IHA President Scott B. Tittle shares why helping Hoosiers maintain health coverage as new HIP work requirements take effect is essential to protecting access to care close to home.
Keeping Hoosiers Covered Is Essential to Protecting Access to Care
By Scott B. Tittle, President, Indiana Hospital Association
Beginning Jan. 1, Indiana will enter a new chapter for the Healthy Indiana Plan (HIP) as compliance determinations begin under the new work requirements for certain Hoosiers. For Indiana’s hospitals, that means doing everything we can now to help eligible Hoosiers understand the changes, maintain their coverage and stay connected to care.
HIP was created with work and personal responsibility at its core, and we recognize the importance of that principle. Good health and the ability to work, learn, and contribute to our communities go hand in hand. As these requirements take effect, we want to ensure the process is clear and workable, so eligible Hoosiers can maintain their coverage. Hospitals across the state have already begun incorporating information about the new requirements into their patient navigation efforts to help them do just that.
That work has real urgency. Since the beginning of 2025, 519,000fewer Hoosiers are enrolled in Medicaid[1],while another 60,000 have lost Marketplace coverage because of federal changes to the premium subsidies[2]. The state estimates another 58,000 HIP members, roughly 12% of current enrollees, could be at risk of losing coverage under the new HIP work requirements[3].
For the patients hospitals care for every day, those numbers are more than statistics. When someone loses coverage, their health needs don’t simply disappear. Prescriptions still need to be filled and chronic conditions managed. But without coverage, people are more likely to delay care until a health problem becomes more serious. Too often, the emergency department becomes the place they turn when they can’t wait any longer.
We’re already seeing the strain. Indiana hospital emergency department visits grew 16.8% in 2025, compared with 1.4% nationally[4]. At the same time, Indiana hospitals are absorbing more of the cost of caring for uninsured patients, with uncompensated care rising 30% just in the last year[5].
That care still has a cost. As more patients arrive uninsured or underinsured, hospitals are strained and have fewer resources to invest in the people and services their communities rely on. That is especially concerning when nearly half of Indiana hospitals are already operating at a loss[6].
Medicaid reimbursement adds to that pressure. Indiana hospitals have not seen a meaningful increase in Medicaid base rates since 1991. And while Indiana’s new State Directed Payment program provides some much-needed relief, those federal funds will not close the entire gap and changes under the One Big Beautiful Bill Act (OBBBA) will soon phase down those enhanced payments. Indiana hospitals are projected to lose $12.7 billion over the next decade as a result of those changes -- the seventh-highest impact in the nation[7].
To understand what financial strain can mean for a community, consider maternity care.
Since 2020, 16 Indiana hospitals have announced the closure of their obstetrics departments[8]. Johnson Memorial Health in Franklin became the 16th, ending a maternity program that has served generations of families for nearly 80 years.
When the maternity center closed, an OB-GYN who had spent over a decade caring for mothers and babies there shared a video of the doors closing for the last time. After decades of births, proud parents, and new beginnings, the hallway went dark and quiet.
For the caregivers who devoted years of their lives to that unit and the families who counted on it, the closure was the loss of something deeply personal. It is also a reminder that hospital financial stability ultimately affects whether essential services remain available close to home.
Coverage isn't the only part of the equation. Even when patients have insurance, hospitals spend significant resources trying to get paid for care already provided. In 2025, Indiana hospitals delivered more than $717 million in care that went unpaid as insurers delayed or denied payments, while spending more than $400 million pursuing payments owed to them[9]. Meanwhile, Hoosier families and employers continue to face rising premiums and out-of-pocket costs.
At the same time, all five of Indiana’s largest nonprofit hospital systems have lowered prices, according to the State’s own report[10]. We’ll keep working to make care more affordable, but those savings should also reach the Hoosier families and employers paying for coverage.
As we head into the next legislative session, Indiana has an opportunity to strengthen insurer accountability on timely provider payments and patient responsibility amounts, while protecting affordability and access. Hospitals will also continue working with the administration and community partners to help eligible Hoosiers navigate the new HIP requirements and stay covered.
Even with those efforts, some Hoosiers may lose coverage. Their need for care won’t disappear, and neither will Indiana’s hospitals’ commitment to caring for them.
Keeping Hoosiers covered isn’t just about having an insurance card. It’s about ensuring the care they depend on is still there when they need it.
[1] https://www.in.gov/fssa/medicaid-enrollment-dashboard/
[3] https://www.in.gov/fssa/hip/files/HWR%20noncompliance.pdf
[4] https://my.ihaconnect.org/Portals/0/IHA_Impact%20Report_FINAL.pdf
[5] Indiana hospital data submission, SFY 2025- 2026
[8] https://my.ihaconnect.org/Portals/0/Indiana%20Hospital%20Service%20Closures%5B86%5D.pdf
