Reports of children with disabilities abruptly losing Medicaid have intensified debate over Indiana’s eligibility reviews, disability assessments and efforts to control costs.
State Rep. Victoria Garcia Wilburn, a Democrat whose House District 32 includes western Fishers, says eligible families are being harmed by processing delays and a new waiver-assessment system. Indiana’s Family and Social Services Administration, or FSSA, says eligibility standards have not changed and that its process is more accurate and consistent with federal requirements.
A WRTV investigation profiled two Kokomo families with children who have autism. Ruth Hevelone said her son Sammy lost Medicaid after documents submitted May 22 remained unprocessed on an FSSA worker’s task list. The termination disrupted waiver-funded therapy and his father’s income as a full-time caregiver.
Former FSSA employee Will Colteryahn helped resolve the case. WRTV reported that coverage was restored within hours following one email, although the family still lost several months of caregiver income.
Trisha Norfleet said her son was removed because of family income even though parental income generally is disregarded for children receiving the Family Supports Waiver. Indiana’s waiver rules confirm that policy. FSSA said it collects parental income for possible future policy changes but does not currently use it to determine eligibility. Privacy rules prevented the agency from discussing either case.
Wilburn, an occupational therapist and Indiana University associate professor, said the accounts resemble complaints from constituents.
“These are families doing everything right and losing coverage because of state errors,” she said, calling the situation a “manufactured” crisis.
Two separate processes are involved. Routine Medicaid renewals verify financial and household information. A case can close for a “procedural” reason when required information is missing or its review is incomplete. Disability-waiver assessments separately determine whether someone requires an institutional level of care. Losing underlying Medicaid eligibility can also end waiver services.
Preliminary federal data show procedural terminations accounted for 44% to 46% of all Indiana cases due for renewal during October, November and December 2025. In April 2026, 46% of the state’s 87,136 renewal cases were closed for procedural or administrative reasons—the highest reported state rate that month.
A procedural termination does not establish that someone was ineligible. It also does not prove the person remained eligible. The dispute is how often qualified people lose coverage because documents are delayed, lost or misunderstood.
WTHR found that Indiana assessed 15,476 people with new disability-waiver tools during the first six months of 2026. Of those, 772—about 5%—were formally denied, while another 1,721 underwent additional review. Published FSSA figures put the previous denial rate below 1%, although reports cite different historical baselines.
FSSA says the former assessment was insufficiently standardized and poorly suited to children. The agency says trained people—not artificial intelligence—make final decisions and potential denials receive a second review.
Families and disability advocates argue that standardized questions can miss whether a child performs an activity safely, independently and consistently. They also want access to assessment questions and scoring methods, portions of which FSSA says are proprietary.
State officials say tighter reviews protect taxpayers and preserve Medicaid. FSSA projected $465.9 million in state savings over two fiscal years, partly because of declining enrollment after changes to eligibility redeterminations. Its own program-integrity report, however, says an “improper payment” does not necessarily indicate fraud and that many sampled eligibility errors resulted from state employee mistakes.
Wilburn argues that budget control has been placed ahead of continuity of care. FSSA counters that historically low denial rates allowed some recipients to remain on waivers after they no longer met federal standards. Secretary Mitch Roob has rejected lawmakers’ request to pause new denials.
The evidence shows a sharp enrollment decline, unusually high procedural termination rates and more waiver denials. It does not show that every terminated enrollee remained eligible. Unanswered questions include how many denials are reversed, how often timely paperwork goes unprocessed and whether the new assessments accurately measure children’s needs.
Members receiving an adverse notice should follow its appeal instructions immediately. Filing before the effective date may preserve benefits during an appeal. Free assistance is available from Covering Kids & Families of Indiana and Indiana Disability Rights. Wilburn has invited affected District 32 residents to contact her office.