Medicaid office accelerates emergency payments for providers under risk based managed care program

On April 17, 2025, Indiana House Legislation introduced House Bill 1474, a significant piece of legislation aimed at addressing financial challenges faced by healthcare providers participating in the state's risk-based managed care program. The bill outlines a structured approach for providers to receive temporary emergency assistance payments when they encounter financial emergencies, ensuring continuity of care for Medicaid recipients.

The primary purpose of House Bill 1474 is to establish a framework for determining when a provider is in a financial emergency and to facilitate timely assistance from managed care organizations. Key provisions include requirements for providers to demonstrate their participation in claims submission education and training, as well as their adherence to uniform billing requirements. The bill mandates that the Office of Medicaid Policy and Planning must assess a provider's financial status within seven days of receiving a written request for assistance.

Notably, if a provider is deemed to be experiencing a financial emergency, the bill directs managed care organizations to issue a temporary emergency assistance payment within seven days. This payment is calculated as 75% of the provider's average monthly Medicaid claims for long-term services and supports over the previous six months, adjusted based on the organization's covered population.

The introduction of House Bill 1474 has sparked discussions among lawmakers and stakeholders regarding its implications for the healthcare system in Indiana. Supporters argue that the bill is essential for safeguarding access to care, particularly for vulnerable populations reliant on Medicaid services. Critics, however, have raised concerns about the potential financial burden on managed care organizations and the overall sustainability of the program.

As the bill progresses through the legislative process, experts suggest that its passage could lead to improved financial stability for healthcare providers, ultimately benefiting patients. However, the ongoing debates surrounding funding and implementation strategies will be crucial in determining the bill's effectiveness and long-term impact on Indiana's healthcare landscape.

In conclusion, House Bill 1474 represents a proactive step by Indiana lawmakers to address the financial challenges faced by healthcare providers in the managed care system, with potential far-reaching effects on both providers and patients alike. The coming weeks will be critical as discussions continue and the bill moves toward potential enactment.