An Indiana Medicaid member lost her coverage for almost two weeks despite submitting necessary paperwork to the state by its deadline. The member said she was only able to get her coverage back by involving her state lawmakers.
The Indiana Family and Social Services Administration informed Eliza Brader her coverage would end on May 1, 2025. Brader, a project manager for the Observing Civic Engagement Lab at Indiana University, could appeal the decision by submitting additional documentation within a certain window.
Brader's coverage through the Healthy Indiana Plan, or HIP, ended despite meeting the deadline. She said the local FSSA office told her there was a delay due to a paperwork backlog and staffing issues.
“They told me that the staff were given such a heavy workload that they weren't meeting, they weren't actually getting their work done like by normal time frame,” Brader said.
FSSA said it has no reports of “staffing shortages leading to systematic delays in Medicaid eligibility processing.”
“I feel like an ant with a boot over its head, and I'm waiting to decide whether or not they're going to step on me,” Brader said.
A SNAP application led to a Medicaid redetermination
When Brader applied for the Supplemental Nutrition Assistance Program, or SNAP, and was denied, it also triggered a Medicaid redetermination. The letter that said her coverage would sunset on May 1 said she had unverified information. But Brader said everything with FSSA should have been up-to-date.
The letter also explains the appeal process.
To maintain coverage, the letter said Medicaid members have to file an appeal within 33 business days from the date of notice or by close of business on what is known as the “adverse action.” The deadline is determined by whichever is later.
FSSA said the adverse action is “the last day that a state worker can take action on a case before the benefits are loaded/added for the following month.”
Brader turned in the requested documentation, which she said was about 60 pages, on April 30 — the adverse action date.
“When I turned it in at the office, I said, ‘because this is on the due date, you know, my Medicaid is set to expire tomorrow, will there be a gap in coverage?’” Brader said. “And the initial answer was, ‘I don't know, but there is a two week backlog of paperwork, so you will probably lose your Medicaid even though you have turned in this documentation.’”
Brader said she verified with the office that all of her paperwork was in order. She said the office said she was good to go. She called on May 2 to follow-up.
“When I called on the phone, they said, ‘we're actually missing yet another piece of paperwork, and it all depends on whether or not they decide to accept what you've already turned in. Because what you've already turned in might be enough, but it might not be, so I can't tell you, it'll depend on how that caseworker feels about your documentation,’” Brader said.
Brader said she lived “in limbo” for several days, unsure of if she would have the coverage she relied on. She considered what it might mean to not have Medicaid coverage while she waits. Brader said she was running low on several of her medications, but she still had enough of the medication she took for her heart arrhythmia.
She said while she could get by without the other medications, if she stopped taking her heart medication, she could risk going into supraventricular tachycardia, or SVT. It would cause her heart rate to rise and make it difficult for blood to make it to the rest of her body.
Brader reached out to Tracey Hutchings-Goetz with the community advocacy group Hoosier Action who told her to keep them in the loop.
State lawmakers, legislative assistants step in
Brader called her local FSSA office again on May 12.
“They decided to accept it, which was great, so I was going to get my Medicaid back,” Brader said. “However, again, there's still a paperwork backlog. ‘We can give you no idea of the timeline, even though we agree you should have never been kicked off Medicaid. And you know, expect about two weeks.’”
Brader had already run out of two medications, and was about to run out of her heart medication. She said she felt exhausted, so she reached back out to Hoosier Action.
Hutchings-Goetz said she learned a potential solution through other advocates she’s worked with.
"They mentioned, 'Hey, you know, you can actually contact your elected official about this, and it really helps,'" Hutchings-Goetz said.
Hutchings-Goetz reached out to Rep. Matt Pierce (D-Bloomington), Sen. Shelli Yoder (D-Bloomington) and their legislative assistants. On the same day that Brader was told it would take two more weeks, staffers from both offices had coordinated, reached out to FSSA and Brader had her coverage back.
Hutchings-Goetz said many people aren’t aware that legislative assistants can reach out to state agencies to help navigate issues like Brader’s.
“There was no way as a citizen without power to get through that system,” Brader said. “There is no way to get them to listen to you and actually ensure that the paperwork will be done unless you go outside of the FSSA.”
Best practices for reaching out to lawmakers
A House staffer explained when a constituent calls a lawmaker’s office, legislative assistants will make sure the lawmaker is aware of the issue, but the legislative assistant is typically the one working with the person to help resolve it.
They said while they aren’t looking for every detail, it’s useful for people to have the necessary information on hand. For example, the basic timeline of events, if there was any follow-up from the agency when the person reached out on their own and any information that can help the legislative assistants determine what the issue is or what question isn’t being answered.
The staffer also said to be aware of which state legislator you’re contacting. They said they typically try to respond to issues from constituents from the district that the legislator serves, especially in cases where it might involve a local office.
The staffer said it can be beneficial to reach out both through a phone call and an email, but said legislative assistants are prepared and able to address needs through either means of communication.
They said reaching out to legislators is a worthwhile option to pursue, especially if someone is unsure about what options are available and what can be done about the issue. Legislative assistants are connected to state agencies through liaisons. The staffer said it’s their job to help people get answers even if they don’t immediately have them the moment someone reaches out. They said they can often even highlight resources that people may not have known about.
The staffer said the specific steps of the process or how two offices work together can differ from lawmaker to lawmaker and between caucuses.
Concerns about broader issues
Hutchings-Goetz said she’s concerned that Brader’s experience isn’t unique, but instead represents a pattern that is going to be repeated “over and over again” in Indiana.
She said there are multiple things going wrong, and each presents a broader concern as more Medicaid changes are expected from state and federal legislation.
Hutchings-Goetz said there were issues with paperwork processing, which means people who are qualified for coverage losing it.
“That, first of all, is a serious concern unto itself,” Hutchings-Goetz said. “Then secondarily, the paperwork backlog and staffing shortage — that is entirely a preventable problem.”
READ MORE: Medicaid members in HIP program say federal, state policy changes put their lives at risk
Despite claims from FSSA that there are no staffing shortages, Hutchings-Goetz said she doesn’t know how there can be a paperwork backlog without a staffing shortage.
“You can't work towards a solution if we can't agree on whether or not there is a problem,” Hutchings-Goetz said. “Until we get to that point, we will just be playing Whack-A-Mole.”
FSSA also said that it also hasn’t introduced the quarterly eligibility checks Secretary Mitch Roob announced in January
Some of the quarterly eligibility checks and a version of work reporting requirements were included in Senate Enrolled Act 2. During testimony on SEA 2, Roob said FSSA “may have to augment some of our vendor contracts, but we will not need to add additional staff.” He also told lawmakers during that testimony that the agency had “begun doing redeterminations on a quarterly basis to about 47 percent of those who are eligible for Medicaid.”
Despite that testimony, Roob recently said “as soon as we can turn that on, we will.” He also said FSSA is not sure how it plans to handle the additional administrative burden of the work reporting requirements in the federal legislation.
Hutchings-Goetz said she’s concerned there’s a paperwork backlog before changes could make the program even more complex.
“It's clear that our computer systems and our automated systems are not preventing or solving these problems,” Hutchings-Goetz said.
In addition, Hutchings-Goetz said it’s important to know that people can reach out to their lawmakers as a solution and make them aware that paperwork processing errors are an issue — but she said it does highlight an issue.
“You should not have to tap in your elected officials to make bureaucracy function,” Hutchings-Goetz said. “This should not be a necessary part of the process. People should not have to fight to maintain health care coverage that they qualify for and have demonstrated their qualifications for, right?”
Human cost of paperwork processing issues
Brader said she was grateful for how much Hutchings-Goetz and her state lawmakers’ offices were able to help. Brader said she’s concerned about the harm this could cause to herself and other Medicaid members.
“I'm afraid of people rationing medication, which is something that I already do out of fear of what the FSSA has done to me in the past,” Brader said. "I think the paperwork backlog is going to kill people."
Brader said this wasn’t the first time she’s had an issue like this. In fact, she said she’s encountered this issue several times, including three times in the past year.
“There were instances before I got involved with Hoosier Action that I just went without health care for a while,” Brader said. “There was a period of several months that I went without health care because I just knew that they didn't care.”
In addition to losing coverage in the past due to other SNAP applications, Brader also said she lost coverage in December 2024 when she was moved into the HIP Medically Frail program.
She received a letter from FSSA that informed her she would lose coverage on Jan. 1, 2025 if she didn’t submit additional documentation. However, her coverage was terminated early without any notification.
When she called FSSA, she was told her early termination was due to an error in FSSA’s system. However, the person she spoke to said FSSA wouldn’t be able to reinstate her coverage until she submitted her paperwork.
Brader said it may seem dramatic, but the consequences to these types of issues can be death.
“My heart is powered by a battery, partially,” Brader said. “It's actually like 80 percent of my heartbeats are powered by this pacemaker. If something were to happen to it and I had no health care, I either go potentially hundreds of thousands of dollars in debt — or I die. Those are my options.”
Without health care coverage, Brader said that most people tend to rely on the emergency room for care. B she said their job isn’t preventative care — they are there to stabilize patients.
“You don't get health care until you are actively dying, and then you get no follow-up to prevent you from actively dying again,” Brader said. “Without health care, our ERs become a triage for people, like myself, who have health conditions that are deadly, and we are triaged, and then we wait, we wait and wait and hope that we don't start dying again.”
And Brader said it’s difficult to avoid being in this position. Brader has a master’s degree in public policy and she’s been in the HIP program for years.
“Paperwork — I am no stranger to. And I also can barely understand some of the letters they send me,” Brader said. “I do legal analysis. If I have such trouble understanding what they actually want and what the rules actually are, how can anyone else be expected to know what they want, what the FSSA wants, to know what their rights are, and to know when to keep calling back?”
Advice from advocates
Like most Medicaid members, this isn’t the only thing on Brader’s mind. She has other commitments to keep to manage her job and her health. She also has things she enjoys doing, like “being a nerd” and enjoying time with the close-knit community she’s built around her.
But, over time, the paperwork has become a task that Brader has to keep in the front of her mind. Even with advocates like Hutchings-Goetz helping her, Brader said she feels like the system is designed to make you feel worn down to give up.
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Hutchings-Goetz said it can be easy to get lost in that feeling, but she encourages Medicaid members to avoid it as much as possible. She said there are a number of things that people can do if they’re concerned about this type of issue in addition to reaching out to their lawmakers.
“I always encourage folks, you know, documentation, documentation, documentation,” Hutchings-Goetz said. “You are going to want to keep track of all of your information, and stay organized and have the dates for that.”
That can mean keeping track of why you reached out to FSSA and when. Hutchings-Goetz said advocates and Medicaid members have raised concerns about FSSA’s communication and when people receive their notices in the mail. She said some members have said they’ve received mail after the date that they would have had to take action.
Keeping the notices can be important, but also keeping something that verifies when the notice was received can be beneficial.
“It can also be helpful to reach out to a friend, a loved one or an organization for additional moral support,” Hutchings-Goetz said. “Then, of course, health care navigators and Indiana Legal Services are also, you know, available, as well if it comes to it.”
Hutchings-Goetz said she’s worried about an increase in these types of issues in the future, but she wants people to be prepared.
“I would urge folks to not sit in shame if they get kicked off, and to educate themselves about their rights,” Hutchings-Goetz said.
Hutchings-Goetz said there are several organizations throughout the state, including Hoosier Action, that have educational materials on what people enrolled in Medicaid should know about the program.
Abigail is our health reporter. Contact them at aruhman@wfyi.org or on Signal at IPBHealthRuhman.65.