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. This guide
does not provide detailed eligibility criteria for Medicaid
Disability.
- 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 while you wait for your Medicaid application to be
completed. You may qualify for one of two benefit packages
based on income. Please review all eligibility criteria
below.
Eligibility Factors
- Asset test*
- Income / Family size
Asset Test
Maximum of $1,000 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? Your family home,
household goods like furniture or appliances, personal items such
as jewelry or clothes.
*Asset test applies only to Package A
Income/Family Size
Hoosier Healthwise Package A
| Family Size |
Income Limit (Per Month) |
Additional Details |
| 2 |
$229.50 |
Count unborn child as 1 in family size.
Family size does not include step parents.
In determining income: deduct $90 from your gross monthly job
earnings. If you pay child care, you can deduct up to $200 per
child.
|
| 3 |
$288 |
| 4 |
$346.50 |
| 5 |
$405 |
Hoosier Healthwise Package B - Pregnancy Only Coverage
| Family Size |
Income Limit (Per Month) |
Additional Details |
| 2 |
Up to $2,522 |
Count unborn child as 1 in family size.
Family size does not include step parents.
In determining income: deduct $90 from your gross monthly job
earnings. If you pay child care, you can deduct up to $200 per
child.
These income standards are effective March 1, 2012 through
February 28, 2013.
|
| 3 |
$3,182 |
| 4 |
$3,842 |
| 5 |
$4,502 |
- Low Income Family
-
Program Options
Low-income families typically fall into the Hoosier Healthwise
Program. Eligibility criteria for a low income family is provided
below.
Eligibility Factors
- Age
- Asset test
- Income / Family size
Asset Test
Maximum of $1,000 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? Your family home,
household goods like furniture or appliances, personal items such
as jewelry or clothes.
Income/Family Size
| Family Size |
Income Limit (Per Month) |
Additional Details |
| 2 |
$229.50 |
Family size does not include step parents.
|
| 3 |
$288 |
| 4 |
$346.50 |
| 5 |
$405 |
- 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
This program serves children up to age 19.
Income/Family Size
Hoosier Healthwise Package A
| Family Size |
Income Limit (Per Month) |
Additional Details |
| 1 |
$1,397 |
Income of a step parent cannot be used to find a step child
ineligible.
In determining income: deduct $90 from your gross monthly job
earnings. If you pay child care, you can deduct up to $200 per
child.
These income standards are effective March 1, 2012 through
February 28, 2013.
|
| 2 |
$1,892 |
| 3 |
$2,387 |
| 4 |
$2,882 |
| 5 |
$3,377 |
Other Health Insurance
You can have private health insurance. It will be the primary
payer for your medical care.
Hoosier Healthwise Package C
| Family Size |
Income Limit (Per Month) |
Additional Details |
| 1 |
$2,328 |
Income of a step parent cannot be used to find a step child
ineligible.
In determining income: deduct $90 from your gross monthly job
earnings. If you pay child care, you can deduct up to $200 per
child.
These income standards are effective March 1, 2012 through
February 28, 2013.
|
| 2 |
$3,153 |
| 3 |
$3,978 |
| 4 |
$4,803 |
| 5 |
$5,628 |
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.
Other Health Insurance
You cannot have private health insurance and qualify for Package
C.
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 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, 2012 the limit is
$2,094.00 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.
- Developmental Disability
-
Developmental Disability Waivers These waivers
are for children and adults with a developmental disability. There
are 3 developmental disability waivers; the DD Waiver, Autism
Waiver, and Support Services Waiver.
Eligibility Factors
- Medical Conditions/ADLs
- Income
Medical Conditions/ADLs
To be eligible you must be:
- Diagnosed as having a Developmental Disability
- Meet ICF/MR Level of Care;
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.) and
needing lifelong or for an extended duration an aggressive program
of both specialized and generic services, individually planned and
coordinated by an interdisciplinary team, and 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, 2012 the limit is
$2,094.00 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".