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Indiana has 42 community health centers across 490 sites serving 820,253 patients — the #8 FQHC state by patients outside California and Texas. As an expansion state, Medicaid anchors the safety net, and H.R. 1 work requirements plus the December 2026 funding cliff are the key risks.
Indiana is a Medicaid-expansion state whose ~42 community health center organizations serve roughly 700,000 patients (over half on Medicaid) through the Healthy Indiana Plan (HIP) — but 2025–2026 brought a wave of state-level retrenchment layered on top of federal H.R. 1 cuts. SEA 2 (signed May 2025) reinstated 20-hour HIP work requirements and a budget-based enrollment cap, and 2026's SB 1 plus a proposed elimination of 340B/Medicaid drug rebates threaten to push more than 100,000 Hoosiers off coverage and strip millions in 340B savings from FQHCs like HealthNet. With ~24% of health-center budgets coming from federal grants, IPHCA-member FQHCs are squeezed between the Dec 2026 federal funding cliff and an aggressive state cost-cutting agenda, partly offset by Indiana's $206.9M first-year Rural Health Transformation Program award.
Patient-weighted across the 41 centers with UDS 2024 data.
Indiana remains a reduced/restricted practice state: nurse practitioners must maintain a written collaborative practice agreement with a supervising physician — including the physician's review of at least a 5% random sample of charts where medications were prescribed — under Indiana Code 25-23-1-19.4, though pending legislation would remove the agreement requirement effective July 1, 2026.
Medicaid community-engagement (work) requirements under CMS-2454-IFC (80 hrs/month, full implementation Jan 1, 2027) plus expiry of the enhanced ACA premium tax credits (end of 2025) threaten Indiana's expansion population and FQHC Medicaid revenue.
5 primary-sourced findings on Indiana FQHC policy and financing.
Indiana's FSSA plans to stop reimbursing Medicaid for drugs purchased under the federal 340B program effective July 1, 2026, capturing the rebates for the state (~$63M/year) instead of letting safety-net providers keep the savings. HealthNet (10 Indianapolis health centers) estimates $3M in annual savings at risk and the Damien Center $5M; IPHCA-member FQHCs warn it will reduce medication access and care for low-income Hoosiers. HealthNet CEO René Kougal: '340B savings are what allow health centers to keep serving patients.'
WFYI IndianapolisSB 1, passed in the 2026 session (sponsor Sen. Chris Garten) and aligned with H.R. 1's federal welfare changes, layers stricter work requirements and more frequent eligibility checks onto HIP. The advocacy group Hoosier Action estimates over 100,000 additional people could lose coverage from state changes alone, and nearly 400,000 by 2034 once combined with federal cuts — the majority from the Medicaid expansion population that drives more than half of FQHC patient volume. FSSA had announced over $400M in projected savings via population reductions.
WFYI IndianapolisIndiana was awarded $206.9 million for year one of the five-year federal Rural Health Transformation Program (created by H.R. 1 / the One Big Beautiful Bill Act to partly offset rural Medicaid cuts), with $120 million routed through the state's GROW (Growing Rural Opportunities for Well-being) Regional Grants. Eight regional coalitions — one per region — submitted letters of intent by May 1 with full applications due July 1, 2026, funding five goals including sustainable access, workforce development, and chronic disease management. FQHCs cannot apply alone; they must join a regional coalition, making IPHCA-member participation strategic.
Indiana Department of Health / Indiana Capital ChronicleSenate Enrolled Act 2, signed by Gov. Mike Braun on May 1, 2025, requires FSSA to seek federal approval for a 20-hour/week work-or-volunteer requirement on able-bodied adult HIP enrollees (with a dozen-plus 'good cause' exemptions), and increases the frequency of eligibility checks. The House had removed the original 500,000-person hard enrollment cap in favor of a fiscal/budget-based cap allowing FSSA to halt new enrollment once the appropriation runs out. The law targets the sustainability of Indiana's Medicaid expansion after a 2023 forecasting error; opponents warned of billions in lost federal match.
WFYI / Indiana Senate RepublicansIndiana's ~42 community health center organizations serve about 700,000 patients and received nearly $88 million in HRSA primary care grants in 2024, with federal grants making up roughly 24% of FQHC budgets (e.g., HealthNet, which serves 61,000 patients). A January 2025 federal funding freeze briefly locked one-third of Indiana FQHCs out of their grant accounts, underscoring exposure as the Community Health Center Fund approaches its December 2026 reauthorization cliff. IPHCA CEO Ben Harvey: 'There's certainly a level of vulnerability health centers have just because of their reliance on federal funding.'
WFYI IndianapolisBy patients (HRSA UDS 2024). Tap for the full profile.
| Organization | Patients | Sites | Uninsured | Revenue (990) | District |
|---|---|---|---|---|---|
| The Health & Hospital Corporation of Marion County Indianapolis | 111,197 | 12 | 6.65% | — | IN-07 |
| Northshore Health Centers, Inc. Portage | 81,963 | 22 | 21.99% | $64M | IN-01 |
| Health Net, Inc. Indianapolis | 60,775 | 29 | 21.7% | — | IN-07 |
| Meridian Health Services Corp. Muncie | 54,024 | 51 | 11.23% | $120M | IN-05 |
| Healthlinc Inc. Valparaiso | 48,302 | 16 | 13.31% | $70M | IN-01 |
| 219 Health Network Inc. East Chicago · Look-Alike | 48,160 | 32 | 1.92% | $20M | IN-01 |
| Indiana Health Centers Incorporated Indianapolis | 38,766 | 22 | 11.5% | $42M | IN-07 |
| Jane Pauley Community Health Center, Inc. Indianapolis | 35,515 | 21 | 11.38% | $36M | IN-07 |
| Valley Professionals Community Health Center Inc. Clinton | 27,706 | 16 | 4.03% | $42M | IN-08 |
| Neighborhood Health Clinics Fort Wayne | 23,472 | 9 | 23.73% | — | IN-03 |
2 hospital/university/county-operated: 1 university, 1 hospital.
| District | Representative | Sites |
|---|---|---|
| IN-07 | Andre Carson | 93 |
| IN-01 | Frank J. Mrvan | 87 |
| IN-08 | Mark B. Messmer | 64 |
| IN-05 | Victoria Spartz | 52 |
| IN-06 | Jefferson Shreve | 46 |
| IN-03 | Marlin A. Stutzman | 44 |
Indiana ranks #8 by FQHC patients and #6 by organization count among the 57 national-breadth states/territories (excludes California and Texas, which have dedicated dashboards). All 42 centers depend on the federal Community Health Center Fund, authorized only through December 31, 2026.
FQHC data from the HRSA bulk-sites file + UDS 2024 + IRS 990. State policy profile via NACHC/KFF/AANP. Intelligence items cite primary sources. Federal items apply to all states; state items are Indiana-only. Updated 2026-06-03.