About Indiana Medicaid

How Medicaid Benefits Indiana

Good health is important to everyone. Indiana Medicaid provides a healthcare safety net to over one million Hoosiers with low incomes who are aged, disabled, blind, pregnant, or meet other eligibility requirements.

Programs and Services

Members receive Medicaid services through multiple delivery systems. To be reimbursed for services, providers must enroll with the Indiana Health Coverage Programs (IHCP). See Become a Provider for more information.

Traditional Medicaid

Traditional Medicaid provides coverage for healthcare services rendered to a number of specific eligibility groups. Traditional Medicaid providers are reimbursed under the fee-for-service (FFS) delivery system. Providers bill the IHCP claims processing contractor for services rendered to eligible members.

Hoosier Care Connect

Hoosier Care Connect serves members eligible for the IHCP on the basis of age, blindness, or disability. Hoosier Care Connect members receive full Medicaid benefits, in addition to care coordination services and other FSSA-approved enhanced benefits.

Hoosier Care Connect operates under a risk-based managed care (RBMC) service delivery system in which the State pays contracted managed care entities (MCEs) a set monthly fee for each member enrolled in the MCE's plan. This fee, called a capitation premium, covers the cost of care for services covered under the MCE program and incurred by IHCP enrollees in the MCE plan. The MCE assumes financial risk for services rendered to members in its plan.

Each MCE maintains its own provider and member services units. Each MCE pays claims, performs prior authorization (PA), and is responsible for subrogation activities. Providers should contact the MCE for specific claims payment, and PA policies and guidelines.

All providers rendering services to Hoosier Care Connect members, including out-of-state providers, must enroll with the IHCP and with one or more of the MCEs. To be reimbursed for services rendered to members in Hoosier Care Connect, IHCP-enrolled providers must be contracted with the managed care plan in which the member is enrolled. See the Managed Care pages on this site for more information.

Hoosier Healthwise

The Hoosier Healthwise program provides coverage primarily for children, including those who are eligible for Children's Health Insurance Program (CHIP). The State operates the Hoosier Healthwise program under a risk-based managed care (RBMC) service delivery system for eligible members. In RBMC, the State pays contracted managed care entities (MCEs) a set monthly fee for each member enrolled in the MCE's plan. This fee, called a capitation premium, covers the cost of care for services covered under the MCE program and incurred by IHCP enrollees in the MCE plan. The MCE assumes financial risk for services rendered to members in its plan.

Each MCE maintains its own provider and member services units. Each MCE pays claims, performs prior authorization (PA), and is responsible for subrogation activities. Providers should contact the MCE for specific claims payment, and PA policies and guidelines.

All providers rendering services to Hoosier Healthwise members, including out-of-state providers, must enroll with the IHCP and with one or more of the MCEs. To be reimbursed for services rendered to members in Hoosier Healthwise, IHCP-enrolled providers must be contracted with the managed care plan in which the member is enrolled. See the Managed Care pages on this site for more information.

The Healthy Indiana Plan

The Healthy Indiana Plan (HIP) program covers all eligible Hoosiers ages 19-64 with incomes up to and including 133% of the federal poverty level (FPL). HIP provides affordable healthcare choices to thousands of otherwise uninsured or underinsured individuals throughout Indiana. HIP coverage is focused on preventive services and covers essential medical services, similar to commercial plans.

Within HIP there are four distinct plan options - HIP Plus, HIP Basic, HIP State Plan, and HIP Employer Link. There are two cost-sharing structures - monthly contributions to a Personal Wellness and Responsibility (POWER) Account similar to a health savings account, or copayment obligations.

HIP operates under a risk-based managed care (RBMC) service delivery system in which the State pays contracted managed care entities (MCEs) a set monthly fee for each member enrolled in the MCE's plan. This fee, called a capitation premium, covers the cost of care for services covered under the MCE program and incurred by IHCP enrollees in the MCE plan. The MCE assumes financial risk for services rendered to members in its plan.

Each MCE maintains its own provider and member services units. Each MCE pays claims, performs prior authorization (PA), and is responsible for subrogation activities. Providers should contact the MCE for specific claims payment, and PA policies and guidelines.

All providers rendering services to HIP members, including out-of-state providers, must enroll with the IHCP and with one or more of the MCEs. To be reimbursed for services rendered to members in Hoosier Care Connect, IHCP-enrolled providers must be contracted with the managed care plan in which the member is enrolled. See the Managed Care pages on this site for more information.

Special Programs

Providers can enroll in special programs at initial enrollment, or they can enroll later by updating their IHCP provider enrollment profiles. For some special programs, providers must specifically request to be enrolled in (opt into) the program. This includes the following programs:

  • 590 Program
  • Medical Review Team (MRT)
  • Presumptive Eligibility for Pregnant Women (PEPW)
  • Hospital Presumptive Eligibility (Hospital PE)
  • Presumptive Eligibility (PE)
  • Pre-Admission Screening and Resident Review (PASRR)
  • Waiver