Indiana lawmaker calls for change in Medicaid system INDIANAPOLIS (WISH) — State lawmakers demand answers after an Indiana’s I-Team investigation found the state removed families with disabled children from Medicaid. State Rep. Victoria Garcia Wilburn, D-Fishers, called on the Indiana Fa mily and Social Services Administration (FSSA) to provide “honest answers” about the denials. “I have heard from constituents living nearly every version of this: the new disability assessment that finds people doing better than they are, waitlists that never end, and paperwork the state never processed,” Wilburn said. “These are families doing everything right and losing coverage because of state errors. They deserve honest answers about who is making these determinations and how, and a system that does not force them to fight for care their children are plainly owed.” Rep. Garcia Wilburn (Photo Provided/Indiana House Democrats) Parents of kids with disabilities rely heavily on Medicaid and its Home and Community Based Services waivers. These programs help fund critical therapies like speech, occupational, physical and behavioral. Indiana’s I-Team spoke with several families with Medicaid waivers who say they lost coverage, which meant their children were not able to receive critical therapies. FSSA has launched a new assessment tool which is leading to more Medicaid waiver denials. Advocates at the Arc of Indiana say paperwork errors and slow processing is also contributing to the issue. Karly Sciortino-Poulter said, “I have seen this problem has certainly escalated in the last two years. I have probably consulted on or worked on more Medicaid appeals in the last two years than I have in the 10 years before combined. So we’re having more problems right now.” Sciortino-Poulter said in some cases, people are getting cut off because they never got a letter from FSSA asking for certain in the first place. “It’s an automated situation, and because their paperwork hasn’t been processed and been uploaded into the computer system, the computer system turns it off, and then it’s harder to get back on,” Sciortino-Poulter said. State Rep. Victoria Garcia Wilburn, D-Fishers, says the state is punishing families. “The children in this story did not become ineligible overnight. Their paperwork sat unprocessed on a state task list until the system shut their coverage off automatically. There is nothing more accurate about a process that lets a child’s speech, occupational and behavioral therapies lapse over the state’s own backlog. It simply punishes families for mistakes they did not make.” Over the past year, 343,000 Hoosiers lost Medicaid coverage, among the highest rates in the country, and up to 40% of the cases up for renewal late last year were terminated for procedural reasons rather than any question of eligibility, Wilburn said. She added, “These stories were a long time coming, and the crisis is a manufactured one. In April, I warned that the state was more focused on cutting Medicaid spending than on delivering the care it promised eligible Hoosiers. This investigation, and others in recent weeks, show that playing out. FSSA is doing too much too fast, and vulnerable Hoosiers are paying for the chaos it has created inside the agency.”  Under the old assessment system, FSSA’s denial rate for Medicaid waivers was .02% and it’s currently at 6%, according to FSSA. State Rep. Robin Shackleford, D-Indianapolis, is the ranking minority member of the health committee. She is calling for a pause to Medicaid waiver denials. “We need to halt denying anyone else that has a disability and they’re on that waiver. Halt that until we can audit this assessment tool, because to me it seems like it’s something wrong with that assessment tool. You have the problem of those new assessment tools, and we have seen that you have over 700 people that have been kicked off of the program just merely because of an assessment that got done and saying they no longer need the program, so that is very heavy.” Rep. Robin Shackleford (Circle City Broadcasting) Shackleford says the new assessment tool is aimed at cutting costs. Shackleford also says the state is shifting the burden on parents. “If you have someone that has autism, they were eligible for the program, they still have autism. They still got needs to be met, but because of now this new tool that FSA is using in order to reduce costs, it’s looking like they’re no longer eligible for the program.” From June 30, 2025: People with disabilities fear loss of coverage as new Medicaid rules take effect From Aug. 23, 2025: Indiana’s proposed Medicaid waiver changes could slash therapy hours for disabled Family and Social Services Administration (FSSA) (Circle City Broadcasting) Statement “The Bureau of Disability Services (BDS) has not changed eligibility criteria for Indiana’s waiver programs. What has changed is the assessment process we use to evaluate those criteria. The new process is more accurate, more consistent, and better aligned with federal requirements and long‑standing program expectations. “Despite misinformation circulating publicly, eligibility determinations are made by trained human professionals, not by artificial intelligence or machine learning. No AI system is making decisions about whether an individual qualifies for services. Historically, Indiana’s waiver program issued very few denials of any kind. This led to situations where individuals remained on the waiver for many years—even when their level of need no longer met the federal standard. The program has always required periodic reviews to confirm that individuals continue to meet eligibility criteria, and we are now ensuring those reviews happen as intended. “Importantly, eligibility standards have not changed. The improved assessment process simply provides a more accurate picture of an individual’s current needs. While the updated process has resulted in some changes in outcomes, those outcomes reflect long‑standing federal requirements that Indiana is obligated to follow. “We understand the concerns raised and are carefully reviewing each case to ensure decisions are correct, consistent, and fair. FSSA remains committed to supporting Hoosiers with disabilities and ensuring that waiver services are available to those who meet the eligibility criteria.” Marcus J Barlow, deputy chief of staff and director of the Office of Strategic Communications and Public Affairs ...read more read less