Martinez, who has three children, said she had received notice in March that her coverage and one child’s coverage were set for a year. State officials confirmed that returned mail led to a request for information. The state also sought verification after her daughter applied for, but did not receive, a job at WaWa. The daughter had to sign a statement confirming she was not earning income.

Martinez eventually regained coverage, but said resolving the issue took substantial time and effort. She is among Indiana Medicaid recipients who say missed mail, delayed paperwork or processing problems have put their coverage at risk.

More than 500,000 Indiana residents have lost Medicaid coverage since the start of 2025, according to the state’s enrollment dashboard. The losses have come as the state conducts more eligibility checks. State officials say many people removed from the rolls were no longer eligible; advocates say administrative hurdles have also contributed.

A Georgetown University report found Indiana had the nation’s largest decline in children covered by Medicaid, with enrollment dropping nearly 20 percent. The state’s Family and Social Services Administration has linked hundreds of millions of dollars in savings to the eligibility reviews.

Indiana is preparing to add work requirements to Medicaid on Jan. 1, 2027, under new federal requirements. The state has identified 58,000 enrollees as not currently meeting the upcoming rules, according to a state report, and officials are hiring 400 additional staff to handle the requirements and eligibility checks.

Advocates fear the added rules could accelerate coverage losses. Tracey Hutchings-Goetz of Hoosier Action warned that the increase could bring Indiana’s uninsured rate back to levels seen before the Affordable Care Act. She said losing coverage could also mean more people turning to emergency rooms and worse health outcomes.

Hospital officials have raised concerns about the financial effects of more uninsured and underinsured patients. Erik Swanson of health care consulting firm Kaufman Hall said an increase would have an unfavorable effect on health systems’ finances.

Family and Social Services Administration Secretary Mitch Roob has also voiced concern, saying 58,000 people have already been identified as out of compliance with the forthcoming rules. At the same time, he has said Medicaid members are responsible for meeting program requirements. An agency spokesperson said the state has at least one office in every county to help people navigate the process and that it wants recipients to keep their coverage.

For Martinez, the experience left her skeptical that the system is working for recipients. “I think that it’s set up like this on purpose so that people will give up,” she said.