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Medicaid Programs

There are several program options available under Indiana Medicaid.  Each program is designed to meet the medical needs of a certain group of people.  Each program has different eligibility criteria; this means that a different set of measures are used to determine if a person qualifies for that program. This list provides a general overview of available programs.  You can learn more about each program by selecting a specific program area.

Hoosier Healthwise

Hoosier Healthwise is Indiana's health care program for low income parents/caretakers, pregnant women, and children. Based on family income, children up to age 19 may be eligible for coverage. The program covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, surgeries, and family planning at little or no cost to the member or the member's family.

CARE SELECT

Care Select is a health care program that is designed to serve Medicaid recipients who may have special health needs or benefit from specialized attention.  In Care Select, you pick a primary doctor and a health plan by choosing one of the Care Management Organizations (CMOs) contracted with the state to coordinate your health care needs.  The CMO will assist you in coordinating your health care benefits and tailor them to your individual needs, circumstances, and preferences.

People served by Care Select may be aged, blind, disabled, wards of the court, current and former foster children, or children receiving adoptive services.  You 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

 

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.

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.

Indiana wants to build on the successes of the current HIP program to provide health insurance coverage options to more adults.  This new program, called HIP 2.0, is in the proposal stages - no applications are being taken at this time.

If you would like to learn more about HIP 2.0, you can go to the HIP 2.0 Proposal web page.

TRADITIONAL MEDICAID

Traditional Medicaid is a low income health care program that offers coverage for medical services, such as doctor visits, prescription 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.

WAIVERS

Waiver services allow members to live in a community setting and avoid institutional placement.  To be eligible for any waiver program, you must meet 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.

Presumptive Eligibility for Pregnant women

Presumptive Eligibility for Pregnant Women (PEPW) offers temporary coverage of prenatal care services to pregnant women while their Medicaid applications are pending.  The goal of PEPW is to offer health care to women early in their pregnancies, so they stay healthy and have healthy babies. Presumptive Eligibility means that we presume you are eligible for the Hoosier Healthwise program based on some preliminary information that you provide.

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.

1915(I) HOME AND COMMUNITY-BASED PROGRAMS

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 Children's Mental Health Wraparound (CMHW), the Behavioral & Primary Healthcare Coordination (BPHC), and the Adult Mental Health and Habilitation (AMHH) programs.