State officials on Tuesday said they were waiting for fiscal year-end data and a new Medicaid forecast to ascertain how the program’s ballooning expenditures will affect the state’s bottom line.

State Comptroller Elise Nieshalla, Office of Management and Budget Director Cris Johnston and Acting State Budget Director Joseph Habig held a news conference Tuesday highlighting Indiana’s fiscal year-end data. Yet they gave few updates regarding the state’s Medicaid program because officials were still awaiting June’s Medicaid financial data.

State officials in December reported a nearly $1 billion forecasting error. At the time, state lawmakers pledged to cover the unexpected shortfall with an additional $713.1 million over the biennium from the state surplus and $271.2 million out of a Medicaid reserve account. (Tuesday’s fiscal year data reflected the same dollar amounts.)

That month, officials predicted the state’s Medicaid funding shortfall to be $255.2 million for the fiscal year. Through May, the latest month data was available, the projection had increased to $392.9 million, the Indiana Family and Social Services Administration reported, cautioning that some of the increase stemmed from assessment fee collection timing. Yet-to-be-released June data will determine whether the state’s $255.2 million estimate was too high or low.

State officials in December estimated the shortfall for fiscal year 2025 to be $457.9 million. Johnston, however, said that estimate could change with a new Medicaid forecast later this year.

“This December’s forecast — they will take into consideration some of the actions that FSSA [Indiana Family and Social Services Administration] has taken and factor that into their forecast,” Johnston said. “So I’d imagine that $457 million is going to be a different number come later this year.”

Since last December, the Indiana Family and Social Services Administration has implemented changes to what it says was the main cause of the increased Medicaid costs — what used to be the state’s Aged and Disabled Waiver. (The waiver has since become two separate waivers: the Health and Wellness Waiver, for Hoosiers aged 59 and younger, and the PathWays for Aging Waiver, for Hoosiers aged 60 and older.)

Specifically, attendant care expenditures under the now-severed waiver were driving the increases, according to the administration. In commentary released with its May Medicaid financial report, the administration reported that attendant care expenditures for the fiscal year have exceeded the December 2023 forecast by $42.8 million and the budget by $503 million.

According to the administration’s May Medicaid financial report, the state’s fiscal year-to-date Medicaid expenditures were more than $62 million, after adjustments, above what the December forecast predicted. And through May, Medicaid expenditures for nearly 2 million Hoosiers outpaced what lawmakers had budgeted for by $384 million, after adjustments.

The administration has moved to corral attendant care expenditures by no longer allowing spouses, biological parents and guardians of minors — whom the state dubs “legally responsible individuals” — to provide attendant care. Earlier this year, the agency allowed them to transition to the state’s Structured Family Caregiving program, which often pays less under a capped per diem structure. The switch and other changes are estimated to save the state about $300 million over the biennium, the administration says.

State officials on Tuesday said Indiana was sitting on a nearly $2.6 billion surplus. But some remained cautious about the news, including Sen. Ryan Mishler, R-Mishawaka, who said in a statement the state’s Medicaid spending “is not sustainable and could adversely affect other aspects of our state’s budget.”

Even after the state’s “unwinding” efforts — which have seen more than 400,000 Hoosiers disenrolled from Medicaid since April 2023 (about a quarter of whom have re-enrolled, according to the administration) — Indiana’s Medicaid spending for the 2024 fiscal year through May was up by nearly $2 billion compared to the prior fiscal year at the same time.

Further highlighting the increased costs to the state, no reversions were made from the Office of Medicaid Policy and Planning in the 2024 fiscal year. More than $526 million in reversions were made during the 2023 fiscal year.

Contact Jarred Meeks on X @jarredsmeeks or email him at [email protected].

Correction: This article has been updated to reflect Cris Johnston’s correct job title.