Advocacy Activity

IRHA Joins Bill Signing for House Enrolled Act 1271, Securing New Protections for Rural Health Providers

The Indiana Rural Health Association was proud to join state leaders, lawmakers, and health care stakeholders for the ceremonial bill signing of House Enrolled Act 1271. IRHA supported efforts to advance this legislation, which represents a meaningful step forward for payment fairness, transparency, and accountability in Indiana’s health care system.

For rural hospitals, clinics, and providers, predictable reimbursement is essential to maintaining access to care. House Enrolled Act 1271 addresses several payer practices that can create financial uncertainty for providers, including downcoding, retroactive reimbursement changes, and recoupments of claims that have already been paid. A key provision of the new law places stronger guardrails around downcoding, helping ensure that payment reductions are transparent, clinically justified, and subject to a clear appeals process. The legislation also limits certain retroactive reimbursement reductions and restricts the timeframe in which payers may seek recoupment after a claim has been paid.

IRHA worked alongside partners and stakeholders to help elevate the impact these payer practices have on rural and independent providers. These protections are especially important for facilities operating on thin margins and with limited administrative capacity. Reducing unnecessary payment disputes and surprise clawbacks allows providers to focus more resources on patient care and preserving access to essential services in rural communities.

IRHA appreciates the leadership of the bill’s author, Representative Julie McGuire, its Senate sponsors, and the many organizations and advocates who helped move this legislation forward. House Enrolled Act 1271 reflects what can be accomplished when policymakers and health care stakeholders work together to support providers and protect access to care across Indiana.

Indiana Rural Health Advocacy Academy Launches Third Cohort

Equipping Rural Health Leaders to Advocate Effectively

The Indiana Rural Health Association has launched the third cohort of the Indiana Rural Health Advocacy Academy (IRHAA), a member-focused training program designed to strengthen rural health advocacy across Indiana. Effectively collaborating with, educating, and advocating to lawmakers is essential to advancing rural health priorities. For many rural health stakeholders, however, advocacy can feel difficult to begin without the right tools, confidence, and understanding of the policy making process.

Through hands-on training, expert-led workshops, and practical resources, IRHAA helps participants learn how to advocate effectively, testify confidently, and build lasting relationships with policymakers. The program equips members with the knowledge and skills needed to address critical issues facing rural healthcare and ensure the voices of Indiana’s rural communities are heard.

IRHAA is designed for rural health stakeholders who want to:

  1. Increase their confidence in advocating for rural health;

  2. Better understand policy issues affecting the rural health industry; and

  3. Develop effective advocacy strategies.

The Academy is structured to accommodate busy schedules, with self-guided sessions complemented by bi-weekly touch points with IRHA staff and guests with Advocacy expertise. Sessions and touch points are conducted virtually via Zoom and generally last between 30 and 60 minutes. Independent work may be completed at each participant’s convenience.

The IRHAA curriculum includes:

  1. IRHAA 101

  2. Understanding Federal Rural Health Policy

  3. Indiana’s Rural Health Landscape

  4. Advocacy Skills

  5. Stating Your Case & Sustaining Advocacy Efforts

Open to IRHA members, the Advocacy Academy continues to build a stronger network of informed rural health advocates who are prepared to engage policymakers and advance policies that support rural providers, patients, and communities. Interested IRHA members should be ready to sign up for the fourth cohort in the Fall of 2026.

For additional questions about IRHAA or IRHA’s advocacy efforts, please contact Dan Hardesty, Senior Director of Government Affairs, at [email protected].

IRHA Comments on FSSA Proposed Rule Affecting 340B Medicaid Reimbursement

Feedback calls for targeted exemptions for rural healthcare providers

The Indiana Rural Health Association (IRHA) submitted comments in response to the Family and Social Services Agency’s proposed rule via a Medicaid State Plan Amendment to eliminate Medicaid reimbursement for 340B-purchased drugs. In its comments, IRHA urged the agency to exempt rural healthcare providers from this policy, emphasizing the critical role these organizations play in maintaining access to care for rural Hoosiers.

The 340B program remains an essential tool for rural providers, enabling them to stretch limited federal resources and sustain vital services—particularly in areas such as obstetrics and behavioral health, where reimbursement challenges are significant. Read the proposed rule here and IRHA’s full comment letter here.

2026 Indiana General Assembly Session Recap

Session Overview

The 2026 Indiana General Assembly session addressed several healthcare policy issues affecting rural providers and communities across Indiana. Lawmakers considered and enacted several measures related to Medicaid administration, healthcare payment practices, workforce development, and patient protections. The following summary highlights key legislation enacted during the session with implications for rural healthcare providers and the patients they serve.

IRHA Advocacy During the 2026 Session

Throughout the 2026 legislative session, the Indiana Rural Health Association worked with legislators, state agencies, and partner organizations to advance rural healthcare priorities. The association’s advocacy agenda was shaped through ongoing dialogue with its members, ensuring that the perspectives and challenges of rural providers and communities were reflected in policy discussions at the Statehouse. IRHA monitored key legislation, testified on several bills affecting rural providers and patients, and engaged policymakers on issues related to Medicaid policy, healthcare payment practices, and workforce development. IRHA also worked to connect lawmakers directly with rural stakeholders so that the realities of delivering care in rural Indiana remained part of the legislative conversation. Continued engagement from rural providers and community partners remains essential, and IRHA encourages members to remain involved so that rural voices continue to inform healthcare policy decisions in the years ahead.

Key Medicaid and Health Policy Legislation

Senate Enrolled Act 1 was the Senate’s priority legislation and one of the most significant healthcare policies enacted during the session. The law establishes the Rural Health Transformation Fund and includes several policy changes related to the administration of Indiana’s Medicaid and Supplemental Nutrition Assistance Program (SNAP). The legislation also includes provisions intended to align certain state policies with federal requirements and address administrative error rates within the programs.

The law includes expanded eligibility verification requirements, additional cross-agency data matching, and more frequent eligibility redeterminations for certain Medicaid populations, including participants in the Healthy Indiana Plan. Because Medicaid plays a significant role in supporting healthcare access in many rural communities, providers and policymakers across the state will continue monitoring how these changes affect program administration and healthcare access for Hoosiers as implementation moves forward.

IRHA Priority Legislation

Several measures closely followed by the Indiana Rural Health Association were enacted during the session.

House Enrolled Act 1271 establishes new guardrails for insurer payment practices by restricting certain downcoding practices, requiring transparency when claims are reduced, and limiting the timeframe in which insurers may recoup previously paid claims.

House Enrolled Act 1277 addresses operational and reimbursement challenges within Indiana’s Medicaid long-term care system, including issues associated with the Pathways for Aging program. The law includes provisions transitioning certain individuals from managed care to fee-for-service Medicaid following extended nursing facility stays and directs the state to develop a new reimbursement methodology for home health services.

House Enrolled Act 1358 includes provisions supporting the Rural Health Transformation Program and requires medical students to complete both nutrition education and a rural clinical rotation during their training, strengthening exposure to rural practice environments for future physicians.

Additional healthcare legislation enacted during the session includes House Enrolled Act 1278, which addresses workforce challenges in the nursing profession and updates vacancy procedures for the Indiana Board of Nursing; House Enrolled Act 1296, which strengthens oversight of recovery residences and addiction recovery programs through new registration requirements; Senate Enrolled Act 225, which revises medical debt collection for hospitals; and Senate Enrolled Act 282, which establishes regulatory standards for drug compounding and medical spa operations. Legislation strengthening penalties for battery against healthcare workers was also enacted through House Enrolled Act 1249.

Looking Ahead

The 2026 session addressed several important healthcare policy issues and laid the groundwork for future discussions around Medicaid policy, workforce development, and healthcare system sustainability. As implementation of these policies begins, the Indiana Rural Health Association will continue working with policymakers, providers, and partners to ensure rural communities remain part of the conversation as new healthcare policies are developed.

IRHA Releases 2026 Advocacy Priorities

Ensuring Comprehensive Care, Strengthening the Rural Workforce, and Building Healthier, Sustainable Communities

Advocacy Priorities
The Indiana Rural Health Association champions reliable access to high-quality comprehensive healthcare for every rural Hoosier. To do so, IRHA, advocates for policies that increase access for rural Hoosiers while also ensuring sustainable revenue for rural providers. Specifically ensuring fair and timely reimbursement from Medicare Advantage and other payers, preserving maternal and infant health services, and protecting essential programs such as 340B while reducing administrative barriers from prior authorization. IRHA also works to grow and sustain the rural health workforce by supporting education pipelines, residency and GME expansion, EMS training pathways, and incentives that promote long-term retention of clinicians across all disciplines. Another core priority is building healthier rural communities by strengthening health education, promoting nutrition and physical activity, and advancing infrastructure needs including transportation and broadband access to support in-person and telehealth.

Rural Health Transformation Program
Through the Rural Health Transformation Fund, the IRHA advocates for strategic investments that modernize rural healthcare and enhance community well-being. Priorities include directing funds to hospitals and providers for facility upgrades, adopting technologies that expand specialty care and chronic disease management, and creating innovative, value-based care solutions suited to the realities of rural practice. The program also supports expanding rural residency opportunities, reducing provider burnout through technology, launching remote patient monitoring and telehealth services, and enabling regions to design tailored solutions that address their own health challenges. This targeted investment strengthens the long-term sustainability of rural healthcare systems and the communities they serve.

IRHA unveiled its 2026 Advocacy Priorities at the Annual Public Policy Forum. Add your voice, share your story, and stand with us as a rural health advocate.

2026 IRHA Advocacy priorities

Indiana Rural Health Transformation Program

The Rural Health Transformation Program (RHT) is a $50 billion federal investment (FY 2026–2030) designed to strengthen access, stabilize the health workforce, expand technology, and encourage care innovation in rural America. States must apply for and administer these funds, shaping locally driven strategies that meet the needs of rural communities.

Indiana’s Process & Working Group
To guide Indiana’s participation, the Indiana Family and Social Services Administration (FSSA), in partnership with the Indiana Department of Health, has convened a statewide Working Group. This body brings together state leaders, legislators, and rural health representatives including the Indiana Rural Health Association (IRHA) to shape the state’s application, identify priorities, and ensure that rural voices are at the center of decision-making. Meeting materials, recordings, and participation details are available on the Indiana FSSA RHT Working Group page. Stakeholders are encouraged to attend sessions, review past discussions, and submit input to [email protected].

Key RHT Dates:

  • Optional Letter of Intent: September 30, 2025

  • Full Application Due: November 5, 2025

  • Expected CMS Awards & Earliest Start: December 31, 2025

Essential Resources:

IRHA Sends Letter to DC on Proposed Medicaid Cuts

Click here to view IRHA's letter to Indiana's Congressional delegation detailing the impact of proposed changes to the Medicaid program.

For additional questions or recommendations, please contact Dan Hardesty at the email address below.

Dan Hardesty, MPA

Director of Government Affairs
Indiana Rural Health Association
[email protected]