Last Updated: February 2026
The Indiana Medicaid fee schedule in 2026 brings major rate increases for providers.
Indiana now pays 100% of the prior year’s Medicare rates for many services.
This is one of the biggest Medicaid reimbursement changes in recent Indiana history.
Here is a quick summary of what changed:
- Professional fee schedule now matches 100% of 2025 Medicare rates
- Anesthesia conversion factor updated to $19.37
- MDwise exited as a managed care plan option
- New HCBS waiver services added for 2026
- Home health agencies must enroll in Medicare by July 2026
- Hospice per diem rates updated for federal fiscal year 2026
What Is the Indiana Medicaid Fee Schedule?
The Indiana Medicaid fee schedule is a list of payment rates. It shows how much the state pays providers for covered services.
The Indiana Health Coverage Programs (IHCP) manages this schedule.
Who Uses the Fee Schedule?
Doctors, hospitals, and clinics use it. It covers services like office visits, lab work, and medical equipment. The rates apply to both fee-for-service and managed care claims.
The IHCP updates the fee schedule monthly. New rates post on the second Tuesday of each month. Providers can search by CPT or HCPCS code online.
If you want to understand Medicaid eligibility requirements for 2026, knowing the fee schedule helps. It shows what services Indiana Medicaid covers and how much providers get paid.
2026 Professional Fee Schedule Update (Bulletin BT2025156)
On November 6, 2025, the IHCP released Bulletin BT2025156. This bulletin announced the biggest rate change for 2026.
What Changed?
Starting January 1, 2026, Indiana Medicaid pays 100% of the 2025 Medicare fee schedule rates.
This applies to three main areas:
- Physician services — office visits, surgeries, and consultations
- Durable medical equipment (DME) — wheelchairs, oxygen supplies, and more
- Transportation services — ambulance and non-emergency medical transport
Indiana Medicaid used to pay well below Medicare. This update is a big increase for many providers.
Anesthesia Conversion Factor
The IHCP anesthesia conversion factor also changed. It now matches the 2025 Medicare rate of $19.37.
This rate applies to claims on or after January 1, 2026.
What Services Are NOT Affected?
Some services did not get this rate increase. These include:
- Applied behavior analysis (ABA)
- Dental services
- Home health services
- Medicaid Rehabilitation Option (MRO)
- Waiver services
These services follow different fee schedules and rate rules.
If you are comparing rates across states, check our guide on the Medicaid Fee Schedule 2026 for a broader view.
DME Rates and the 21st Century Cures Act
Indiana also updated select DME and medical supply rates.
This change follows the 21st Century Cures Act.
How Are DME Rates Set?
Under Section 1903(i)(27) of the Social Security Act, states must use specific Medicare rates for certain DME codes.
Indiana now uses the lowest non-zero 2026 Indiana Medicare DMEPOS fee schedule amount.
Some codes use the competitive bidding single payment amount instead.
These changes apply retroactively to January 1, 2026. CMS will release the final code list soon.
Preview Fee Schedules
The IHCP posted four preview fee schedules online. These show the new 2026 rates for:
- Physician services
- DME and medical supplies
- Non-emergency medical transportation (NEMT)
- Ambulance and EMT services
Providers can download these from the IHCP Fee Schedules page.
MDwise Exits Indiana Managed Care in 2026
Effective January 1, 2026, MDwise is no longer a managed care option.
This affects both the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) programs.
Which Plans Remain?
Indiana now has three managed care entities (MCEs):
| Managed Care Plan | Status in 2026 |
|---|---|
| Anthem | Active |
| CareSource | Active |
| MHS (Managed Health Services / Centene) | Active |
| MDwise | Exited |
What Happened to MDwise Members?
Members had an open enrollment period from November 1 to December 15, 2025. They could pick a new plan during that time. Members who did not choose were auto-assigned to another MCE.
Key Transition Rules
There are important rules for the MDwise transition:
- Prior authorizations from MDwise are honored for up to 90 days by the new MCE
- PAs expire when the 90 days end or approved units run out — whichever comes first
- Pharmacy claims for MDwise members before January 1, 2026, are processed by MedImpact through March 31, 2026
Understanding the 2026 HIP income limits can help members choose the right plan.
Managed Care Fee Schedule Requirements
All managed care plans must follow the new IHCP rates. This is a key rule for 2026.
What Must MCEs Do?
Each MCE must update its fee schedule to match the IHCP 2026 Professional Fee Schedule.
They must also adopt the $19.37 anesthesia conversion factor. The deadline was January 1, 2026.
This means the IHCP fee schedule acts as a minimum rate floor for all Indiana Medicaid managed care plans. No MCE can pay below these rates for covered services.
Hospice Rates for Federal Fiscal Year 2026
Indiana updated its Medicaid hospice rates for 2026. These rates follow the federal fiscal year — October 1, 2025, through September 30, 2026.
How Are Hospice Rates Calculated?
The IHCP uses federal hospice per diem rates as a base. It then applies the Hospice Wage Index to adjust for Indiana labor costs.
Key details include:
- The service intensity add-on (SIA) payment is paid on top of routine home care per diem rates
- Providers who submit quality data get the full rate
- Providers who do not report quality data face a 4% rate reduction
Bulletin BT2025138 has the full rate tables.
HCBS Waiver Updates for 2026
Indiana made big changes to its Home and Community-Based Services (HCBS) waivers in 2026. These changes affect thousands of Hoosiers with disabilities.
Health and Wellness (H&W) and TBI Waiver Changes
The FSSA received CMS approval for waiver amendments. Changes took effect January 1, 2026. Key updates include:
- New self-directed service options — members get full employer and budget authority
- Home Modifications and Home Modification Assessment were combined into one service
- Extended Employment Services were added to the H&W waiver
- Attendant Care — payment can now go to legally responsible individuals in extraordinary cases
Family Supports and CIH Waiver Changes
These waivers also got updates. They include new service caps and a new eligibility assessment tool.
The tool is age-appropriate and helps determine eligibility for people with intellectual disabilities.
Waiver Capacity and Waiting List
Here are the current waiver slot numbers:
| Waiver Detail | Number |
|---|---|
| Combined H&W and PathWays slots (July 2025 – June 2026) | 55,969 |
| People on the H&W waiver waiting list (January 2026) | 6,456 |
These numbers show high demand for waiver services in Indiana.
Home Health Medicare Enrollment Mandate
Starting July 1, 2026, all home health agencies in Indiana Medicaid must also be enrolled in Medicare. This is a new requirement under Bulletin BT202595.
Who Does This Affect?
This rule applies to both existing and new home health agencies. Agencies that are not enrolled in Medicare after the deadline may lose Medicaid reimbursement.
This is an important change. Home health providers should start the Medicare enrollment process now.
Provider Enrollment Licensing Changes
Starting March 25, 2026, new licensing rules take effect for waiver providers. This was announced in Bulletin BT202622.
What Changed?
A personal services agency license is now required for new enrollments and recertifications.
This applies to certain waiver provider specialties. Providers can no longer use a home health agency license as an alternative.
Indiana Medicaid Eligibility and Income Limits in 2026
Eligibility rules also changed in 2026. These changes matter for both members and providers.
Aged, Blind, and Disabled (ABD) Income Limits
ABD income limits increased on January 1, 2026. This followed the federal 2.8% COLA adjustment.
Individuals in this group may now qualify at slightly higher income levels.
HIP and Children’s Medicaid Limits
HIP, children’s Medicaid, and pregnant women’s limits still use 2025 Federal Poverty Levels.
These limits will update in March 2026 when new FPL numbers take effect.
To learn more, check our guide on Indiana Medicaid eligibility in 2026. You can also compare Medicaid income limits by state in 2026 to see how Indiana compares.
If you need help getting started, here is a step-by-step guide on how to apply for Medicaid in Indiana.
How to Access the Indiana Medicaid Fee Schedule
Providers can access the fee schedule online. Here is how:
- Visit the IHCP Fee Schedules page
- Search by CPT or HCPCS code
- Or download the full schedule as an Excel file
The schedule updates on the second Tuesday of each month after 4 p.m. It reflects data current as of the previous Sunday.
For reimbursement questions, email: FSSA.IHCPReimbursement@fssa.in.gov
Key Official Resources
| Resource | Where to Find It |
|---|---|
| IHCP Fee Schedules | in.gov/medicaid — Fee Schedules |
| IHCP Bulletins | in.gov/medicaid — Bulletins |
| BT2025156 — 2026 Professional Fee Schedule | BT2025156.pdf |
| BT2025157 — MDwise Transition | BT2025157.pdf |
| BT202614 — H&W and TBI Waiver Amendments | BT202614.pdf |
| IHCP Provider Portal | portal.indianamedicaid.com |
| Upcoming Medicaid Changes | in.gov/fssa — Upcoming Changes |
Frequently Asked Questions
What is the Indiana Medicaid fee schedule for 2026?
The 2026 Indiana Medicaid fee schedule now pays 100% of the 2025 Medicare rates. This applies to physician services, DME, and transportation. The IHCP announced this change in Bulletin BT2025156, effective January 1, 2026.
Did Indiana Medicaid rates increase in 2026?
Yes. Indiana Medicaid rates increased significantly in 2026. The state now matches 100% of prior-year Medicare rates for many services. The anesthesia conversion factor also rose to $19.37.
Is MDwise still a Medicaid plan in Indiana in 2026?
No. MDwise exited Indiana’s managed care program on January 1, 2026. Former MDwise members were reassigned to Anthem, CareSource, or MHS. Prior authorizations from MDwise are honored for up to 90 days.
What are the Indiana Medicaid income limits for 2026?
ABD income limits increased on January 1, 2026, due to the 2.8% federal COLA. HIP and children’s limits still use 2025 Federal Poverty Levels. New FPL-based limits will update in March 2026.
Do Indiana managed care plans have to follow the new fee schedule?
Yes. All managed care entities must match the 2026 IHCP Professional Fee Schedule. This includes the $19.37 anesthesia conversion factor. The deadline to update was January 1, 2026.
Will home health agencies need Medicare enrollment in Indiana?
Yes. Starting July 1, 2026, all Medicaid home health agencies must also be enrolled in Medicare. Agencies without Medicare enrollment after this date may lose Medicaid reimbursement in Indiana.
This article is for informational purposes only. Always verify details with official Indiana FSSA and IHCP sources. Data sourced from IHCP Bulletins BT2025156, BT2025157, BT2025138, BT202614, BT202595, and BT202622.
