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Eligibility Guide

Eligibility Guide imagePlease 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 rules for several typical Medicaid recipient groups. You must apply to know for sure whether you qualify for coverage.

Please note: these income limits include income before taxes and not take-home pay.

Pregnant Women

Program Options

Pregnant Women typically fall into the Hoosier Healthwise (HHW) program. 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 $2,815

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, 2017.

 

 

 

3 $3,540
4 $4,264
5 $4,989

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.

Children

Program Options

Children who are not disabled and not living in an institution will be served through Hoosier Healthwise. If your child is disabled or living in an institution, please refer to the Aged, Blind, and Disabled section.

Eligibility Factors

Age

These programs serve children through the age of 18.

Current Health Insurance Coverage

Having private insurance may affect eligibility.

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
1 $2,513

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, 2017.

2 $3,384
3 $4,255
4 $5,125
5 $5,996

Based on income, you may have a monthly premium.  You can learn more about the premiums by visiting the Hoosier Healthwise and M.E.D. Works Premium Payments webpage.

Adults

Program Options

Generally, adults who are not disabled or institutionalized will be served through the Healthy Indiana Plan (HIP).

Eligibility Factors

Age

Individuals must be age 19 or older.

Current Health Insurance Coverage

Having Medicare or private insurance may affect eligibility.

Income/Family Size

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

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, 2017.

 

2 $1,890
3 $2,377
4 $2,863
5 $3,350

If eligible for HIP, you will be required to make a monthly contribution of 2% of your family income to receive HIP Plus benefits. To learn more about HIP Plus and HIP Basic, visit the Healthy Indiana Plan webpage.

Aged, Blind, and Disabled

Program Options

Individuals who are aged, blind, or disabled, including those who are institutionalized, will be served through one of the following programs:

  • Traditional Medicaid (including M.E.D. Works)
  • Hoosier Care Connect

Eligibility Factors

Age

Most programs serve individuals of all ages.

Disability Status

If disabled, your disability must meet the definition of the Social Security Administration.

Income/Family Size

Family Size Income Limit (Per Month) Additional Details
1 $3,518

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, 2017.

Working disabled individuals may be eligible for M.E.D. Works with slightly higher income and will be required to pay a monthly premium.

Institutionalized, disabled individuals may be eligible with slightly higher incomes and be required to pay a monthly patient liability.

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, a home (if it is where you live), burial spaces, and retirement savings held by you or, if married, your spouse.

Home and Community Based Services

Home and Community Based Services (HCBS) allow individuals with special medical or developmental needs to live in the least restrictive setting while receiving the medical care and supports they need.

Program Options

Specialized Programs

If you do not qualify for any of the above Indiana Medicaid programs, you may qualify for one of the following specialized programs:

  • Family Planning Eligibility Program
  • Emergency Services Only
  • End-Stage Renal Disease (ESRD)