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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 groups.
  • 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 Eligibility Guide to get detailed information on eligibility criteria.

Hoosier Healthwise

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.  This will allow you to receive important prenatal care while your Medicaid application is being processed.

Care Select

Care Select is Indiana's health care program designed to serve individuals who may have special health needs or benefit from specialized attention.  People served by Care Select may be aged, blind, disabled, wards of the court, current or former foster children, or children receiving adoptive services.   Individuals must also have one of the following medical conditions:

  • Asthma
  • Diabetes
  • Heart Failure
  • Congestive Heart Failure
  • Hypertensive Heart Disease
  • Hypertensive Kidney Disease
  • Rheumatic Heart Illness
  • Severe Mental Illness
  • Serious Emotional Disturbance (SED) for Wards and Fosters
  • Depression

Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP) covers adults age 19-64 whose incomes are at or below the federal poverty level and who are not covered by Medicare or other minimum essential health coverage.  Enrollment limits apply to adults without dependent children.  HIP requires you to make a minimal monthly contribution to your coverage based on the amount of your income.  HIP does not cover vision, dental or maternity services.  For more information about the Healthy Indiana Plan, click here.

Traditional Medicaid

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, have a spend down/monthly deductible, or are refugees.

Waiver

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 Waiver.

M.E.D. Works

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 you.

Family Planning Eligibility Program

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.

Federal Health Insurance Marketplace

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 coverage programs.

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.