MedicaidAdministrativeMedium impact
BT2025128: Performance standards updated for qualified providers determining presumptive eligibility
Indiana Medicaid (IHCP)·IN·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana updated performance standards for qualified providers (QPs) making presumptive eligibility determinations for Medicaid. The first evaluation period was delayed from Q4 2025 to Q1 2026, with specific 95% performance thresholds now required for application submissions, completeness, and eligibility determinations.
Action Required
Before January 1, 2026: Qualified providers in Indiana must ensure 95% compliance rates for presumptive eligibility determinations including: application submissions, complete information, and successful eligibility determinations. Review current PE processes and implement quality checks. Failure to meet standards will result in written violations and potential loss of QP status after three violations within 12 months.