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The Indiana Medicaid Program provides medical care to nearly 1,000,000 Hoosiers.

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Open Enrollment Period

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OPEN ENROLLMENT PERIOD

With the Hoosier Healthwise program, you must remain enrolled in your chosen health plan for a one-year period so long as you remain eligible. This gives your health plan an opportunity to improve the care it provides. You may change your health plan, but only during certain times of the year or if your change reason falls under the conditions outlined below.

Open Enrollment Periods:

• Anytime during your first 90 days with a new health plan.
• Annually during your open enrollment period.
• Anytime you file a grievance with your health plan and the State finds that you have a good reason to change health plans. Another name for good reason to change health plans is "just cause." This is when you have concerns over the quality of care being provided by your health plan.  You must first contact your health plan so they can attempt to resolve your concern.  If you are still unhappy after contacting your health plan, you can call the Hoosier Healthwise Helpline at 1-800-889-9949, and they will review your request.

"Just Cause" Reasons:

• Lack of access to medically necessary services covered under the MCO's contract with the State.
• The member's doctor switches to a different plan (MCO).  The member may call the Hoosier Healthwise Helpline at 1-800-889-9949 to change to the doctor's new plan.  The member will then need to contact the doctor's new plan to select that doctor.
• The MCO does not, for moral or religious objections, cover the service the enrollee seeks.
• The enrollee needs related services to be performed at the same time; not all related services are available within the MCO's network; and the enrollee's primary care provider or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk.
• Lack of access to providers experienced in dealing with the enrollee's health care needs.
• Poor quality of care. Poor quality of care includes failure to comply with established standards of medical care administration and significant language or cultural barriers.