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Eligibility Guide

Please select the category that best describes you or the person who needs medical coverage.

This is only a guide and is intended to show basic eligibility criteria for several typical Medicaid recipient groups.

Please note: 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.

Pregnant Women

Program Options

Pregnant Women typically fall into the Hoosier Healthwise (HHW) program. You can receive immediate medical attention by applying for Presumptive Eligibility for Pregnant Women (PEPW) while you wait for your Medicaid application to be completed. Please review all eligibility criteria below.

Eligibility Factors

  • Pregnancy
  • Income / Family size

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
2 Up to $2,727

Count unborn child as 1 in family size.

Family size is based on the tax household, including the unborn child(ren). If you do not file taxes, the household includes the pregnant woman, her child(ren) (biological, adopted, and step), her unborn child(ren), and her spouse, if married.

These income standards are effective March 1, 2014.

 

 

 

3 $3,431
4 $4,134
5 $4,838
Low Income Parents/Caretakers

Program Options

Low income parents and caretakers typically fall into the Hoosier Healthwise (HHW) Program. Eligibility criteria for a low income parents and caretakers is provided below.

Eligibility Factors

  • Income / Family size

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
2 $247

Family size is based on the tax household. If you do not file taxes, the household includes the parent/caretaker, the parent/caretaker's child(ren) (biological, adopted, and step), and spouse, if married.

 

3 $310
4 $373
5 $435
Children Only

Program Options

Most children will fall into the Hoosier Healthwise Program. You may qualify for one of two benefit packages based on income. Please review all eligibility criteria below.

If you are a child with significant or special health needs, you may be enrolled in the Care Select program.

Eligibility Factors

  • Age
  • Income / Family size

Age

This program serves children up to age 19.

Income/Family Size

Hoosier Healthwise Package A

Family Size Income Limit (Per Month) Additional Details
1 $1,537

Family size is based on the tax household. If you do not file taxes, the household includes the child(ren), the child(ren)'s parent(s) (biological, adopted, and step), and the child(ren)'s sibling(s) (biological, adopted, and step).

These income standards are effective March 1, 2014.

2 $2,072
3 $2,606
4 $3,141
5 $3,675

Other Health Insurance

You can have private health insurance and qualify for Package A. It will be the primary payer for your medical care.

Hoosier Healthwise Package C

Family Size Income Limit (Per Month) Additional Details
1 $2,432

Family size is based on the tax household. If you do not file taxes, the household includes the child(ren), the child(ren)'s parent(s) (biological, adopted, and step), and the child(ren)'s sibling(s) (biological, adopted, and step).

These income standards are effective March 1, 2014.

2 $3,278
3 $4,123
4 $4,969
5 $5,815

If you qualify for HHW Package C, you may have a premium. This is a payment that you will have to make for your health care.  For more information on the HHW Package C premiums, refer to the FAQ: Hoosier Healthwise page.

Other Health Insurance

You cannot have private health insurance and qualify for Package C.

Healthy Indiana Plan (HIP)

Program Options

Adults typically fall into the Healthy Indiana Plan (HIP) program. Eligibility criteria for adults is provided below.

Eligibility Factors

  • Age
  • Current health insurance coverage
  • Income / Family size

Age

Individuals must be between the ages of 19 and 64.

Current Health Insurance Coverage

Individuals must not be covered by Medicare or other minimum essential health coverage.

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
1 $973

Family size is based on the tax household. If you do not file taxes, the household includes the child, the child's parents (biological, adopted, and step), and the child's siblings (biological, adopted, and step).

These income standards are effective March 1, 2014.

Enrollment limits apply to adults without dependent children.

2 $1,311
3 $1,649
4 $1,988
5 $2,326

HIP requires you to make a monthly contribution of 2% of your family income. This is a payment that you will have to make for your health care coverage.

M.E.D. Works

Program Options

Employees with disabilities typically fall into the M.E.D. Works program. Eligibility criteria for employees with disabilities is provided below.

Eligibility Factors

  • Asset test
  • Age
  • Disability status
  • Employment status
  • Income / Family size

Asset Test

Maximum of $2,000 (single) or $3,000 (married) in assets.What is counted as an asset? This includes items such as a bank account balance, cash on hand, stocks and bonds, property (other than your family home), equity in a vehicle after $5,000 has been excluded. What does not count as an asset? A vehicle (if you use it to drive to work or medical appointments), a home (if it is where you live), burial spaces, and retirement savings held by you or, if married, your spouse.

Age

Individuals must be between the ages of 19 and 64.

Disability Status

Individuals must be disabled according to Indiana's definition of disability.

Employment Status

Individuals must be working.

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
1 $3,404

The income standard is based only on the individual.  Income of other household members, including the spouse, are not counted.

These income standards are effective March 1, 2014.

M.E.D. Works may require you to pay a premium based on the amount of your income. This is a payment that you will have to make for your health care coverage.  For more information on the premiums, refer to the FAQ: M.E.D. Works page.

Family Planning Services Only

Program Options

If you do not qualify for any of the above Indiana Medicaid programs, you may be able to qualify for the Family Planning Eligibility Program. Eligibility criteria for the Family Planning Eligibility Program is provided below.

Eligibility Factors

  • Income / Family size

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
1 $1,372

Family size is based on the tax household. If you do not file taxes, the household includes the child, the child's parents (biological, adopted, and step), and the child's siblings (biological, adopted, and step).

These income standards are effective March 1, 2014.

2 $1,849
3 $2,326
4 $2,803
5 $3,280

Home and Community Based Services Waivers

Waiver services allow individuals with special medical or developmental needs to live in the least restrictive setting while receiving the medical care and supports they need.

Complex Medical Condition

Nursing Facility Level of Care Waivers These waivers are for children and adults whose needs are primarily medical. There are two waiver programs: the Aged and Disabled Waiver and the Traumatic Brain Injury (TBI) Waiver.

Eligibility Factors

  • Medical Conditions/ADLs
  • Income
  • Assets

Medical Conditions/Activities of Daily Living A person must have an unstable complex medical condition which requires:

  • direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain; OR
  • direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, central intravenous access (I.V.); OR
  • direct assistance for special routines or prescribed treatments from others such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen; OR
  • direct assistance for special routines or prescribed treatments from others such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen; OR
  • other substantial medical conditions.
  • OR

  • Diagnosis of a Traumatic Brain Injury for the TBI Waiver

Income

  • The income of the individual can be up to 300% of the maximum SSI benefit amount. Effective January 1, 2014 the limit is $2,163.00 per month. This amount adjusts annually according based on any changes to SSI.
  • Parental income and resources disregarded for children under 18
  • If your income is above 300% SSI you may still qualify with a spend down if you have a Qualified Income Trust, also known as a "Miller trust".

Asset Test

Spousal impoverishment provisions apply. When a couple applies for Medicaid, an assessment of their resources is made. The couple's resources, regardless of ownership, are combined. The couple's home, household goods, an automobile, and burial funds are not included in the couple's combined resources. The result is the couple's combined countable resources. This amount is then used to determine the Spousal Share, which is one-half of the couple's combined resources.

Intellectual Disability

Intermediate Care Facility for the Intellectually Disabled (ICF/IID) Waivers These waivers are for children and adults with an intellectual disability. There are two intellectual disability waivers: the Community Integration and Habilitation Waiver (formerly the Developmental Disabilities Waiver and Autism Waiver) and the Family Supports Waiver (formerly Support Services Waiver).

Eligibility Factors

  • Medical Conditions/ADLs
  • Income

Medical Conditions/ADLs

To be eligible you must be:

  • Diagnosed as having an intellectual disability;
  • Meet ICF/IID (formerly ICF/MR) Level of Care

ICF/IID (formerly ICF/MR) Level of Care

A person must have a disability that is attributable to:

  • Mental retardation, autism, epilepsy, cerebral palsy or a condition (other than mental illness) similar to mental retardation that results in impairment of functioning similar to that of a person who is mentally retarded;
  • Originates before the person is twenty-two (22) years of age;
  • Has continued or is expected to continue indefinitely, and
  • Constitutes a substantial disability to the person's ability to function normally in society due to substantial functional limitations in three of the six major life areas: self-care, receptive and expressive language, learning, mobility, self-direction and capacity for independent living.
  • The disability must result in the person requiring 24-hour supervision. (For purposes of the Waiver, the person must require access to 24-hour assistance, as needed. This can be provided through emergency beepers, telephone systems, or in other ways.) The person must also need, for lifelong or for an extended duration, an aggressive program of both specialized and generic services, individually planned and coordinated by an interdisciplinary team, that's intended to promote greater self-determination and functional independence.

Income

  • The income of the individual can be up to 300% of the maximum SSI benefit amount. Effective January 1, 2014 the limit is $2,163.00 per month. This amount adjusts annually according based on any changes to SSI.
  • Parental income and resources disregarded for children under 18
  • If your income is above 300% SSI, you may still qualify with a spend down if you have a Qualified Income Trust, also known as a "Miller trust".