Medicaid population | Assumes a Medicaid enrollment projection of 1.83 million people in Indiana based on Congressional Budget Office (CBO) HR 1 impact estimate. |
Key Context for SB 1 Coverage Loss Analysis
- Congressional Budget Office (CBO) via KFF estimates the total coverage loss of 167,000-278,000 by 2034 caused by HR 1. Total average 220,000 people by 2034, a loss of 12% Medicaid membership.
- 70.6% of coverage loss due to work reporting requirements according to CBO estimate ratio.
- Assumes a Medicaid enrollment of 1.83 million people in Indiana.
- The impact of Medicaid work reporting requirements has been disputed with CBPP and others arguing that CBO underestimated the coverage losses due to Medicaid work reporting requirements.
- Using Arkansas implementation as an example, CBPP estimates work reporting requirements put 148,000-218,000 Hoosiers at risk or 32% of the Medicaid expansion population at risk for coverage loss.
- CPBB total Medicaid coverage loss estimate is therefore higher than CBO estimate: 212,000-282,680 Hoosiers or an average 247,340.
- Overall CPBB disenrollment projected Medicaid disenrollment rate is therefore 13.5%
- Indiana Medicaid enrollment as of January 2026: 1,631,059, HIP Enrollment: 546,474, Projected 2026 Expansion Population: 352,175
- The legality of certain SEA 1 provisions remains dubious as they are in conflict with HR 1, including:
- SEA 1 expands the requirement to conduct more frequent redeterminations to include Medicaid enrollees beyond the expansion adult group, including pregnant individuals.
- HR 1 requires states to use available data to attempt to verify exemptions before requiring individuals to submit additional information. SEA 1 appears to prohibit individuals from being automatically exempt on the basis of medical frailty even if there is available data.
- HR 1 includes a mandatory exemption for individuals who were an inmate of a public institution and within three months of release. SEA 1 does not include the 90-day post-release in its inmate exemption.
- HR 1 requires a mandatory exemption from Medicaid work requirements if the individual is a member of a “household that receives supplemental nutrition assistance program benefits” and is not exempt from SNAP work requirements. SEA 1 excludes individuals subject to the 3-month SNAP time limit but who haven’t used up their 3 months, and individuals in households where someone in the household is receiving SNAP.
For more information contact Tracey Hutchings-Goetz at tracey@hoosieraction.org or 847-650-2981.
