SB 1

           Second Regular Session of the 124th General Assembly (2026)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
  Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2025 Regular Session of the General Assembly.
       SENATE ENROLLED ACT No. 1
   AN ACT to amend the Indiana Code concerning human services
and to make an appropriation.
    Be it enacted by the General Assembly of the State of Indiana:
    SECTION 1. IC 4-12-1-18, AS AMENDED BY P.L.174-2022,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2026 (RETROACTIVE)]: Sec. 18. Except for allotment
stipulations provided in IC 4-12-18 and IC 12-8-15, federal funds
received by an instrumentality are appropriated for purposes specified
by the federal government and the general assembly, if that body elects
to appropriate federal funds, subject to allotment by the budget agency.
The provisions of this chapter and other laws concerning the
acceptance, disbursement, review, and approval of grants, loans, and
gifts made by the federal government or any other source to the state
or its agencies apply to instrumentalities.
    SECTION 2. IC 12-7-2-24.3 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2026]: Sec. 24.3. "Candy", for purposes of IC 12-14-30-10, has
the meaning set forth in IC 12-14-30-10(a).
    SECTION 3. IC 12-7-2-179.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 179.5. "Soft drink", for purposes
of IC 12-14-30-10, has the meaning set forth in IC 12-14-30-10(b).
    SECTION 4. IC 12-8-15 IS ADDED TO THE INDIANA CODE AS
A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2026 (RETROACTIVE)]:
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   Chapter 15. Indiana Rural Health Transformation Fund
   Sec. 1. (a) The Indiana rural health transformation fund is
established as a dedicated fund for the purpose of implementing
the Indiana rural health transformation program authorized by
federal law under Section 71401 of Public Law 119-21 (42 U.S.C.
1397ee), and based on Indiana's federally approved application.
The fund shall be administered by the office of the secretary.
   (b) Money in the fund is continuously appropriated. The fund
consists of federal funds received from the federal government
under Section 71401 of Public Law 119-21.
   (c) The expenses of administering the fund shall be paid from
money in the fund to the extent allowable by federal law under
Section 71401 of Public Law 119-21.
   (d) The treasurer of state shall invest the money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public funds may be invested. Interest that
accrues from these investments shall be deposited in the fund.
   (e) Money in the fund at the end of a state fiscal year does not
revert to the state general fund.
   (f) The secretary may make recommendations concerning
expenditures from the fund to the budget committee, and beginning
December 1, 2026, allotments and expenditures from the fund are
subject to budget committee review before the allotment and
expenditure may occur.
   (g) This section expires December 31, 2032.
   Sec. 2. (a) Beginning December 1, 2026, the office of the
secretary shall before June 1 and December 1 of each year submit
a written report for review to the budget committee concerning the
following:
     (1) An itemization of each of the expenditures of money from
     the fund since the last report to the budget committee.
     (2) The aggregate amount of expenditures of money from the
     fund since the last report to the budget committee.
     (3) Anticipated expenditures for the subsequent six (6)
     months.
     (4) Whether the office of the secretary is meeting the
     benchmarks set forth in the state federally approved
     application for the federal funds.
     (5) Whether the office of the secretary believes the state is
     meeting the federally approved application requirements
     necessary to continue to receive federal funds for operation of
     the Indiana rural health transformation program.
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    (b) On June 1, 2026, the office of the secretary shall submit a
written report to the budget committee concerning the following:
      (1) An itemization of each of the expenditures of money from
      the fund since the last report to the budget committee.
      (2) The aggregate amount of expenditures of money from the
      fund since the last report to the budget committee.
      (3) Anticipated expenditures for the subsequent six (6)
      months.
      (4) Whether the office of the secretary is meeting the
      benchmarks set forth in the state federally approved
      application for the federal funds.
      (5) Whether the office of the secretary believes the state is
      meeting the federally approved application requirements
      necessary to continue to receive federal funds for operation of
      the Indiana rural health transformation program.
    (c) This section expires December 31, 2033.
    SECTION 5. IC 12-14-30-4, AS ADDED BY P.L.207-2017,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2026]: Sec. 4. (a) The division shall notify the United States
Department of Agriculture and take any other action necessary for the
state to
      (1) elect to participate in; and
      (2) implement, beginning January 1, 2018;
terminate the state's participation in the use of expanded categorical
eligibility within SNAP unless required by federal law.
    (b) The division: shall implement for the expanded categorical
eligibility a countable asset limitation for resources that does not
exceed five thousand dollars ($5,000). In determining whether an
individual meets the resource requirement of this subsection, an
individual's funeral and burial resources, including both revocable and
irrevocable resources, may not be counted.
      (1) may not apply gross income standards higher than the
      standards specified in 7 U.S.C. 2014(c);
      (2) may not allow countable financial resources that are
      higher than the standards specified in 7 U.S.C. 2014(g)(1)
      other than the financial resources described in 7 U.S.C.
      2014(g)(2)(D); and
      (3) may apply alternate vehicle allowance standards
      authorized by 7 U.S.C. 2014(g)(2)(D).
    (c) The division may adopt rules under IC 4-22-2 necessary to
implement this section.
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   (d) Before November 1, 2018, the division shall submit a report in
an electronic format under IC 5-14-6 to the legislative council
concerning the projected total amounts that individuals receiving
SNAP benefits would be required to repay over the period beginning
January 1, 2018, and ending December 31, 2019, due to positive errors,
in which individuals are approved for an amount in error and then are
required to repay the amount. The projected total amounts must be
based on the amounts that individuals receiving SNAP benefits have
been required to repay over the period beginning January 1, 2018, and
ending September 30, 2018, due to positive errors.
   SECTION 6. IC 12-14-30-9 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2026]: Sec. 9. (a) An individual is not eligible to receive SNAP
benefits unless the individual is a resident of the United States who
meets at least one (1) of the following:
      (1) Is a citizen or national of the United States.
      (2) Is an alien lawfully admitted for permanent residence (as
      defined in 8 U.S.C. 1101(a)(20) as an immigrant (as defined in
      8 U.S.C. 1101(a)(15)), not including the following:
         (A) An alien visitor.
         (B) A tourist.
         (C) A diplomat.
         (D) A student.
         (E) Any other individual admitted temporarily without
         intent to abandon the individual's residence in a foreign
         country.
      (3) Is an alien who has been granted the status of Cuban or
      Haitian entrant, as set forth in Section 501(e) of the Refugee
      Education Assistance Act of 1980.
      (4) Is an individual lawfully residing in the United States in
      accordance with a Compact of Free Association under 8
      U.S.C. 1612(b)(2)(G).
   (b) The division shall verify that an individual is eligible for
SNAP benefits under subsection (a) and 7 U.S.C. 2015(f) during
enrollment and eligibility recertification by verifying citizenship or
eligible alien status using the Social Security Administration
database or the Systematic Alien Verification for Entitlements
(SAVE) online service.
   (c) If the division is unable to verify eligibility under subsection
(b), the division shall verify citizenship through an acceptable form
of proof of citizenship or eligible alien status. An acceptable form
of proof includes the following:
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      (1) A certified birth certificate.
      (2) United States passport.
      (3) United States Citizenship and Immigration Services
      documentation.
The individual shall submit the documentation to the division
required for verification under this subsection.
    (d) The division shall submit to the United States Department of
Agriculture information concerning any household member for
whom the division is unable to verify eligible citizenship or
immigration status, regardless of whether the household member
is applying to participate in SNAP as a member of the household.
    (e) Notwithstanding any option set forth in 7 CFR 273.11(c)(3),
the division:
      (1) shall consider the entire income and financial resources of
      any individual determined to be ineligible to participate in
      SNAP under subsection (a) or 7 U.S.C. 2015(f) when
      determining the eligibility and benefit allotment of the
      household of which the individual is a member; and
      (2) may not prorate or exclude the income or financial
      resources of the ineligible individual.
    SECTION 7. IC 12-14-30-10 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 10. (a) As used in this section,
"candy" means a preparation of sugar, honey, or other natural or
artificial sweeteners in combination with chocolate, fruits, nuts, or
other ingredients or flavorings in the form of bars, drops, or pieces.
The term does not include any preparation requiring refrigeration.
    (b) As used in this section, "soft drink" means nonalcoholic
beverages that contain natural or artificial sweeteners. The term
does not include beverages that contain milk or milk products, soy,
rice, or similar milk substitutes, or are exclusively naturally
sweetened using natural vegetable or fruit juice.
    (c) A SNAP recipient may not use SNAP benefits to purchase
candy or soft drinks.
    (d) If the office of the secretary determines that a waiver or
authorization by a federal agency is needed to implement this
section, the office of the secretary shall request the necessary
waiver or authorization.
    SECTION 8. IC 12-15-1-24, AS AMENDED BY THE
TECHNICAL CORRECTIONS BILL OF THE 2026 GENERAL
ASSEMBLY, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2027]: Sec. 24. (a) Except as required under federal law,
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the office of the secretary may not accept self-attestation of any of the
following in the administration of the Medicaid program without
verification before enrollment:
       (1) Income.
       (2) Residency.
       (3) Age.
       (4) Household composition.
       (5) Caretaker or relative status.
       (6) Receipt of other coverage.
    (b) The office of the secretary shall enter into a data matching
agreement with:
       (1) the state lottery commission; and
       (2) the Indiana gaming commission;
to, on at least a monthly basis, identify individuals receiving Medicaid
assistance with lottery and gambling winnings of at least three
thousand dollars ($3,000). Upon verification of any winnings resulting
in the individual no longer being eligible for Medicaid, the office of the
secretary shall terminate the individual's enrollment.
    (c) On at least a monthly basis, the office of the secretary shall
review vital statistics information provided by the Indiana department
of health under IC 16-19-3-19 to determine removal of deceased
individuals from Medicaid enrollment.
    (d) On at least a quarterly basis, the office of the secretary shall
receive and review information from the department of state revenue
and the department of workforce development concerning Medicaid
recipients that indicates a change in circumstances that may affect
eligibility, including changes to employment or wages.
    (e) On at least an annual basis, the office of the secretary shall
receive and review information from the department of state revenue
concerning Medicaid recipients, including:
       (1) adjusted gross income; and
       (2) family composition;
that indicates a change in circumstances that may affect Medicaid
eligibility.
    (f) On at least a monthly basis, the office of the secretary shall
review information concerning Medicaid recipients who also receive
SNAP benefits to determine whether there has been any change in
circumstances that may affect Medicaid eligibility, including a change
in residency as may be identified through electronic benefit transfer
program transactions.
    (g) On at least a monthly basis, the office of the secretary shall
receive and review information from the department of correction
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concerning Medicaid recipients that may indicate a change in
circumstances that may affect Medicaid eligibility.
    (h) Upon receiving information concerning a Medicaid recipient
that indicates a change in circumstances that may affect Medicaid
eligibility, the office of the secretary shall promptly conduct an
eligibility redetermination for the recipient.
    (i) Unless prohibited by federal law, the office of the secretary
shall conduct a Medicaid eligibility redetermination for a recipient
as follows:
       (1) At least one (1) time every six (6) months for a nonelderly
       adult Medicaid recipient whose eligibility is determined based
       upon a modified adjusted gross income standard under 42
       CFR 435.603, including adults eligible under 42 U.S.C.
       1396u-1.
       (2) At least one (1) time every twelve (12) months for any
       other Medicaid recipient.
    SECTION 9. IC 12-15-1-25, AS ADDED BY P.L.126-2025,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2026]: Sec. 25. (a) Unless prohibited by federal law and on at
least a monthly basis, the office of the secretary shall review the
following to assess continuous eligibility of Medicaid recipients:
       (1) The following information maintained by the United States
       Social Security Administration:
          (A) Earned income information.
          (B) Death register information.
          (C) Incarceration records.
          (D) Supplemental security income information.
          (E) Beneficiary records.
          (F) Earnings information.
          (G) Pension information.
       (2) The following information maintained by the United States
       Department of Health and Human Services:
          (A) Income and employment information maintained in the
          national directory of new hires data base.
          (B) Child support enforcement data.
       (3) Change of address or mail forwarding address information
       maintained by the United States Postal Service.
       (4) Payment and earnings information maintained by the United
       States Department of Housing and Urban Development.
       (5) National fleeing felon information maintained by the United
       States Federal Bureau of Investigation.
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      (6) Tax filing information maintained by the United States
      Department of the Treasury.
    (b) The office of the secretary may contract with an independent
third party for additional data base searches that may contain
information that indicates a change in circumstances that may affect
Medicaid applicant or recipient eligibility.
    (c) At least one (1) time per month, the office of the secretary
shall transmit information as prescribed by the United States
Department of Health and Human Services to prevent Medicaid
enrollment in more than one (1) state.
    SECTION 10. IC 12-15-2-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JANUARY 1, 2027]: Sec. 2. The county
office shall determine eligibility and shall certify to the office at the
time and in the manner required by the office a list of individuals who
have been found eligible to receive Medicaid and the effective date for
the payment of assistance under this chapter. The date must be:
      (1) not earlier than one (1) month before the first day of the
      month in which the application or request is made for individuals
      eligible under IC 12-15-44.5; and
      (2) not earlier than two (2) months before the first day of the
      month in which an application or request is made for any
      other individual not described in subdivision (1).
    SECTION 11. IC 12-15-2-17.2 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 17.2. (a) This section is effective
October 1, 2026.
    (b) Except as otherwise provided by federal law, the office of the
secretary shall count any income of a household member who is
ineligible due to the household member's immigration status when
calculating and determining an individual's financial eligibility for
Medicaid.
    (c) The office of the secretary shall apply for any Medicaid state
plan amendment necessary to implement this section.
    SECTION 12. IC 12-15-2.5-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE OCTOBER 1, 2026]: Sec. 1. (a) This
section does not apply to any alien for whom federal financial
participation is unavailable under 42 U.S.C. 1396b(v)(5) or any
alien who has not satisfied the requirements of 8 U.S.C. 1613.
    (b) A person who:
      (1) is classified as a refugee (as defined in 8 U.S.C. 1101)
      lawfully admitted for permanent residence (as defined in 8
      U.S.C. 1101(a)(20);
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      (2) has been granted the status of Cuban or Haitian entrant
      under Section 501(e) of the Refugee Education Assistance Act
      of 1980; or
      (3) lawfully resides in the United States in accordance with a
      Compact of Free Association under 8 U.S.C. 1612(b)(2)(G);
is eligible for all services under this article as if the person were
classified as a citizen of the United States.
    SECTION 13. IC 12-15-2.5-3, AS AMENDED BY P.L.1-2007,
SECTION 121, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE OCTOBER 1, 2026]: Sec. 3. A person who is in the
United States without permission of the United States Citizenship and
Immigration Services and who does not meet the requirements of 42
U.S.C. 1396b(v)(5) is not entitled to receive assistance under this
article.
    SECTION 14. IC 12-15-2.5-3.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 3.5. (a) This section is effective
October 1, 2026.
    (b) The office of the secretary shall do the following:
      (1) Verify citizenship or satisfactory immigration status for
      each applicant, recipient, or identified household member of
      an applicant or recipient.
      (2) Either:
         (A) after a reasonable opportunity period to verify
         citizenship or satisfactory immigration status where the
         status could not be verified; or
         (B) upon receipt of verification that indicates that the
         applicant, recipient, or household member is not a United
         States citizen or lacks satisfactory immigration status and
         has entered the United States without inspection or
         admission, or has remained beyond the expiration of an
         authorized period of stay;
      promptly refer the applicant, recipient, or household member
      of an applicant or recipient to the United States Department
      of Homeland Security or any other appropriate federal
      authority for further investigation and enforcement.
    SECTION 15. IC 12-15-4-1.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 1.3. (a) This section is effective
October 1, 2026.
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   (b) The office shall include a field concerning an applicant's
immigration status on any Medicaid presumptive eligibility
application used for the Medicaid program.
   (c) A hospital, clinic, or other qualified entity conducting a
presumptive eligibility determination shall collect and transmit the
required information concerning the applicant's immigration
status as part of the individual's presumptive eligibility application.
   (d) A presumptive eligibility application may not be approved
unless the applicant's immigration status has been verified to meet
the requirements set forth in IC 12-15-2.5-1.
   SECTION 16. IC 12-15-44.5-1.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 1.5. As used in this chapter,
"office" refers to the office of the secretary.
   SECTION 17. IC 12-15-44.5-3, AS AMENDED BY P.L.126-2025,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2026]: Sec. 3. (a) The healthy Indiana plan is established. The
secretary shall oversee the plan and has the authority to set policy
for the plan in compliance with this chapter.
   (b) The office, under the direction of the secretary, shall
administer the plan.
   (c) The adult group described in 42 CFR 435.119 may be eligible
for the plan if the conditions in section 4 of this chapter are met and if
the individual meets at least one (1) of the following:
      (1) Is working at least twenty (20) eighty (80) hours per week on
      a monthly average. month.
      (2) Is participating in and complying with the requirements of a
      work program for at least twenty (20) eighty (80) hours per week,
      as determined by the office. month.
      (3) Is volunteering or performing community service at least
      twenty (20) eighty (80) hours per week, as determined by the
      office. month.
      (4) Undertakes a combination of the activities described in
      subdivision (1), (2), or (3) for a combined total of at least twenty
      (20) eighty (80) hours per week, as determined by the office.
      month.
      (5) Participates in and complies with the work requirements of a
      workfare program, as determined by the office. the TANF
      program or SNAP.
      (6) Receives unemployment compensation and complies with
      federal and state work requirements under the unemployment
      compensation system. Has:
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        (A) a monthly income of at least the applicable minimum
        wage requirement under 29 U.S.C. 206, multiplied by
        eighty (80) hours; or
        (B) an average monthly income in the preceding six (6)
        months that is not less than the applicable minimum wage
        requirements under 29 U.S.C. 206, multiplied by eighty
        (80) hours and is a seasonal worker as defined under 26
        U.S.C. 45R(d)(5)(B).
     (7) Participates in a substance use drug addiction or alcoholic
     treatment and rehabilitation program, as defined in 7 U.S.C.
     2012(h).
     (8) Is medically certified as physically or mentally unfit for
     employment. medically frail (as defined in 42 CFR 440.315(f)).
     (9) Is:
        (A) pregnant;
        (B) entitled to postpartum medical assistance under 42
        U.S.C. 1396a(e)(5) or 42 U.S.C. 1396a(e)(16); or is
        (C) a parent, guardian, or caretaker relative responsible for
        the care of a dependent child less than six (6) fourteen (14)
        years of age.
     (10) Is a parent, spouse, or caretaker family caregiver under
     Section 2 of the RAISE Family Caregivers Act personally
     providing the care for an individual with a serious medical
     condition or a disability.
     (11) Is an individual who has been released from incarceration for
     less than ninety (90) days. is an inmate of a public institution.
     (12) Is an Indiana resident enrolled in and attending an accredited
     educational program full at least half time.
     (13) Is, as set forth in the Indian Health Care Improvement
     Act:
        (A) an Indian;
        (B) an urban Indian; or
        (C) a California Indian;
     or has otherwise been determined eligible as an Indian by the
     federal Indian Health Service.
     (14) Is eligible for medical assistance under 42 U.S.C.
     1396a(a)(10)(A)(i)(IX).
     (15) Is a veteran with a disability rated as total under 38
     U.S.C. 1155.
An individual must meet the Medicaid residency requirements under
IC 12-15-4-4 and this article to be eligible for the plan.
   (d) The following individuals are not eligible for the plan:
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       (1) An individual who participates in the federal Medicare
       program (42 U.S.C. 1395 et seq.).
       (2) An individual who is otherwise eligible and enrolled for
       medical assistance.
    (e) The department of insurance and the office of the secretary shall
provide oversight of the marketing practices of the plan.
    (f) The office shall promote the plan and provide information to
potential eligible individuals who live in medically underserved rural
areas of Indiana.
    (g) The office shall, to the extent possible, ensure that enrollment in
the plan is distributed throughout Indiana in proportion to the number
of individuals throughout Indiana who are eligible for participation in
the plan.
    (h) The office shall establish standards for consumer protection,
including the following:
       (1) Quality of care standards.
       (2) A uniform process for participant grievances and appeals.
       (3) Standardized reporting concerning provider performance,
       consumer experience, and cost.
    (i) A health care provider that provides care to an individual who
receives health coverage under the plan shall also participate in the
Medicaid program under this article.
    (j) The following do not apply to the plan:
       (1) IC 12-15-12.
       (2) IC 12-15-13.
       (3) IC 12-15-14.
       (4) IC 12-15-15.
       (5) IC 12-15-21.
       (6) IC 12-15-26.
       (7) IC 12-15-31.1.
       (8) IC 12-15-34.
       (9) IC 12-15-35.
       (10) IC 16-42-22-10.
    SECTION 18. IC 12-15-44.5-3.5, AS AMENDED BY
P.L.180-2022(ss), SECTION 16, IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3.5. (a) The plan
must include the following in a manner and to the extent determined by
the office: secretary:
       (1) Mental health care services.
       (2) Inpatient hospital services.
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      (3) Prescription drug coverage, including coverage of a long
      acting, nonaddictive medication assistance treatment drug if the
      drug is being prescribed for the treatment of substance abuse.
      (4) Emergency room services.
      (5) Physician office services.
      (6) Diagnostic services.
      (7) Outpatient services, including therapy services.
      (8) Comprehensive disease management.
      (9) Home health services, including case management.
      (10) Urgent care center services.
      (11) Preventative care services.
      (12) Family planning services:
          (A) including contraceptives and sexually transmitted disease
          testing, as described in federal Medicaid law (42 U.S.C. 1396
          et seq.); and
          (B) not including abortion or abortifacients.
      (13) Hospice services.
      (14) Substance abuse services.
      (15) Donated breast milk that meets requirements developed by
      the office of Medicaid policy and planning.
      (16) A service determined by the secretary to be required by
      federal law as a benchmark service under the federal Patient
      Protection and Affordable Care Act.
    (b) The plan may not permit treatment limitations or financial
requirements on the coverage of mental health care services or
substance abuse services if similar limitations or requirements are not
imposed on the coverage of services for other medical or surgical
conditions.
    (c) The plan may provide vision services and dental services only
to individuals who regularly make the required monthly contributions
for the plan as set forth in section 4.7(c) of this chapter.
    (d) The benefit package offered in the plan:
      (1) must be benchmarked to a commercial health plan described
      in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
      (2) may not include a benefit that is not present in at least one (1)
      of these commercial benchmark options.
    (e) The office shall provide to an individual who participates in the
plan a list of health care services that qualify as preventative care
services for the age, gender, and preexisting conditions of the
individual. The office shall consult with the federal Centers for Disease
Control and Prevention for a list of recommended preventative care
services.
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   (f) The plan shall, at no cost to the individual, provide payment of
preventative care services described in 42 U.S.C. 300gg-13 for an
individual who participates in the plan.
   (g) The plan shall, at no cost to the individual, provide payments of
not more than five hundred dollars ($500) per year for preventative
care services not described in subsection (f). Any additional
preventative care services covered under the plan and received by the
individual during the year are subject to the deductible and payment
requirements of the plan.
   (h) The office shall apply to the United States Department of Health
and Human Services for any amendment to the waiver necessary to
implement the providing of the services or supplies described in
subsection (a)(15). This subsection expires July 1, 2024.
   SECTION 19. IC 12-15-44.5-4, AS AMENDED BY P.L.216-2025,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4. (a) The plan:
      (1) is not an entitlement program;
      (2) serves as an alternative to health care coverage under Title
      XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.);
      (3) except as provided in section 4.2(a) of this chapter, must not
      grant eligibility under the state Medicaid plan for medical
      assistance under 42 U.S.C. 1396a; and
      (4) must grant eligibility for the plan through an approved
      demonstration project under 42 U.S.C. 1315.
   (b) If any of the following occurs, the office secretary shall
terminate the plan in accordance with section 6(b) of this chapter:
      (1) The:
         (A) percentages of federal medical assistance available to the
         plan for coverage of plan participants described in Section
         1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are
         less than the percentages provided for in Section
         2001(a)(3)(B) of the federal Patient Protection and Affordable
         Care Act; and
         (B) office, after considering the modification and the reduction
         in available funding, does not alter:
            (i) the formula established under IC 16-21-10-13.3(b)(1) to
            cover the amount of the reduction in federal medical
            assistance; or
            (ii) if applicable, the fee formula used to fund the
            reimbursement for inpatient and outpatient hospital services
            under IC 16-21-10-8.5 to cover the amount of the reduction
            in federal medical assistance.
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                                   15
      For purposes of this subdivision, "coverage of plan participants"
      includes reimbursement, payments, contributions, and amounts
      referred to in IC 16-21-10-13.3(b)(1)(A),
      IC 16-21-10-13.3(b)(1)(C), and IC 16-21-10-13.3(b)(1)(D),
      including reimbursement, payments, contributions, and amounts
      incurred before termination of the plan.
      (2) The:
          (A) methodology of calculating the incremental fee set forth in
          IC 16-21-10-13.3 is modified in any way that results in a
          reduction in available funding;
          (B) office, after considering the modification and reduction in
          available funding, does not alter:
            (i) the formula established under IC 16-21-10-13.3(b)(1) to
            cover the amount of the reduction in fees; or
            (ii) if applicable, the fee formula used to fund the
            reimbursement for inpatient and outpatient hospital services
            under IC 16-21-10-8.5 to cover the amount of the reduction
            in fees; and
          (C) office does not use alternative financial support to cover
          the amount of the reduction in fees.
      (3) The Medicaid waiver approving the plan is revoked,
      rescinded, vacated, or otherwise altered in a manner that the state
      cannot comply with the requirements of this chapter.
   (c) If federal financial participation for recipients covered under the
plan is less than ninety percent (90%), the office secretary may
terminate the plan in accordance with section 6(b) of this chapter.
   (d) If the plan is terminated under subsection (b), the secretary may
implement a plan for coverage of the affected population in a manner
consistent with the healthy Indiana plan (IC 12-15-44.2 (before its
repeal)) in effect on January 1, 2014:
      (1) subject to prior approval of the United States Department of
      Health and Human Services; and
      (2) using funding from the incremental fee set forth in
      IC 16-21-10-13.3.
   (e) The office secretary may not operate the plan in a manner that
would obligate the state to financial participation beyond the level of
state appropriations or funding otherwise authorized for the plan.
   (f) The office of the secretary shall submit annually to the budget
committee an actuarial analysis of the plan that reflects a determination
that sufficient funding is reasonably estimated to be available to
operate the plan.
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                                   16
    SECTION 20. IC 12-15-44.5-4.2, AS ADDED BY P.L.126-2025,
SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4.2. (a) Notwithstanding section 3 of this
chapter, the office of the secretary shall amend the Medicaid state plan
to not include individuals described in 42 CFR 435.119. The office of
the secretary shall delay the effective date of the amendment to not
later than upon the completion of negotiations with the United States
Department of Health and Human Services for a 3.0 plan waiver and
an approved implementation of the waiver.
    (b) The office of the secretary shall continue to operate the plan, as
in effect on January 1, 2025, until the effective date of a 3.0 plan
waiver authorized by the United States Department of Health and
Human Services or the expiration, termination, or vacatur of the waiver
authorizing the plan. However, the following statutes shall be
implemented before the following dates:
      (1) Section 3(c) of this chapter, before January 1, 2027.
      (2) Section 5.7 of this chapter, before October 2, 2028.
    SECTION 21. IC 12-15-44.5-4.5, AS ADDED BY P.L.30-2016,
SECTION 30, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4.5. (a) An individual who participates in the
plan must have a health care account to which payments may be made
for the individual's participation in the plan.
    (b) An individual's health care account must be used to pay the
individual's deductible for health care services under the plan.
    (c) An individual's deductible must be at least two thousand five
hundred dollars ($2,500) per year.
    (d) An individual may make payments to the individual's health care
account as follows:
      (1) An employer withholding or causing to be withheld from an
      employee's wages or salary, after taxes are deducted from the
      wages or salary, the individual's contribution under this chapter
      and distributed equally throughout the calendar year.
      (2) Submission of the individual's contribution under this chapter
      to the office to deposit in the individual's health care account in
      a manner prescribed by the office. secretary.
      (3) Another method determined by the office. secretary.
    SECTION 22. IC 12-15-44.5-4.7, AS AMENDED BY
P.L.126-2025, SECTION 12, IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2026]: Sec. 4.7. (a) To participate
in the plan, an individual must:
      (1) apply for the plan on a form prescribed by the office;
      secretary;
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                                   17
      (2) comply with the requirements of section 3(c) of this
      chapter for the three (3) consecutive months immediately
      preceding the month the individual applies to the plan; and
      (3) provide documentary evidence of compliance with
      subdivision (2).
The secretary may not accept self-attestation by the applicant as
evidence of compliance. The office secretary may develop and allow
a joint application for a household.
    (b) A pregnant woman is not subject to the cost sharing provisions
of the plan. Subsections (c) through (g) do not apply to a pregnant
woman participating in the plan.
    (c) An applicant who is approved to participate in the plan does not
begin benefits under the plan until a payment of at least:
      (1) one-twelfth (1/12) of the annual income contribution amount;
      or
      (2) ten dollars ($10);
is made to the individual's health care account established under
section 4.5 of this chapter for the individual's participation in the plan.
To continue to participate in the plan, an individual must contribute to
the individual's health care account at least two percent (2%) of the
individual's annual household income per year or an amount
determined by the secretary that is based on the individual's annual
household income per year, but not less than one dollar ($1) per month.
The amount determined by the secretary under this subsection must be
approved by the United States Department of Health and Human
Services and must be budget neutral to the state as determined by the
state budget agency.
    (d) If an applicant who is approved to participate in the plan fails to
make the initial payment into the individual's health care account, at
least the following must occur:
      (1) If the individual has an annual income that is at or below one
      hundred percent (100%) of the federal poverty income level, the
      individual's benefits are reduced as specified in subsection (e)(1).
      (2) If the individual has an annual income of more than one
      hundred percent (100%) of the federal poverty income level, the
      individual is not enrolled in the plan.
    (e) If an enrolled individual's required monthly payment to the plan
is not made within sixty (60) days after the required payment date, the
following, at a minimum, occur:
      (1) For an individual who has an annual income that is at or below
      one hundred percent (100%) of the federal income poverty level,
      the individual is:
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                                   18
          (A) transferred to a plan that has a material reduction in
          benefits, including the elimination of benefits for vision and
          dental services; and
          (B) required to make copayments for the provision of services
          that may not be paid from the individual's health care account.
      (2) For an individual who has an annual income of more than one
      hundred percent (100%) of the federal poverty income level, the
      individual shall be terminated from the plan and may not reenroll
      in the plan for at least six (6) months.
   (f) The state shall contribute to the individual's health care account
the difference between the individual's payment required under this
section and the plan deductible set forth in section 4.5(c) of this
chapter.
   (g) A member shall remain enrolled with the same managed care
organization during the member's benefit period. A member may
change managed care organizations as follows:
      (1) Without cause:
          (A) before making a contribution or before finalizing
          enrollment in accordance with subsection (d)(1); or
          (B) during the annual plan renewal process.
      (2) For cause, as determined by the office under the direction of
      the secretary.
   (h) The office may reimburse medical providers at the appropriate
Medicaid fee schedule rate for certified medical claims incurred prior
to the beginning of benefits under subsection (c) provided that the
claims:
      (1) were incurred not more than thirty (30) days one (1) month
      prior to the individual's application; and
      (2) are on behalf of an individual who:
          (A) is approved to participate in the plan;
          (B) is enrolled in the plan subject to the provisions in
          subsection (d); and
          (C) was eligible for the plan at the time care and services were
          furnished.
   (i) An enrolled individual in the plan must be in compliance with
section 3(c) of this chapter in each month in order to remain
enrolled in the plan.
   SECTION 23. IC 12-15-44.5-4.9, AS AMENDED BY
P.L.114-2018, SECTION 6, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2027]: Sec. 4.9. (a) An individual who is
approved to participate in the plan is eligible for a twelve (12) month
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                                   19
plan period if the individual continues to meet the plan requirements
specified in this chapter.
    (b) If an individual chooses to renew participation in the plan, the
individual is subject to an annual a semiannual renewal process at the
end of the benefit period to determine continued eligibility for
participating in the plan. If the individual does not complete the
renewal process, the individual may not reenroll in the plan for at least
six (6) months.
    (c) This subsection applies to participants who consistently made
the required payments in the individual's health care account. If the
individual receives the qualified preventative services recommended
to the individual during the year, the individual is eligible to have the
individual's unused share of the individual's health care account at the
end of the plan period, determined by the office, matched by the state
and carried over to the subsequent plan period to reduce the
individual's required payments. If the individual did not, during the
plan period, receive all qualified preventative services recommended
to the individual, only the nonstate contribution to the health care
account may be used to reduce the individual's payments for the
subsequent plan period.
    (d) For individuals participating in the plan who, in the past, did not
make consistent payments into the individual's health care account
while participating in the plan, but:
      (1) had a balance remaining in the individual's health care
      account; and
      (2) received all of the required preventative care services;
the office secretary may elect to offer a discount on the individual's
required payments to the individual's health care account for the
subsequent benefit year. The amount of the discount under this
subsection must be related to the percentage of the health care account
balance at the end of the plan year but not to exceed a fifty percent
(50%) discount of the required contribution.
    (e) If an individual is no longer eligible for the plan, does not renew
participation in the plan at the end of the plan period, or is terminated
from the plan for nonpayment of a required payment, the office shall,
not more than one hundred twenty (120) days after the last date of the
plan benefit period, refund to the individual the amount determined
under subsection (f) of any funds remaining in the individual's health
care account as follows:
      (1) An individual who is no longer eligible for the plan or does
      not renew participation in the plan at the end of the plan period
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                                    20
       shall receive the amount determined under STEP FOUR of
       subsection (f).
       (2) An individual who is terminated from the plan due to
       nonpayment of a required payment shall receive the amount
       determined under STEP SIX of subsection (f).
The office may charge a penalty for any voluntary withdrawals from the
health care account by the individual before the end of the plan benefit
year. The individual may receive the amount determined under STEP
SIX of subsection (f).
    (f) The office, under the direction of the secretary, shall
determine the amount payable to an individual described in subsection
(e) as follows:
       STEP ONE: Determine the total amount paid into the individual's
       health care account under this chapter.
       STEP TWO: Determine the total amount paid into the individual's
       health care account from all sources.
       STEP THREE: Divide STEP ONE by STEP TWO.
       STEP FOUR: Multiply the ratio determined in STEP THREE by
       the total amount remaining in the individual's health care account.
       STEP FIVE: Subtract any nonpayments of a required payment.
       STEP SIX: Multiply the amount determined under STEP FIVE by
       at least seventy-five hundredths (0.75).
    (g) The office of the secretary shall conduct an eligibility
redetermination for each plan participant at least one (1) time
every six (6) months.
    SECTION 24. IC 12-15-44.5-5, AS AMENDED BY P.L.201-2023,
SECTION 136, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 5. (a) A managed care
organization that contracts with the office to provide health coverage,
dental coverage, or vision coverage to an individual who participates
in the plan:
       (1) is responsible for the claim processing for the coverage;
       (2) shall reimburse providers at a rate that is not less than the rate
       established by the secretary; and
       (3) may not deny coverage to an eligible individual who has been
       approved by the office to participate in the plan.
    (b) A managed care organization that contracts with the office to
provide health coverage under the plan must incorporate cultural
competency standards established by the office. secretary. The
standards must include standards for non-English speaking, minority,
and disabled populations.
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                                  21
    SECTION 25. IC 12-15-44.5-5.5, AS ADDED BY P.L.30-2016,
SECTION 33, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 5.5. The office, under the direction of the
secretary, shall refer any member of the plan who:
      (1) is employed for less than twenty (20) hours per week; and
      (2) is not a full-time student;
to a workforce training and job search program.
    SECTION 26. IC 12-15-44.5-5.7, AS AMENDED BY
P.L.114-2018, SECTION 7, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 5.7. (a) Subject to appeal to the
office and except as provided in subsection (b), an individual may
shall be held responsible under the plan for receiving nonemergency
services in an emergency room setting, including prohibiting the
individual from using funds in the individual's health care account to
pay for the nonemergency services and paying a copayment for the
services of at least:
      (1) eight dollars ($8) for an individual who has an income of
      one hundred percent (100%) or less of the federal poverty
      level; or
      (2) thirty-five dollars ($35) for an individual who has an
      income of more than one hundred percent (100%) of the
      federal poverty level;
for the nonemergency use of a hospital emergency department.
    (b) However, An individual may not be prohibited from using funds
in the individual's health care account to pay for nonemergency
services provided in an emergency room setting for a medical condition
that arises suddenly and unexpectedly and manifests itself by acute
symptoms of such severity, including severe pain, that the absence of
immediate medical attention could reasonably be expected by a prudent
layperson who possesses an average knowledge of health and medicine
to:
      (1) place an individual's health in serious jeopardy;
      (2) result in serious impairment to the individual's bodily
      functions; or
      (3) result in serious dysfunction of a bodily organ or part of the
      individual.
    (c) In addition to the copayments described in subsection (a), the
office of the secretary shall require a plan participant who has an
income above one hundred percent (100%) of the federal poverty
level to pay additional cost sharing requirements established by the
office of the secretary in the amount of at least one dollar ($1) and
not more than thirty-five dollars ($35).
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                                  22
    (d) Unless otherwise allowed by federal law, the total aggregate
amount of cost sharing charges imposed on a quarterly basis for a
plan participant under this chapter may not exceed five percent
(5%) of the plan participant's family income.
    SECTION 27. IC 12-15-44.5-6, AS AMENDED BY P.L.216-2025,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 6. (a) For a state fiscal year beginning July 1,
2018, and before July 1, 2024, the office, after review by the state
budget committee, may determine that no incremental fees collected
under IC 16-21-10-13.3 are required to be deposited into the phase out
trust fund established under section 7 of this chapter. This subsection
expires July 1, 2024.
    (b) If the plan is to be terminated for any reason, the office
secretary shall, if required, provide notice of termination of the plan
to the United States Department of Health and Human Services and
begin the process of phasing out the plan.
    (c) Before submitting:
      (1) an extension of; or
      (2) a material amendment to;
the plan to the United States Department of Health and Human
Services, the office secretary shall inform the Indiana Hospital
Association of the extension or material amendment to the plan.
    SECTION 28. IC 12-15-44.5-8, AS AMENDED BY P.L.152-2017,
SECTION 35, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 8. The following requirements apply to funds
appropriated by the general assembly to the plan and the incremental
fee used for purposes of IC 16-21-10-13.3:
      (1) At least eighty-seven percent (87%) of the funds must be used
      to fund payment for health care services.
      (2) An amount determined by the office of the secretary to fund:
          (A) administrative costs of; and
          (B) any profit made by;
      a managed care organization under a contract with the office to
      provide health coverage under the plan. The amount determined
      under this subdivision may not exceed thirteen percent (13%) of
      the funds.
    SECTION 29. IC 12-15-44.5-9, AS AMENDED BY P.L.93-2024,
SECTION 113, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 9. The office secretary may
adopt rules under IC 4-22-2 necessary to implement:
      (1) this chapter; or
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                                   23
      (2) a Section 1115 Medicaid demonstration waiver concerning the
      plan that is approved by the United States Department of Health
      and Human Services.
   SECTION 30. IC 12-15-44.5-10, AS AMENDED BY P.L.126-2025,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2027]: Sec. 10. (a) The secretary has the authority to
provide benefits to individuals eligible under the adult group described
in 42 CFR 435.119 only in accordance with this chapter.
   (b) The secretary shall limit enrollment in the plan to the number of
individuals that ensures that financial participation does not exceed the
level of state appropriations or other funding for the plan.
   (c) The secretary may negotiate and make changes to the plan,
except that the secretary may not negotiate or change the plan in a way
that would do the following:
      (1) Reduce the following:
          (A) Contribution amounts below the minimum levels set forth
          in section 4.7 of this chapter.
          (B) Deductible amounts below the minimum amount
          established in section 4.5(c) of this chapter.
          (C) The number of hours required to satisfy the work
          requirements specified in section 3(c)(1) of this chapter unless
          expressly required by federal law.
      (2) Remove or reduce the penalties for nonpayment set forth in
      section 4.7 of this chapter.
      (3) Revise the use of the health care account requirement set forth
      in section 4.5 of this chapter.
      (4) Include noncommercial benefits or add additional plan
      benefits in a manner inconsistent with section 3.5 of this chapter.
      (5) Allow services to begin:
          (A) without the payment established or required by; or
          (B) earlier than the time frames otherwise established by;
      section 4.7 of this chapter.
      (6) Reduce financial penalties for the inappropriate use of the
      emergency room below the minimum levels set forth in section
      5.7 of this chapter.
      (7) Permit members to change health plans without cause in a
      manner inconsistent with section 4.7(g) of this chapter.
      (8) Operate the plan in a manner that would obligate the state to
      financial participation beyond the level of state appropriations or
      funding otherwise authorized for the plan.
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                                  24
    (d) The secretary may make changes to the plan under this chapter
if the changes are required by federal law or regulation and the office
provides a written report of the changes to the state budget committee.
    (e) The secretary shall verify an individual's compliance with
the requirements of section 3(c) of this chapter on an ongoing, and
at least quarterly, basis. The secretary may not accept any of the
following methods as being sufficient to verify compliance:
      (1) A plan participant's self-attestation of compliance.
      (2) Designations, approvals, or determinations of compliance
      by a managed care organization.
    (f) The secretary may accept a medically frail status set forth in
section 3(c)(8) of this chapter only if the individual has been
medically certified as medically frail (as defined in 42 CFR
440.315(f)) by any of the following:
      (1) A physician.
      (2) A physician's assistant.
      (3) An advanced practice registered nurse.
      (4) A nurse.
      (5) A designated representative of a physician's office, on
      behalf of an individual described in subdivisions (1) through
      (4).
      (6) A psychologist.
      (7) A social worker.
    (g) The secretary may not do any of the following:
      (1) Expand the definition of medically frail for purposes of
      this chapter beyond the definition set forth in 42 CFR
      440.315(f).
      (2) Request the implementation of any additional exemptions
      other than the exemptions set forth in section 3 of this
      chapter.
    SECTION 31. P.L.213-2025, SECTION 25, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JANUARY 1, 2026
(RETROACTIVE)]: SECTION 25. Except as provided for under
IC 4-12-18 and IC 12-8-15, the governor of the state of Indiana is
solely authorized to accept on behalf of the state any and all federal
funds available to the state of Indiana. Federal funds received under
this SECTION are appropriated for purposes specified by the federal
government, subject to allotment by the budget agency. The provisions
of this SECTION and all other SECTIONS concerning the acceptance,
disbursement, review, and approval of any grant, loan, or gift made by
the federal government or any other source to the state or its agencies
and political subdivisions shall apply, notwithstanding any other law.
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                               25
   SECTION 32. P.L.213-2025, SECTION 26, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JANUARY 1, 2026
(RETROACTIVE)]: SECTION 26. Except as provided for under
IC 4-12-18 and IC 12-8-15, federal funds received as revenue by a
state agency or department are not available to the agency or
department for expenditure until allotment has been made by the
budget agency under IC 4-12-1-12(d).
   SECTION 33. An emergency is declared for this act.
SEA 1 — Concur
President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date:  Time:
SEA 1 — Concur