Indiana Medicare Mandate: What Agency Owners Need to Know

If you own or operate a home care agency in Indiana, the clock is ticking. A new Indiana Medicare mandate requires that every provider type 05 must also hold active Medicare provider enrollment — and the deadline is July 1, 2026.

Miss this deadline, and you risk losing your Medicaid reimbursement entirely. No grace period has been announced. No exceptions have been published. This is one of the most consequential compliance requirements Indiana home care agencies have faced in years, and many owners aren’t yet aware it exists.

Here’s everything you need to know.

What Is the Indiana Medicare Mandate?

The Indiana Medicare mandate was introduced through IHCP Bulletin BT202595, issued by the Indiana Family and Social Services Administration (FSSA). It applies to all home health agencies operating under provider type 05 in the IHCP system.

The rule is straightforward: beginning July 1, 2026, if your agency is enrolled with Indiana Medicaid but does not hold an active Medicare provider number, your Medicaid claims will no longer be reimbursed.

This requirement is designed to strengthen provider accountability and align Indiana’s Medicaid home health network with federal Medicare standards. But for many agencies — particularly smaller, independently owned providers who have operated exclusively on Medicaid — it represents an entirely new compliance challenge.

Who Does the Indiana Medicare Mandate Affect?

The Indiana Medicare mandate applies to you if:

Your agency is enrolled as a home health agency (provider type 05) with IHCP
Your agency is physically located in Indiana
You do not currently have an active Medicare provider enrollment

Agencies that already hold an active Medicare number are not required to take any action under this specific bulletin. However, if your Medicare enrollment has lapsed or is pending, you still need to act.

If you are unsure of your current status, log in to the Provider Enrollment, Chain, and Ownership System (PECOS) or contact your billing department to verify your Medicare provider number.

Why July 1, 2026 Is Closer Than You Think

Here is the critical detail most agency owners underestimate: Medicare enrollment takes 4 to 6 months under normal processing conditions — and that is assuming your application is submitted correctly the first time.

As of March 2026, you have approximately four months until the deadline. That means if you have not started the enrollment process, you are already operating at the edge of the timeline. A single error on your application, a missing document, or a scheduling delay with your state survey could push you past the cutoff.

The enrollment process requires:

Submitting your application through PECOS online or via paper form CMS-855A
Undergoing review by Palmetto GBA, Indiana’s Medicare Administrative Contractor (MAC)
Passing an on-site survey conducted by the Indiana Department of Health (IDOH) or an approved accrediting organization

That third step — the survey — is often where timelines slip. If you choose accreditation through a private organization (see below), scheduling depends on their availability, not yours.

Start now. Do not wait until May or June hoping the process will move quickly.

Step-by-Step Process

Step 1: Determine Your Accreditation Path

Before submitting your Medicare application, you need to decide how your agency will meet Medicare’s Conditions of Participation (CoPs). You have two options:

Option A: State Survey by the Indiana Department of Health (IDOH) The IDOH will conduct an initial certification survey of your agency. This is the traditional route and has no direct accreditation fee, but scheduling is subject to the state’s availability and workload.

Option B: Deemed Status Through a CMS-Approved Accrediting Organization (AO) Three organizations are approved to grant deemed status for home health agencies:

ACHC (Accreditation Commission for Health Care)
CHAP (Community Health Accreditation Partner)
TJC (The Joint Commission)

Accreditation through one of these organizations demonstrates that your agency meets or exceeds Medicare CoPs. Many agencies prefer this route because accredited status can also be a competitive differentiator when marketing to referral sources. However, accreditation comes with fees and its own survey scheduling timeline, so contact your preferred AO immediately to get on their calendar.

Step 2: Prepare Your Agency for Medicare Standards

Medicare’s Conditions of Participation set specific requirements for home health agencies around clinical policies, patient rights, care planning, infection control, and quality assessment. If your agency has operated exclusively in the Medicaid world, you may need to update your policies and procedures to meet these standards before your survey.

Areas to review include:

Comprehensive patient assessment (OASIS documentation requirements)
Plan of care processes and physician orders
Clinical supervision of aides and paraprofessionals
Emergency preparedness planning
Quality Assessment and Performance Improvement (QAPI) program

Consider engaging a healthcare compliance consultant familiar with Medicare CoPs to perform a readiness assessment before your survey.

Step 3: Submit Your CMS-855A Application Through PECOS

Once your agency is ready for survey, submit your Medicare enrollment application:

Go to PECOS at pecos.cms.hhs.gov
Create or log into your account and begin a new enrollment application for a home health agency
Alternatively, download and complete paper Form CMS-855A and mail it to Palmetto GBA

Your application will require:

Agency legal name, address, and NPI
Ownership and managing employee information
Disclosure of any adverse legal actions
Accrediting organization information (if applicable)
Supporting documents including state licensure

Step 4: Respond Promptly to Palmetto GBA

After submission, Palmetto GBA may issue a development request — a request for additional information or documentation. These requests have strict response deadlines. Missing a development request deadline can result in your application being rejected, forcing you to start over.

Assign a specific staff member to monitor your application status in PECOS and respond to any communications from Palmetto GBA within 24–48 hours.

Step 5: Pass Your Survey and Receive Your Medicare Provider Number

Once Palmetto GBA receives a positive survey report from IDOH or your accrediting organization, they will issue your Medicare provider number and set an effective date for your enrollment. Confirm that this effective date falls before July 1, 2026.

Notify your IHCP enrollment contact that your Medicare enrollment is active and provide your Medicare provider number for their records.

What Happens If You Miss the Deadline?

If your agency does not have active Medicare enrollment by July 1, 2026, FSSA has indicated that IHCP reimbursement will be suspended. For agencies where Medicaid represents the majority of revenue, this is an existential threat.

There is currently no published appeals process or hardship exemption for agencies that miss the deadline due to processing delays. While it is possible that FSSA could issue guidance accommodating agencies with pending applications in good standing, you should not plan around that possibility. Protect your revenue by acting now.

How the Indiana Medicare Mandate Fits Into a Bigger Picture

This mandate is part of a broader tightening of Indiana’s Medicaid home care landscape in 2026, including:

IHCP Bulletin BT202622, which requires a new PSA license for personal services agencies effective March 25, 2026
Governor Braun’s ongoing Medicaid claims audit following a reported 28.8% improper payment rate
The 70% passthrough rule, requiring agencies to direct at least $24.05 of every $34.36 Attendant Care hour to the caregiver

Indiana’s regulatory environment is becoming significantly more demanding. Agencies that treat compliance as a back-office function rather than a core business priority are at increasing risk. The Indiana Medicare mandate is the most time-sensitive of these issues — but it is not the last one you will face.

Bottom Line

The Indiana Medicare mandate is real, the deadline is firm, and four months is not as much time as it sounds when you factor in surveys, accreditation scheduling, and application processing.

If your agency is looking for an Indiana-based home health software, GEOH Advantage is the answer!

Book a meeting with one of our agency strategists today to learn more!