Am I eligible?
Medicaid eligibility is determined by several factors and can be
complicated. There are many categories of eligibility and
several different Medicaid programs. Please review all of the
eligibility information, and if you think you may be eligible, the
best thing to do is apply. While different Medicaid programs
have different eligibility criteria, in general four main criteria
are used to determine eligibility.
- Income/Family Size: Both
earned (wages from a job) and unearned income (Social Security
Disability payments). Income limits are adjusted to account for the
number of people in your family. Most programs are
based on income that is counted for tax purposes, with some
exceptions. These income limits include income before taxes
and not take-home pay. If you are not otherwise eligible for
Medicaid, a 5 percent income disregard will be applied.
- Age: Eligibility criteria can be based on age.
Certain programs are designed for people in specific age
- Resources/Assets: Certain things you have are
taken into consideration when determining eligibility. Different
programs count different resources/assets. Resources/assets
are not counted for the following groups: children, low
income parent/caretakers, pregnant women, family planning services
only, and former foster children.
- Medical Needs: Specific medical needs may
determine your eligibility, and they may also determine which
program can best serve your needs. Some programs are designed to
meet the medical needs of a targeted group.
What program Might be right for me?
The following list of Medicaid programs can give you an idea of
which program might be right for you. You can also go to the
Guide to get detailed information on eligibility criteria.
Hoosier Healthwise is Indiana's health care program for
children, pregnant women, and low income parents/caretakers. There
are several different program packages under Hoosier Healthwise
that are tailored for specific groups of people.
*If you are a pregnant woman, you may be able to get coverage
immediately under a process called Presumptive Eligibility for
Pregnant Women. This will allow you to receive important
prenatal care while your Medicaid application is being
Hoosier Care Connect is a health care program for individuals
who are aged 65 years and older, blind, or disabled and who are
also not eligible for Medicare. In Hoosier Care Connect, you
select a health plan that works with you and your doctor to
understand your health care needs. These health plans will
make sure that you get the most appropriate care based upon your
Hoosier Care Connect covers a variety of individuals who are not
eligible for Medicare, including:
- Aged individuals;
- Blind individuals;
- Disabled individuals;
- Individuals receiving Supplemental Security Income (SSI);
- Individuals enrolled through M.E.D. Works.
The Healthy Indiana Plan (HIP) covers adults age 19-64
whose incomes are less than approximately 138% of the federal
poverty level and who are not eligible for Medicare or another
Indiana Medicaid category. HIP requires you to make a
minimal monthly contribution to your coverage based on the amount
of your income. For more information about the Healthy
Indiana Plan, click here.
Traditional Medicaid is a low-income health care program that
offers coverage for medical services, such as doctor visits,
prescribed drugs, dental and vision care, family planning, mental
health care, surgeries, and hospitalizations. The Traditional
Medicaid program is for individuals who have both Medicaid and
Medicare or are refugees.
Waiver services are for individuals of any age who have special
medical needs. Waiver services allow members to live in a
community setting and avoid institutional placement. To be
eligible for any waiver program, you must meet both Medicaid
guidelines and waiver eligibility guidelines. Indiana offers five
waiver programs that target specific groups: the Aged and Disabled
Waiver, the Traumatic Brain Injury Waiver, the Community
Integration and Habilitation Waiver, the Family Supports Waiver,
and the Psychiatric Residential Treatment Facility Transition
M.E.D. Works is Medicaid for Employees with Disabilities. Many
disabled people feel that they may be able to return to work but
are fearful of losing their Medicaid benefits. M.E.D. Works is a
program designed to allow disabled employees to work without fear
of losing their Medicaid. M.E.D. Works offers the same coverage
levels as regular Medicaid. There may be small monthly premiums
based on the amount of money a worker earns. If you are receiving
SSDI and no cash benefits and feel that you may be able to return
to work, M.E.D. Works may be the program that would be best for
The Family Planning Eligibility Program is a program allowing
men and women the ability to receive certain family planning
services. The Family Planning Eligibility Program provides services
and supplies to men and women for the primary purpose of preventing
or delaying pregnancy.
Indiana Medicaid has three programs for individuals with
serious mental illness, emotional disturbance, and substance use
disorders that help them remain in the community. These
programs are the Child's Mental Health Wraparound (CMHW), the
Behavioral & Primary Healthcare Coordination (BPHC), and the
Adult Mental Health and Habilitation (AMHH) programs.
If your income is too high to qualify for Indiana Medicaid, you
may be eligible for subsidized health coverage through the federal
Health Insurance Marketplace, found online at www.healthcare.gov.
Depending on your income and family size, you may qualify for a tax
credit that can help you pay the cost of your health insurance.
Go to www.IN.gov/healthcarereform to find a self
screening tool that will help you determine if the Health Insurance
Marketplace is the most likely place for you to qualify for health
How do I apply?
The Division of Family Resources (DFR) is the group that
determines eligibility for all Indiana Social Services Programs.
The DFR will assist you in determining which programs are right for
you and your family. You can learn more about the application
process by going to Apply for Medicaid.