September 8, 2026  – Indiana is moving forward with a $68 billion Medicaid managed care procurement that will determine which private health plans oversee care for nearly 1.5 million residents.

The Indiana Family and Social Services Administration (FSSA) first announced plans for the procurement earlier this year, describing it as the “Mother of All Procurements.” The state is seeking managed care organizations to administer four major Medicaid programs: the Healthy Indiana Plan, Hoosier Healthwise, Hoosier Care Connect and Indiana PathWays for Aging.

Together, the programs account for roughly half of Indiana’s Medicaid spending and cover close to one in five state residents.

The scale is unusual not only because of the dollar amount. Indiana has historically procured its major Medicaid managed care programs separately. Under the new approach, the state intends to select one or more contractors capable of operating across all four programs.

That means winning insurers could be responsible for very different Medicaid populations.

The Healthy Indiana Plan primarily covers adults ages 19 to 64, while Hoosier Healthwise serves children and pregnant women with low incomes. Hoosier Care Connect covers certain adults with disabilities who are not eligible for Medicare. PathWays serves adults age 60 and older who need long-term services and supports, including nursing facility care.

Indiana currently works with several private insurers across its managed care programs, including Anthem, CareSource, Humana, Managed Health Services and UnitedHealthcare. The companies participate in different combinations of the four programs and could be among those competing for the new contracts.

State officials are looking to use the combined purchasing power of the programs to improve value and control costs. The approach is part of a broader state purchasing strategy known as category management, which seeks to combine similar contracts and negotiate from a stronger position.

Cost control has become increasingly important as Medicaid consumes a larger portion of Indiana’s budget. Medicaid represented about 15% of state spending in 2021 and 18% in 2023. In Indiana’s most recent biennial budget, that share has grown to roughly 22%.

The state expects the contracts to begin January 1, 2029. With nearly 1.5 million residents potentially affected, decisions made during the procurement could shape Medicaid access, spending and care delivery in Indiana for years to come.